Rethinking Race/Ethnicity, Income, and Childhood Asthma: Racial/Ethnic Disparities Concentrated among the Very Poor

Objective. Past studies of the prevalence of childhood asthma have yielded conflicting findings as to whether racial/ethnic disparities remain after other factors, such as income, are taken into account. The objective of this study was to examine the association of race/ethnicity and family income with the prevalence of childhood asthma and to assess whether racial/ethnic disparities vary by income strata. Methods. Cross-sectional data on 14,244 children aged <18 years old in the 1997 National Health Interview Survey were examined. The authors used logistic regression to analyze the independent and joint effects of race/ethnicity and income-to-federal poverty level (FPL) ratio, adjusting for demographic covariates. The main outcome measure was parental report of the child having ever been diagnosed with asthma. Results. Bivariate analyses, based on weighted percentages, revealed that asthma was more prevalent among non-Hispanic black children (13.6%) than among non-Hispanic white children (11.2%; p<0.01), but the prevalence of asthma did not differ significantly between Hispanic children (10.1 %) and non-Hispanic white children (11.2%; p=0.13). Overall, non-Hispanic black children were at higher risk for asthma than non-Hispanic white children (adjusted odds ratio [OR] = 1.20; 95% confidence interval [CI] 1.03, 1.40), after adjustment for sociodemographic variables, including the ratio of annual family income to the FPL. Asthma prevalence did not differ between Hispanic children and non-Hispanic white children in adjusted analyses (adjusted OR=0.85; 95% CI 0.71, 1.02). Analyses stratified by income revealed that only among children from families with incomes less than half the FPL did non-Hispanic black children have a higher risk of asthma than non-Hispanic white children (adjusted OR=1.99; 95% CI 1.09, 3.64). No black vs. white differences existed at other income levels. Subsequent analyses of these very poor children that took into account additional potentially explanatory variables did not attenuate the higher asthma risk for very poor non-Hispanic black children relative to very poor non-Hispanic white children. Conclusions. Non-Hispanic black children were at substantially higher risk of asthma than non-Hispanic white children only among the very poor. The concentration of racial/ethnic differences only among the very poor suggests that patterns of social and environmental exposures must overshadow any hypothetical genetic risk.

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Racial/Ethnic Disparities in Dietary Intake of U.S. Children Participating in WIC

Nutrients ◽

10.3390/nu11112607 ◽

2019 ◽

Vol 11 (11) ◽

pp. 2607 ◽

Cited By ~ 5

Author(s):

Meghan C. Zimmer ◽

Veronica Rubio ◽

Kristina W. Kintziger ◽

Cristina Barroso

Keyword(s):

Low Income ◽

Nutrient Intake ◽

Ethnic Disparities ◽

Black Children ◽

Hispanic Children ◽

White Children ◽

Food Package ◽

Race Ethnicity ◽

Racial Ethnic ◽

Hispanic White

Recent studies have assessed diet quality of low-income U.S. children participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), but differences by race/ethnicity remain unknown. We assessed racial/ethnic disparities in nutrient intake from dietary sources (not supplements) among children participating in WIC, with a focus on priority nutrients and food groups for future WIC food package revisions, as described in a recent report by the National Academies of Sciences, Engineering, and Medicine (NASEM). We used data from the 2011–2014 National Health and Nutrition Examination Surveys (NHANES) and multivariable linear regression analysis to evaluate relationships between race/ethnicity and nutrient/food group intake of children participating in WIC. All data were analyzed using SAS 9.4 survey procedures, accounting for the complex survey design of the NHANES. Compared to non-Hispanic White children, Hispanic children had diets with better nutrient distribution and lower dietary energy density, while non-Hispanic Black children had diets with poorer nutrient intake. Hispanic children had higher potassium and fiber intake, and consumed more legumes, while non-Hispanic Black children had lower calcium and vitamin D intake, higher sodium intake, and lower total dairy intake, compared to non-Hispanic White children. These findings can inform WIC nutrition education messages and future food package revisions.

