Racial differences between African-American and white women in insulin resistance and visceral adiposity are associated with differences in apoCIII containing apoAI and apoB lipoproteins

Insulin resistance is associated with endothelial dysfunction. Because African-American women are more insulin-resistant than white women, it is assumed that African-American women have impaired endothelial function. However, racial differences in postprandial endothelial function have not been examined. In this study, we test the hypothesis that African-American women have impaired postprandial endothelial function compared with white women. Postprandial endothelial function following a breakfast (20% protein, 40% fat, and 40% carbohydrate) was evaluated in 36 (18 African-American women, 18 white women) age- and body mass index (BMI)-matched (age: 37 ± 11 yr; BMI: 30 ± 6 kg/m2) women. Endothelial function, defined by percent change in brachial artery flow-mediated dilation (FMD), was measured at 0, 2, 4, and 6 h following a meal. There were no significant differences between the groups in baseline FMD, total body fat, abdominal visceral fat, and fasting levels of glucose, insulin, total cholesterol, low-density lipoprotein cholesterol, or serum estradiol. Although African-American women were less insulin-sensitive [insulin sensitivity index (mean ± SD): 3.6 ± 1.5 vs. 5.2 ± 2.6, P = 0.02], both fasting triglyceride (TG: 56 ± 37 vs. 97 ± 49 mg/dl, P = 0.007) and incremental TG area under the curve (AUC0–6hr: 279 ± 190 vs. 492 ± 255 mg·dl−1·min−1·10−2, P = 0.008) were lower in African-American than white women. Breakfast was associated with a significant increase in FMD in whites and African-Americans, and there was no significant difference in postprandial FMD between the groups ( P > 0.1 for group × time interactions). Despite being insulin-resistant, postprandial endothelial function in African-American women was comparable to white women. These results imply that insulin sensitivity may not be an important determinant of racial differences in endothelial function.

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Race-Specific Association of Caesarean-Section Delivery with Body Size at Age 2 Years

Ethnicity & Disease ◽

10.18865/ed.26.1.61 ◽

2016 ◽

Vol 26 (1) ◽

pp. 61 ◽

Cited By ~ 1

Author(s):

Andrea E Cassidy-Bushrow ◽

Ganesa Wegienka ◽

Suzanne Havstad ◽

Albert M. Levin ◽

Susan V. Lynch ◽

...

Keyword(s):

African American ◽

Caesarean Section ◽

African American Women ◽

Birth Cohort ◽

Racial Differences ◽

White Women ◽

Specific Effect ◽

Delivery Mode ◽

Font Size ◽

African American Mothers

Objectives: African American children are at higher risk of obesity than White children and African American women are more likely to undergo caesarean-section (CS) delivery than White women. CS is associated with childhood obesity, however, little is known whether this relationship varies by race.We examined if the association of CS with obesity at age 2 years varied by race. Design: Longitudinal birth cohort.Setting: Birth cohort conducted in a health care system in metropolitan Detroit, Michigan with follow-up at age 2 years.Participants: 639 birth cohort participants; 367 children (57.4%) were born to African American mothers and 230 (36.0%) children were born via CS.Main Outcome Measure: Obesity defined as body mass index ≥95th percentile at age 2 years.Results: Slightly more children of African American (n=37; 10.1%) than non-African American mothers (n=18; 6.6%) were obese (P=.12). There was evidence of effect modification between race and delivery mode with obesity at age 2 years (interaction P=.020). In children of African-American mothers, CS compared to vaginal birth was associated with a significantly higher odds of obesity (aOR=2.35 (95% CI: 1.16, 4.77), P=.017). In contrast, delivery mode was not associated with obesity at age 2 years in children of non-African-American mothers (aOR=.47 (95% CI: .13, 1.71), P=.25). Conclusions: There is evidence for a race-specific effect of CS on obesity at age 2 years; potential underlying mechanisms may be racial differences in the developing gut microbiome or in epigenetic programming. Future research is needed to determine if this racial difference persists into later childhood. Ethn Dis. 2016;26(1):61-68; doi:10.18865/ed.26.1.61

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Differences in Treatment and Outcome Between African-American and White Women With Endometrial Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2003.01.218 ◽

2003 ◽

Vol 21 (22) ◽

pp. 4200-4206 ◽

Cited By ~ 77

Author(s):

Thomas C. Randall ◽

Katrina Armstrong

Keyword(s):

African American ◽

Endometrial Cancer ◽

African American Women ