What precipitates depression in African-American cancer patients? Triggers and stressors

AbstractObjective:This study examined general and cancer-related stressors of depression that are unique to African-American cancer patients.Method:The study used cohort design and mixed methods. Seventy-four breast and prostate cancer survivors including 34 depressed and 23 non-depressed African-Americans and 17 depressed whites were interviewed. Qualitative data analysis identified themes. The thematic codes were converted to a SPSS data set numerically. The Fisher's exact test was performed to examine group differences in the experience of stress.Results:Significantly more depressed African-Americans experienced a dramatic reaction to a cancer diagnosis (p = 0.03) or had concerns about functional decline (p = 0.01), arguments with relatives or friends (p = 0.02), and unemployment status (p = 0.03) than did non-depressed African-Americans, who reacted to the cancer diagnosis as a matter of reality (p = 0.02). Significantly more depressed African-Americans talked about feeling shocked by a cancer diagnosis (p = 0.04) and being unable to do things that they used to do (p = 0.02) than did depressed whites. Qualitative analysis shed light on the extent of such group differences.Significance of results:Distress from the initial cancer diagnosis and functional decline were likely to have triggered or worsened depression in African-American cancer patients. This study highlighted racial differences in this aspect. It is critical to screen African-American cancer patients for depression at two critical junctures: immediately after the disclosure of a cancer diagnosis and at the onset of functional decline. This will enhance the chance of prompt diagnosis and treatment of depression in this underserved population.

Download Full-text

Nursing home residents with multiple sclerosis: comparisons of African American residents to white residents at admission

Multiple Sclerosis Journal ◽

10.1191/1352458504ms1086oa ◽

2004 ◽

Vol 10 (6) ◽

pp. 660-667 ◽

Cited By ~ 12

Author(s):

Robert J Buchanan ◽

Raymond A Martin ◽

Miguel Zuniga ◽

Suojin Wang ◽

MyungSuk Kim

Keyword(s):

Multiple Sclerosis ◽

African American ◽

African Americans ◽

Racial Differences ◽

Nursing Home Residents ◽

Cognitively Impaired ◽

Nursing Facility ◽

Data Set ◽

Outreach Effort ◽

Multiple Variables

This research profiles African American residents with multiple sclerosis (MS) at admission to the nursing facility and compares them to profiles of white residents with MS using the Minimum Data Set (MDS). We analysed MDS admission assessments for 1367 African Americans with MS and 9294 whites with MS. African American residents with MS were significantly younger at admission than white residents with MS, with almost one half of these African Americans 50 years or younger compared to only one quarter of these whites. African American residents with MS were significantly more physically disabled and cognitively impaired at admission than white residents with MS. Although there were significant racial differences in disability, there were no significant racial differences among these MS residents in the use of various therapies provided by qualified therapists. These observed racial differences among MS residents in disease manifestations, severity, progression and disability are due to multiple variables and point out the need for more research. By combining discoveries from genetics, immunology, epidemiology and virology we can gain a better understanding of the complex pathophysiology of MS and develop more effective treatments and preventive measures. Our findings also indicate potential racial disparities in the use of MS-related care, illustrating that a greater outreach effort may be needed to evaluate and treat African Americans with MS.

Download Full-text

Racial Differences in Motivators and Barriers to Blood Donation Among Blood Donors

Archives of Pathology & Laboratory Medicine ◽

10.5858/133.9.1444 ◽

2009 ◽

Vol 133 (9) ◽

pp. 1444-1447

Author(s):

Beth H. Shaz ◽

Derrick G. Demmons ◽

Krista L. Hillyer ◽

Robert E. Jones ◽

Christopher D. Hillyer

Keyword(s):