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172 Sleep Disparities in Preschool-Aged Children

SLEEP ◽

10.1093/sleep/zsab072.171 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A70-A70

Author(s):

Jennifer Holmes ◽

Olivia Hanron ◽

Rebecca Spencer

Keyword(s):

Sleep Duration ◽

Ethnic Disparities ◽

Data Race ◽

Older Children ◽

Hispanic Children ◽

Sleep Habits ◽

Chi Square ◽

White Children ◽

Race Ethnicity ◽

And Gender

Abstract Introduction Sleep is known to be associated with socioeconomic status (SES) in older children and adults with those from lower SES households often experiencing poorer sleep quality. Whether this disparity exists in early childhood is relatively unknown, despite being an important age marked by sleep transitions and the establishment of lifelong sleep habits. Furthermore, it is a critical period for cognitive development and learning, which are supported by sleep. Here, we explore associations between sleep and SES in a preschool population. We hypothesized that children from lower SES households would exhibit shorter overnight sleep, longer and more frequent naps, and shorter 24-hr sleep. Additionally, we considered racial and ethnic disparities in sleep which can be confounded with SES in some samples. Methods Child (n=441; M age=51.9mo; 45.4% female) sleep was measured objectively using actigraph watches, worn for 3-16 days (M=9.5 days). Caregivers reported child demographics and household data. Race/ethnicity of our sample was 72% White, 10.2% Black, 17.8% other or more than one race, and 28.4% identified as Hispanic. 20.1% of our sample was categorized as low SES. Effects of SES and race/ethnicity on continuous sleep measures were assessed using multiple regression models, with age and gender as covariates. Nap habituality was assessed using chi-square tests. Results Lower SES was associated with shorter nighttime sleep duration, longer nap duration, and shorter 24-hr sleep duration (p’s<.001). Children from lower SES households were also more likely to nap habitually (p=.04) as were Hispanic children (p<.001). Hispanic children also tended to have longer nap bouts (p=.002). Hispanic and Black children on average had shorter overnight sleep durations than White children (p’s<.04), but their 24-hr sleep did not differ. Conclusion SES-related sleep disparities were present in this preschool population, with lower SES children exhibiting poorer sleep. When controlling for SES, Hispanic children tended to sleep less overnight which was compensated for by longer, more frequent naps. This underscores the necessity of naps for some children to achieve adequate sleep. Future directions will explore the relationship between parenting factors and sleep, such as bedtime routines and parent knowledge surrounding child sleep needs. Support (if any) NIH R01 HL111695

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Trends in breast cancer survival by race-ethnicity in Florida.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e18556 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e18556-e18556

Author(s):

Robert Brooks Hines ◽

Asal Johnson ◽

Eunkyung Lee ◽

Stephanie Erickson ◽

Saleh M.M. Rahman

Keyword(s):

Breast Cancer ◽

Ethnic Disparities ◽

Cancer Death ◽

Cancer Outcomes ◽

Subdistribution Hazard ◽

Breast Cancer Death ◽

Breast Cancer Outcomes ◽

Race Ethnicity ◽

Racial Ethnic ◽

Hispanic White

e18556 Background: Considerable efforts to improve disparities in breast cancer outcomes for underserved women have occurred over the past 3 decades. This study was conducted to evaluate trends in survival, by race-ethnicity, for women diagnosed with breast cancer in Florida over a 26-year period to assess potential improvement in racial-ethnic disparities. Methods: This was a retrospective cohort study of women diagnosed with invasive breast cancer in Florida between 1990-2015. Data were obtained from the Florida Cancer Data System. Women in the study were categorized according to race (white/black) and Hispanic ethnicity (yes/no) as non-Hispanic white (NHW), non-Hispanic black (NHB), Hispanic white (HW), and Hispanic black (HB). Cumulative incidence estimates of 5- and 10-year breast cancer death with 95% confidence intervals (CI) were obtained by race-ethnicity, according to diagnosis year. Subdistribution hazard models were used to obtain subdistribution hazard ratios (sHR) for the relative rate of breast cancer death accounting for competing causes. Results: Compared to NHW women, minority women were more likely to be younger, be uninsured or have Medicaid as health insurance, live in high poverty neighborhoods, have more advanced disease at diagnosis, have high grade tumors, have hormone receptor negative tumors, and receive chemotherapy as treatment. Minority women were less likely to receive surgery. Over the course of the study, breast cancer mortality decreased for all racial-ethnic groups, and racial-ethnic minorities had greater absolute and relative improvement in breast cancer survival for nearly all metrics compared to non-Hispanic white (NHW) women. However, for the most recent time period (2010-2015), black women still experienced significant survival disparities with non-Hispanic black (NHB) women having twice the rate of 5-year (sHR = 2.04: 95% CI; 1.91-2.19) and 10-year (sHR = 2.02: 95% CI; 1.89-2.16) breast cancer death. Conclusions: Despite efforts to improve disparities in breast cancer outcomes for underserved women in Florida, additional targeted approaches are needed to reduce the poorer survival in black (especially NHB) women. Our next step is to conduct a mediation analysis of the most important factors driving racial/ethnic disparities in breast cancer outcomes for women in Florida.

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Effects of Race and Ethnicity on Clinical Features, Tumor Genetics and Outcome in Children with KMT2A Rearranged Acute Myeloid Leukemia

Blood ◽

10.1182/blood-2020-136737 ◽

2020 ◽

Vol 136 (Supplement 1) ◽

pp. 34-34

Author(s):

Casey L. McAtee ◽

Joseph Lubega ◽

Michael E. Scheurer ◽

Rachel E. Rau

Keyword(s):

Clinical Features ◽

Black Children ◽

Study Entry ◽

Hispanic Children ◽

Poor Outcome ◽

Race Ethnicity ◽

Tumor Genetics ◽

The Difference ◽

Induction Failure ◽

Racial Ethnic

Black and Hispanic children with AML tend to have worse outcomes compared to White non-Hispanic children. Potential contributing factors include higher acuity at presentation, higher infection related mortality, and less availability of hematopoietic stem cell donors (Winestone. Amer J Hematol. 2017; Aplenc. Blood 2006; Gramatges. PBC 2017). We hypothesized that differences in disease biology contribute to inferior outcomes along racial/ethnic lines, and these differences may be apparent among specific cytogenetic subsets. To test this hypothesis, we mined the publicly available TARGET AML dataset which includes 956 newly diagnosed children with AML enrolled on Children's Cancer Group study CCG-2961 or Children's Oncology Group studies AAML03P1 or AAML0531. There were 557 White, non-Hispanic (WNH), 115 Black (including six Black Hispanic), 170 non-Black Hispanic, 45 Asian, and 69 patients of other races included in our analysis. Overall survival (OS) was defined as time from study entry until death; event free survival (EFS) was time from study entry to first event (induction failure, death, death without remission, or relapse). Patients were censored at the date of last contact. We used the Kaplan-Meier method to estimate OS and EFS; the log-rank statistic tested survival differences. Pearson's chi-squared or Fisher's exact test was used to test for differences between proportions. Welch's t-test, ANOVA, and Wilcoxon rank-sum tests were used for continuous variables. Comparing tumor cytogenetics by race/ethnicity: when compared to WNH children, t(8;21) was more common among Black (OR=2.03; 95% CI: 1.20-3.42) and Hispanic (OR=2.04; 95% CI: 1.29-3.24) children. Black children were also more likely to have either -5/-5q or -7/-7q compared to WNH (OR=2.60; 95% CI: 1.29-5.23). We then interrogated KMT2A rearrangements (KMT2Ar), finding that there was no difference in the percentage of patients with a KMT2Ar on the basis of race/ethnicity. The distribution of various KMT2A fusions in Hispanic patients was not significantly different than WNH, but Black children were more likely to have t(6;11)(q27;q23) both overall (OR=5.78; 95% CI: 1.73-19.28) and among patients with KMT2Ar (OR 7.29; 95% CI: 1.94-27.40). Black KMT2Ar children were older than WNH and Hispanic KMT2Ar children (11.2 vs. 6.5 years, p=0.002). Hispanic children with KMT2Ar had a higher presenting white blood cell count (WBC median 114,700/µL) compared to WNH (median WBC 49,600/µL; p=0.01) and Black (38,300/µL; p=0.006) children. We then investigated survival: similar to prior studies, Black children had inferior EFS and OS compared to WNH (both p<0.0001). Hispanic and Asian children had similar survival to WNH children. However, the EFS/OS of both Black and Hispanic children with KMT2Ar were worse than WNH with KMT2Ar (Fig1A,B), though the reasons for poor outcome were different for Black and Hispanic children. Eight of 21 Hispanic children had induction failure compared to 0/19 Black and 1/85 WNH children (p<0.001), whereas Black children tended to suffer death or relapse as first event. Higher WBC at presentation did not explain the difference in outcome for Hispanic children: when we restricted our analysis to those with a presenting WBC >100,000/µL, Hispanic children still had an inferior EFS compared to WNH with a trend towards inferior OS (Fig 1C, D). The poor outcome of Black children with KMT2Ar may be driven by the higher proportion with the known poor prognostic t(6;11) and older age; but even when restricted to age >10yrs, Black children tended to have worse outcomes compared to WNH patients. In conclusion, using the TARGET data set, we identified differences in tumor genetics, clinical features and outcome by race/ethnicity. Specifically, among KMT2Ar patients, we found that Black and Hispanic children had significantly worse outcomes than WNH - but for different reasons with potential biologic implications. The difference in age and distribution of KMT2A fusion among Black children suggest distinct AML pathogenesis, while higher presenting WBC and increased induction failure risk among Hispanic children suggest that genetic factors may contribute to disease phenotype and response to therapy. In ongoing work, we are investigating racial/ethnic differences in tumor biology and pharmacogenomics to better understand the causes of poor outcome with the ultimate aim of eliminating long-standing survival disparities. Disclosures Rau: Jazz Pharmaceuticals, Inc.: Consultancy, Other: Travel Fees.