African American ◽

African Americans ◽

Racial Differences ◽

Blood Donors ◽

Blood Donation ◽

Screening Process ◽

Center Staff ◽

Predominately White ◽

Donation Frequency ◽

The Right

Abstract Context.—Nationally, African Americans are underrepresented in community blood donation programs. To increase blood donation by African Americans, differences between motivators and barriers to blood donation between races should be investigated. Objective.—To investigate motivators and barriers to blood donation in African American and white blood donors. Design.—An 18-item, anonymous, self-administered questionnaire regarding demographics and motivators and barriers to donation was completed by blood donors at a predominately African American and a predominately white fixed donation site. Results.—A total of 599 participants (20% African American, 75% white, and 5% other) completed the survey. The most commonly reported reasons to donate included: “because it is the right thing to do” (45% African Americans and 62% white) and “because I want to help save a life” (63% African Americans and 47% white). Unpleasant experiences did not differ as a barrier to continue donation between African Americans and whites. African Americans placed more importance on donating blood to someone with sickle cell disease, convenience of blood donation, treatment of donor center staff, and level of privacy during the screening process. Conclusions.—These data suggest that in a large metropolitan area, reasons for donation among African American and white donors differ. To retain and increase donation frequency of African American donors, these factors should be considered in creating an African American donor recruitment and retention program.

Download Full-text

Abstract 3060: Racial Disparities in Early Institution of “Do Not Resuscitate” Orders Influence Survival in Acute Ischemic Strokes.

Stroke ◽

10.1161/str.43.suppl_1.a3060 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Pratik Bhattacharya ◽

Ambooj Tiwari ◽

Sam Watson ◽

Scott Millis ◽

Seemant Chaturvedi ◽

...

Keyword(s):

Critical Care ◽

African American ◽

Ischemic Stroke ◽

African Americans ◽

Acute Ischemic Stroke ◽

Racial Differences ◽

Racial Disparity ◽

Retrospective Chart Review ◽

Do Not Resuscitate ◽

Dnr Orders

Background: The importance of early institution of “Do Not Resuscitate” (DNR) orders in determining outcomes from intracerebral hemorrhage is established. In the setting of acute ischemic stroke, African Americans tend to utilize critical care interventions more and palliative care options less than Caucasians. Recent epidemiological studies in acute ischemic stroke have shown a somewhat better survival for African Americans compared with Caucasians. Our hypothesis was that racial differences in early institution of DNR orders would influence mortality in acute ischemic stroke. Methods: a retrospective chart review was conducted on consecutive admissions for acute ischemic stroke across 10 hospitals in Michigan for the year 2006. Subjects with self reported race as African American or Caucasian were selected. Demographics, stroke risk factors, pre morbid status, DNR by day 2 of admission, stroke outcome and discharge destination were abstracted. Results: The study included 574 subjects (144 African American, 25.1%; 430 Caucasian, 74.9%). In-hospital mortality was significantly higher among Caucasians (8.6% vs. 1.4% amongst African Americans, p=0.003). More Caucasians had institution of DNR by day 2 than African Americans (22.5% vs. 4.3%, p<0.0001). When adjusted for racial differences in DNR by day 2 status, Caucasian race no longer predicted mortality. Caucasians were significantly older than African Americans (median age 76 vs. 63.5 years, p<0.0001); and age was a significant predictor of DNR by day 2 and mortality. In the adjusted analysis, however, age marginally influenced the racial disparity in mortality ( table ). Caucasians with coronary disease, atrial fibrillation, severe strokes and unable to walk prior to the stroke tend to be made DNR by day 2 more frequently. Only 27.1% of Caucasians with early DNR orders died in the hospital, whereas 20.8% were eventually discharged home. Conclusions: Early DNR orders result in a racial disparity in mortality from acute ischemic stroke. A substantial proportion of patients with early DNR orders eventually go home. Postponing the use of DNR orders may allow aggressive critical care interventions that may potentially mitigate the racial differences in mortality.

Download Full-text

Spirituality among African Americans

10.1093/oso/9780197565001.003.0008 ◽

2021 ◽

pp. 154-176

Author(s):

Jason E. Shelton

Keyword(s):

African American ◽

Comparative Analysis ◽

African Americans ◽

Personal Identity ◽

Racial Differences ◽

National Survey ◽

African American Community ◽

Black And White ◽

Spiritual But Not Religious ◽

Blacks And Whites

This chapter assesses the importance of spirituality among African Americans. More specifically, it examines the extent to which respondents in a large, multiyear national survey view themselves as a “spiritual person.” Four sets of comparative analysis are offered: (1) racial differences among black and white members of various evangelical Protestant traditions, (2) racial differences among black and white members of various mainline Protestant and Catholic traditions, (3) denominational differences specifically among African Americans, and (4) racial differences among blacks and whites who view themselves as “spiritual but not religious.” The findings reveal significant interracial and intraracial differences in how spirituality shapes one’s personal identity. Because organized religion has historically been so central to African American community life, the implications for the growth in noninstitutional spirituality are considered.