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County‐Level Factors Associated With Cardiovascular Mortality by Race/Ethnicity

Journal of the American Heart Association ◽

10.1161/jaha.120.018835 ◽

2021 ◽

Vol 10 (6) ◽

Author(s):

Bongeka Z. Zuma ◽

Justin T. Parizo ◽

Areli Valencia ◽

Gabriela Spencer‐Bonilla ◽

Manuel R. Blum ◽

...

Keyword(s):

Risk Factors ◽

Healthcare Access ◽

Ethnic Disparities ◽

County Level ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Race Ethnicity ◽

Racial Ethnic ◽

Hispanic White ◽

Cvd Mortality

Background Persistent racial/ethnic disparities in cardiovascular disease (CVD) mortality are partially explained by healthcare access and socioeconomic, demographic, and behavioral factors. Little is known about the association between race/ethnicity‐specific CVD mortality and county‐level factors. Methods and Results Using 2017 county‐level data, we studied the association between race/ethnicity‐specific CVD age‐adjusted mortality rate (AAMR) and county‐level factors (demographics, census region, socioeconomics, CVD risk factors, and healthcare access). Univariate and multivariable linear regressions were used to estimate the association between these factors; R 2 values were used to assess the factors that accounted for the greatest variation in CVD AAMR by race/ethnicity (non‐Hispanic White, non‐Hispanic Black, and Hispanic/Latinx individuals). There were 659 740 CVD deaths among non‐Hispanic White individuals in 2698 counties; 100 475 deaths among non‐Hispanic Black individuals in 717 counties; and 49 493 deaths among Hispanic/Latinx individuals across 267 counties. Non‐Hispanic Black individuals had the highest mean CVD AAMR (320.04 deaths per 100 000 individuals), whereas Hispanic/Latinx individuals had the lowest (168.42 deaths per 100 000 individuals). The highest CVD AAMRs across all racial/ethnic groups were observed in the South. In unadjusted analyses, the greatest variation ( R 2 ) in CVD AAMR was explained by physical inactivity for non‐Hispanic White individuals (32.3%), median household income for non‐Hispanic Black individuals (24.7%), and population size for Hispanic/Latinx individuals (28.4%). In multivariable regressions using county‐level factor categories, the greatest variation in CVD AAMR was explained by CVD risk factors for non‐Hispanic White individuals (35.3%), socioeconomic factors for non‐Hispanic Black (25.8%), and demographic factors for Hispanic/Latinx individuals (34.9%). Conclusions The associations between race/ethnicity‐specific age‐adjusted CVD mortality and county‐level factors differ significantly. Interventions to reduce disparities may benefit from being designed accordingly.

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Race/ethnicity in systemic AL amyloidosis: perspectives on disease and outcome disparities

Blood Cancer Journal ◽

10.1038/s41408-020-00385-0 ◽

2020 ◽

Vol 10 (11) ◽

Author(s):

Andrew Staron ◽

Lawreen H. Connors ◽

Luke Zheng ◽

Gheorghe Doros ◽

Vaishali Sanchorawala

Keyword(s):

Minority Groups ◽

Ethnic Disparities ◽

Sociodemographic Factors ◽

Al Amyloidosis ◽

Advocacy Groups ◽

Disease Characteristics ◽

Race Ethnicity ◽

The Impact ◽

Racial Ethnic ◽

Hispanic White

Abstract In marked contrast to multiple myeloma, racial/ethnic minorities are underrepresented in publications of systemic light-chain (AL) amyloidosis. The impact of race/ethnicity is therefore lacking in the narrative of this disease. To address this gap, we compared disease characteristics, treatments, and outcomes across racial/ethnic groups in a referred cohort of patients with AL amyloidosis from 1990 to 2020. Among 2416 patients, 14% were minorities. Non-Hispanic Blacks (NHBs) comprised 8% and had higher-risk sociodemographic factors. Hispanics comprised 4% and presented with disproportionately more BU stage IIIb cardiac involvement (27% vs. 4–17%). At onset, minority groups were younger in age by 4–6 years. There was indication of more aggressive disease phenotype among NHBs with higher prevalence of difference between involved and uninvolved free light chains >180 mg/L (39% vs. 22–33%, P = 0.044). Receipt of stem cell transplantation was 30% lower in Hispanics compared to non-Hispanic White (NHWs) on account of sociodemographic and physiologic factors. Although the age/sex-adjusted hazard for death among NHBs was 24% higher relative to NHWs (P = 0.020), race/ethnicity itself did not impact survival after controlling for disease severity and treatment variables. These findings highlight the complexities of racial/ethnic disparities in AL amyloidosis. Directed efforts by providers and advocacy groups are needed to expand access to testing and effective treatments within underprivileged communities.

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Racial and Ethnic Disparities in Heart and Cerebrovascular Disease Deaths During the COVID-19 Pandemic in the United States

Circulation ◽

10.1161/circulationaha.121.054378 ◽

2021 ◽

Author(s):

Rishi Wadhera ◽

Jose F. Figueroa ◽

Fatima Rodriguez ◽

Michael Liu ◽

Wei Tian ◽

...

Keyword(s):