Download Full-text

Fourteen Percent of Healthy African Americans Participating In the Zimmerman Program for the Molecular and Clinical Biology of VWD (ZPMCB VWD) Are Heterozygous for the VWF Gene Mutation H817Q Associated with Type 2N Von Willebrand Disease

Blood ◽

10.1182/blood.v116.21.239.239 ◽

2010 ◽

Vol 116 (21) ◽

pp. 239-239

Author(s):

Kenneth D Friedman ◽

Daniel B. Bellissimo ◽

Pamela A. Christopherson ◽

Veronica H Flood ◽

Joan Cox Gill ◽

...

Keyword(s):

African American ◽

African Americans ◽

Racial Differences ◽

Healthy Subjects ◽

Von Willebrand Disease ◽

Compound Heterozygous ◽

Healthy Controls ◽

Clinical Biology ◽

A1 Domain ◽

Von Willebrand

Abstract Abstract 239 Von Willebrand disease (VWD) is a common hereditary bleeding disorder caused by reduced concentration or abnormal structure/function of von Willebrand Factor (VWF). Most published studies of normal VWF have been carried out in European or North American subjects without regard to racial differences. In the process of studying healthy controls in the Zimmerman Program for the Molecular and Clinical Biology of VWD (ZPMCB-VWD), we identified a common polymorphism (D1472H) in the VWF A1-domain in African Americans that affects the measurement of VWF function by ristocetin cofactor (VWF:RCo) but does not appear associated with increased bleeding risk. We therefore explored whether other polymorphisms or mutations were identified more frequently in African Americans. VWF sequencing was performed on 191 healthy controls including 66 that were self-identified as African American. European Bleeding Score was obtained and normal in all healthy subjects. Among the African Americans, 9 individuals were heterozygous for the reported type 2N H817Q mutation and one was homozygous. Factor VIII binding to VWF (VWF:F8B) was determined with a standard FVIII binding assay using the subject's plasma VWF and recombinant FVIII. The VWF:F8B was significantly reduced in H817Q heterozygotes when compared to 10 healthy study subjects without the H817Q mutation (65 ± 11 versus 108 ± 11, p=0.003). The VWF:F8B was further reduced to 37 using the plasma VWF from the homozygous H817Q subject. However, the observed VWF:F8B in these individuals with H817Q are still considerably higher that that observed in patients enrolled in ZPMCB-VWD that are either homozygous or compound heterozygous with the common R854Q type 2N VWD (VWF:F8B < 13). Of the 116 self-identified Caucasian healthy subjects, none had the H817Q mutation, but 3 were heterozygous for the R854Q mutation; their mean plasma VWF:F8B was reduced to 51. While the homozygous R854Q patients had reduced plasma FVIII levels (mean FVIII=24 IU/dL), none of the sequenced healthy control subjects had plasma FVIII levels below 53 IU/dL, Some have advocated FVIII/VWF:Ag ratios as a screen for type 2N VWD. The subject with homozygous H817Q had only a mildly reduced FVIII/VWF:Ag ratio (0.59), while the heterozygous H817Q were not reduced (mean=0.90), thereby demonstrating that the VWF:F8B assay has greater sensitivity for type 2N VWF binding defects than the FVIII/VWF:Ag ratio. Since the previously reported A1-domain D1472H polymorphism was common in African Americans, we explored the prevalence of this polymorphism in the healthy subjects with the H817Q mutation. All H817Q heterozygous subjects were either homozygous (4) or heterozygous (5) for the D1472H polymorphism. The one individual who was H817Q homozygous was also D1472H homozygous, suggesting that there may be an extended haplotype present in African Americans. In summary, an H817Q type 2N mutation is commonly found in healthy African American subjects with an allele frequency of 0.083, predicting that approximately 7 in 1,000 African Americans would be homozygous for the H817Q type 2N mutation. Our data, and the rarity of diagnosis of type 2N VWD in African Americans suggests that while mutation H817Q may interfere with the interaction of FVIII with VWF, this mutation appears to confer little or no clinical symptoms. Disclosures: No relevant conflicts of interest to declare.