United States ◽

Heart Disease ◽

Cerebrovascular Disease ◽

Ethnic Minorities ◽

Minority Group ◽

Ethnic Disparities ◽

The United States ◽

Race Ethnicity ◽

Racial Ethnic ◽

Hispanic White

Background: Cardiovascular deaths increased during the early phase of the COVID-19 pandemic in the United States. However, it is unclear whether racial/ethnic minorities have experienced a disproportionate rise in heart disease and cerebrovascular disease deaths. Methods: We used the National Center for Health Statistics to identify heart disease and cerebrovascular disease deaths for non-Hispanic White, non-Hispanic Black, non-Hispanic Asian, and Hispanic individuals from March-August 2020 (pandemic period), as well as for the corresponding months in 2019 (historical control). We determined the age- and sex-standardized deaths per million by race/ethnicity for each year. We then fit a modified Poisson model with robust standard errors to compare change in deaths by race/ethnicity for each condition in 2020 vs. 2019. Results: There were a total of 339,076 heart disease and 76,767 cerebrovascular disease deaths from March through August 2020, compared to 321,218 and 72,190 deaths during the same months in 2019. Heart disease deaths increased during the pandemic in 2020, compared with the corresponding period in 2019, for non-Hispanic White (age-sex standardized deaths per million, 1234.2 vs. 1208.7; risk ratio for death [RR] 1.02, 95% CI 1.02-1.03), non-Hispanic Black (1783.7 vs. 1503.8; RR 1.19, 1.17-1.20), non-Hispanic Asian (685.7 vs. 577.4; RR 1.19, 1.15-1.22), and Hispanic (968.5 vs. 820.4, RR 1.18, 1.16-1.20) populations. Cerebrovascular disease deaths also increased for non-Hispanic White (268.7 vs. 258.2; RR 1.04, 95% CI 1.03-1.05), non-Hispanic Black (430.7 vs. 379.7; RR 1.13, 95% CI 1.10-1.17), non-Hispanic Asian (236.5 vs. 207.4; RR 1.15, 1.09-1.21), and Hispanic (264.4 vs. 235.9; RR 1.12, 1.08-1.16) populations. For both heart disease and cerebrovascular disease deaths, each racial and ethnic minority group experienced a larger relative increase in deaths than the non-Hispanic White population (interaction term, p<0.001). Conclusions: During the COVID-19 pandemic in the US, Black, Hispanic, and Asian populations experienced a disproportionate rise in deaths due to heart disease and cerebrovascular disease, suggesting that racial/ethnic minorities have been most impacted by the indirect effects of the pandemic. Public health and policy strategies are needed to mitigate the short- and long-term adverse effects of the pandemic on the cardiovascular health of minority populations.

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The Benefits of Rental Assistance for Children's Health and School Attendance in the United States

Demography ◽

10.1215/00703370-9305166 ◽

2021 ◽

Author(s):

Andrew Fenelon ◽

Michel Boudreaux ◽

Natalie Slopen ◽

Sandra J. Newman

Keyword(s):

School Attendance ◽

Average Length ◽

Ethnic Disparities ◽

Black Children ◽

The United States ◽

Future Research ◽

Latino Children ◽

The Impact ◽

Racial Ethnic ◽

Hispanic White

Abstract Programs that provide affordable and stable housing may contribute to better child health and thus to fewer missed days of school. Drawing on a unique linkage of survey and administrative data, we use a quasi-experimental approach to examine the impact of rental assistance programs on missed days of school due to illness. We compare missed school days due to illness among children receiving rental assistance with those who will enter assistance within two years of their interview, the average length of waitlists for federal rental assistance. Overall, we find that children who receive rental assistance miss fewer days of school due to illness relative to those in the pseudo-waitlist group. We demonstrate that rental assistance leads to a reduction in the number of health problems among children and thus to fewer days of school missed due to illness. We find that the effect of rental assistance on missed school days is stronger for adolescents than for younger children. Additionally, race-stratified analyses reveal that rental assistance leads to fewer missed days due to illness among non-Hispanic White and Hispanic/Latino children; this effect, however, is not evident for non-Hispanic Black children, the largest racial/ethnic group receiving assistance. These findings suggest that underinvestment in affordable housing may impede socioeconomic mobility among disadvantaged non-Hispanic White and Hispanic/Latino children. In contrast, increases in rental assistance may widen racial/ethnic disparities in health among disadvantaged children, and future research should examine why this benefit is not evident for Black children.

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Racial/Ethnic Variability in Hypertension Prevalence and Risk Factors in National Health Interview Survey

ISRN Hypertension ◽

10.5402/2013/257842 ◽

2013 ◽

Vol 2013 ◽

pp. 1-8 ◽

Cited By ~ 12

Author(s):

L. Holmes ◽

J. Hossain ◽

D. Ward ◽

F. Opara

Keyword(s):

Risk Factors ◽

National Health ◽

National Health Interview Survey ◽

Ethnic Disparities ◽

Health Interview Survey ◽

Ethnic Variability ◽

Interview Survey ◽

Race Ethnicity ◽

Racial Ethnic ◽

Hispanic White

Objective. Hypertension is one of the leading causes of death attributed to cardiovascular diseases, and the prevalence varies across racial/ethnic groups, with African Americans being disproportionately affected. The underlying causes of these disparities are not fully understood despite volume of literature in this perspective. We aimed in this current study to examine ethnic/racial disparities in hypertension utilizing Hispanics as the base racial/ethnic group for comparison. Research Design and Methods. We utilized the National Health Interview Survey (NHIS), which is a large cross-sectional survey of the United States non-institutionalized residents to investigate the racial/ethnic disparities in hypertension after the adjustment of other socio-economic, demographic, and prognostic risk factors. The study participants were adults (n = 30,852). Data were analyzed using Chi square statistic, and logistic regression model. Results. There were statistically significant differences by race/ethnicity with respect to income, education, marital status, smoking, alcohol, physical activities, body mass index, and age, P < 0.01, but not insurance coverage, P > 0.01. Hispanic ethnicity (18.9%) compared to either non-Hispanic white (27.7%) or non-Hispanic black (35.5%) was associated with the lowest prevalence of hypertension. Race/ethnicity was a single independent predictor of hypertension, with non-Hispanic black more likely to be hypertensive compare with Hispanic, prevalence odds ratio (POR), 2.38, 99% Confidence Interval (CI), 2.17–2.61 and non-Hispanic white, POR, 1.64, 99% CI, 1.52–1.77. After controlling for the confounding variables, the racial/ethnic differences in hypertension persisted. Conclusions. Racial/ethnic disparities in hypertension persisted after controlling for potential predictors of hypertension in NHIS, implying the inability of known hypertension risk factors to account for racial/ethnic variability in hypertension in US.

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Recent trends in US mortality in early and middle adulthood: racial/ethnic disparities in inter-cohort patterns

International Journal of Epidemiology ◽

10.1093/ije/dyy255 ◽

2018 ◽

Vol 48 (3) ◽

pp. 934-944 ◽

Cited By ~ 3

Author(s):

Emma Zang ◽

Hui Zheng ◽

Yang Claire Yang ◽

Kenneth C Land

Keyword(s):

Baby Boomers ◽

Ethnic Disparities ◽

Mortality Data ◽

Mortality Trends ◽

Mortality Pattern ◽

Drug Poisoning ◽

Gender And Race ◽

Race Ethnicity ◽

Racial Ethnic ◽

Hispanic White

Abstract Background A striking increase in the all-cause mortality of US middle-aged non-Hispanic Whites in the past two decades has been documented by previous studies. The inter-cohort patterns in US mortality, as well as their racial/ethnic disparities, are still unclear. Methods Using official mortality data, we study US annual mortality rates for ages 25–54 from 1990 to 2016 by gender and race/ethnicity. We conduct an age-period-cohort analysis to disentangle the period and cohort forces driving the absolute changes in mortality across cohorts. Nine leading causes of death are also explored to explain the inter-cohort mortality patterns and their racial/ethnic disparities. Results We find cohort-specific elevated mortality trends for gender- and race/ethnicity-specific populations. For non-Hispanic Blacks and Hispanics, Baby Boomers have increased mortality trends compared with other cohorts. For non-Hispanic White females, it is late-Gen Xers and early-Gen Yers for whom the mortality trends are higher than other cohorts. For non-Hispanic White males, the elevated mortality pattern is found for Baby Boomers, late-Gen Xers, and early-Gen Yers. The mortality pattern among Baby Boomers is at least partially driven by mortality related to drug poisoning, suicide, external causes, chronic obstructive pulmonary disease and HIV/AIDS for all race and gender groups affected. The elevated mortality patterns among late-Gen Xers and early-Gen Yers are at least partially driven by mortality related to drug poisonings and alcohol-related diseases for non-Hispanic Whites. Differential patterns of drug poisoning-related mortality play an important role in the racial/ethnic disparities in these mortality patterns. Conclusions We find substantial racial/ethnic disparities in inter-cohort mortality patterns. Our findings also point to the unique challenges faced by younger generations.

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