Download Full-text

Disparities in survival outcomes in African Americans in renal cell carcinoma: Impact of oncological versus nononcological factors.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.7_suppl.595 ◽

2019 ◽

Vol 37 (7_suppl) ◽

pp. 595-595

Author(s):

Margaret Frances Meagher ◽

Aaron Bradshaw ◽

David Anyakora ◽

Dattatraya H Patil ◽

Kazutaka Saito ◽

...

Keyword(s):

Overall Survival ◽

African American ◽

African Americans ◽

Cancer Mortality ◽

Tumor Size ◽

Radical Nephrectomy ◽

Functional Decline ◽

Tumor Grade ◽

Survival Outcomes ◽

African American Race

595 Background: African-Americans have increased incidences of renal cortical tumor subtypes of lower oncological potential in the setting of lower risk disease when compared to other ethno-racial groups. However, survival outcomes are similar. We investigated the impact of African-American race on overall survival, oncological outcomes, functional outcomes, and non-cancer mortality. Methods: Multi-institutional retrospective analysis of patients who underwent partial or radical nephrectomy between 1998-2018. Primary outcome was overall survival (OS). Secondary outcomes included non-cancer mortality (NCM), recurrence free survival (RFS), and estimated glomerular filtration rate (eGFR) decline. Multivariable logistic regression (MVA) were used to elucidate predictive factors for OS, NCM, and RFS, and eGFR <45 and <30 ml/min/1.73m2. Results: 3,088 patients were divided into African American (AA, n=353) and Non-African American (NAA, n=2735) sub-groups. No difference was noted between groups with respect to mean tumor size (p=0.211) or metastases presence (p=0.846). African-American race was an independent risk factor for functional decline to eGFR<45 (OR 4.43, p<0.001) and eGFR<30 (OR 5.15, p<0.001). MVA for worsened NCM demonstrated African-American race (OR=1.72, p=0.042), increasing age (OR=1.03, p=0.001), radical nephrectomy (OR=2.98, p<0.001), and increasing tumor size (OR=1.26, p<0.001) to be independent risk factors. MVA for worsened OS included increasing age (OR=1.04, p<0.001), tumor size (OR=1.182, p<0.001), clear cell histology (OR=1.62, p<0.001), high tumor grade (OR=2.12, p<0.001), and post-operative eGFR <45 (OR=2.12, p<0.001). MVA for worsening RFS demonstrated high tumor grade (OR=2.38, p<0.001) and increasing clinical tumor size (OR=1.152, p<0.001) to be independent factors. Conclusions: African Americans undergoing renal surgery for RCC appear to have similar OS and RFS, but poorer NCM than non-African American patients. The cause of these disparities is multi-faceted and likely associated with functional decline. Nephron-sparing management should be considered in African-Americans presenting with renal cortical tumors.

Download Full-text

Comorbidity burden in prostate cancer patients by ESRD status.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e17510 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e17510-e17510

Author(s):

Nagaraju Sarabu ◽

Weichuan Dong ◽

Austin Fernstrum ◽

Al Ray ◽

Lee Evan Ponsky ◽

...

Keyword(s):

Prostate Cancer ◽

African American ◽

Cancer Patients ◽

Cancer Diagnosis ◽

Age Groups ◽

Treatment Modalities ◽

Fee For Service ◽

Comorbidity Burden ◽

Study Population ◽

Esrd Patients

e17510 Background: The co-occurrence of cancer and end-stage-renal disease (ESRD) may pose significant challenge in the management of both diseases. Further complicating clinical decisions is our limited understanding of the comorbidity burden (CB), which also affects their outcomes to a considerable extent. The purpose of this study is to characterize the CB in prostate cancer patients, with and without ESRD. Methods: Using SEER-Medicare database between years 2000-2016, we retrieved sociodemographic variables, including age (40-54, 55-64, 65-74, and 75+), race (African American vs. all others), marital status (married/partnered vs. all others), residence in a census tract with poverty rate > 20%, and dual Medicare-Medicaid enrollment status; chronic conditions identified in the year of cancer diagnosis; and ESRD status preceding prostate cancer diagnosis. We limited our study population to cancer patients enrolled in Medicare at the time of cancer diagnosis, and were receiving their care through the fee-for-service system. In this descriptive analysis, we compared the prevalence of these conditions between prostate cancer patients by ESRD status. Results: Our study population included 2,046 ESRD and 302,136 non-ESRD men diagnosed with incident prostate cancer during the study period. Compared to non-ESRD patients, a disproportionately higher percentage of ESRD patients were in the 40-54 and 55-64 age groups compared to non-ESRD (11.0 vs 0.95% and 32.2% vs. 8.51%, respectively). Similarly, the percentage of prostate cancer patients who were African American was 44.1% among ESRD patients, compared with 13.6% in their non-ESRD counterparts. With regard to comorbidities, several conditions were significantly higher in ESRD than non-ESRD patients, including: anemia (65.4% vs. 15.3%), congestive heart failure (31.1% vs. 8.9%), ischemic heart disease (38.9% vs. 25.2%), diabetes (40.7% vs. 17.0%), hypertension (68.0% vs. 42.6%), hypothyroidism (4.6% vs. 2.9%), hyperlipidemia (43.1% vs. 35.1%), and stroke (3.7% vs. 2.5%). Conclusions: Compared to their non-ESRD counterparts, ESRD patients present with high CB, severely compromising their physiologic reserve and tolerance for various cancer treatment modalities, and affecting outcomes. Future studies should compare the prevalence of specific combinations of conditions constituting multimorbidity between ESRD and non-ESRD patients, and identify multimorbidity profiles associated with a lower likelihood to receive standard treatment. Such detailed analysis will be foundational to clinical management and outcome studies.

Download Full-text

Racial Differences in Neuropsychiatric Symptoms Among Dementia Patients: A Comparison of African Americans and Whites

International Psychogeriatrics ◽

10.1017/s1041610200007341 ◽

2000 ◽

Vol 12 (S1) ◽

pp. 395-402 ◽

Cited By ~ 3

Author(s):

Carl I. Cohen

Keyword(s):

African American ◽

Nursing Home ◽

African Americans ◽

Racial Differences ◽

Neuropsychiatric Symptoms ◽

Psychotic Symptoms ◽

Sociodemographic Variable ◽

Behavioral Disturbances ◽

Dementia Patients ◽

Nursing Home Patients

Race is a critical sociodemographic variable that may serve as a marker for genetic, clinical, cultural, and socioeconomic factors. There have been several studies that found differences between African Americans and Whites in the neuropsychiatric symptoms of dementia. There have been fairly consistent findings that psychotic symptoms—hallucinations and delusions—are more prevalent among African American patients with dementia (Cohen & Carlin, 1993; Cooper et al., 1991, Deutsch et al., 1991; Fabrega et al., 1988), and that depression is higher among Whites than among African Americans (Fabrega et al., 1988; Walker et al., 1995). One study by Class and colleagues (1996) also suggested that behavioral disturbances might be higher among White than among African American nursing home patients, a majority of whom had dementia.

Download Full-text

Interaction of race with weight loss and resolution of obesity co-morbidities in patients undergoing laparoscopic roux-en-y gastric bypass (lrygb): an analysis of 83,059 bold database patients00000000000

Advances in Obesity Weight Management & Control ◽

10.15406/aowmc.2021.11.00339 ◽

2021 ◽

Vol 11 (3) ◽

pp. 76-84

Author(s):

Jeffrey S Emrich ◽

Casey G Sheck ◽

Leon Kushnir ◽

Cristina Nituica ◽

Gus J Slotman

Keyword(s):

Weight Loss ◽

African American ◽

African Americans ◽

Racial Differences ◽

Term Treatment ◽

Medical Problems ◽

Obstructive Sleep ◽

Co Morbidity ◽

Long Term Treatment ◽

Racial Variations

Background: Previous studies identified differences by race in the distribution of medical problems associated with morbid obesity. Whether or not outcomes after LRYGB also vary by race is unknown. Objective: To identify racial variations in weight loss and resolution of obesity co-morbidities after LRYGB. Methods: Data from 83,059 BOLD database LRYGB patients was analyzed retrospectively in five groups: African-American (n=9,055), Caucasian (n=63,352), Hispanic (n=6,893), Asian (n=198), and Other (n=3,561). Results: Weight and BMI were higher in African-Americans versus Caucasians, Hispanics, Other (12 months, p<0.0001). Hypertension persisted increased among African-Americans versus Caucasians, Hispanics, Other through 24 months (p<0.01). Caucasian cholelithiasis (18 months, p<0.05), abdominal panniculitis (12 months, p<0.01,) and depression (24 months, p<0.05) continued higher than other races. GERD was highest in African-Americans and Caucasians. Dyslipidemia affected Caucasians, African-Americans, and Other most (12 months, p<0.05). Hispanic depression was lowest (24 months, p<0.05). Other had highest stress urinary incontinence (12 months, p<0.05). Racial differences in diabetes, liver disease, obstructive sleep apnea, obesity hypoventilation syndrome, gout, back and musculoskeletal pain, leg edema, alcohol use, and non-depression psychological issues were not significant beyond 6 months. Resolution of angina, CHF, pulmonary hypertension, and polycystic ovarian disease did not vary by race. Conclusions: LRYGB improves obesity weight and co-morbidity outcomes overall, but long-term treatment effects vary by race. African-American weight and hypertension, and African-American/Caucasian GERD, and dyslipidemia resolve least. Caucasian abdominal issues and depression dominate. Racial variations in many obesity co-morbidities disappear by 12 months post-operatively.

Download Full-text

NT-proBNP, race and endothelial function in the Multi-Ethnic Study of Atherosclerosis

Heart ◽

10.1136/heartjnl-2019-314707 ◽

2019 ◽

Vol 105 (20) ◽

pp. 1590-1596 ◽

Cited By ~ 1

Author(s):

Sushan Yang ◽

Shi Huang ◽

Lori B Daniels ◽

Joseph Yeboah ◽

Joao A C Lima ◽

...

Keyword(s):

African American ◽

African Americans ◽

Endothelial Function ◽

Racial Differences ◽

Asian American ◽

Vascular Function ◽

Chinese Americans ◽

Mediation Effect ◽

Linear Regression Models ◽

Ethnic Study

ObjectiveNatriuretic peptides (NPs) are hormones with cardioprotective effects. NP levels vary by race; however, the pathophysiological consequences of lower NP levels are not well understood. We aimed to quantify the association between NPs and endothelial function as measured by flow-mediated dilation (FMD) and the contribution of NP levels to racial differences in endothelial function.MethodsIn this cross-sectional study of 2938 Multi-Ethnic Study of Atherosclerosis participants (34% Caucasian, 20% African-American, 20% Asian-American and 26% Hispanic) without cardiovascular disease at baseline, multivariable linear regression models were used to examine the association between serum N-terminal pro-B-type NP (NT-proBNP) and natural log-transformed FMD. We also tested whether NT-proBNP mediated the relationship between race and FMD using the product of coefficients method.ResultsAmong African-American and Chinese-American individuals, lower NT-proBNP levels were associated with lower FMD, β=0.06 (95% CI: 0.03 to 0.09; p<0.001) and β=0.06 (95% CI: 0.02 to 0.09; p=0.002), respectively. Non-significant associations between NT-proBNP and FMD were found in Hispanic and Caucasian individuals. In multivariable models, endothelial function differed by race, with African-American individuals having the lowest FMD compared with Caucasians, p<0.001. Racial differences in FMD among African-Americans and Chinese-Americans were mediated in part by NT-proBNP levels (African-Americans, mediation effect: −0.03(95% CI: −0.05 to −0.01); Chinese-Americans, mediation effect: −0.03(95% CI: −0.05 to −0.01)).ConclusionsLower NP levels are associated with worse endothelial function among African-Americans and Chinese-Americans. A relative NP deficiency in some racial/ethnic groups may contribute to differences in vascular function.

Download Full-text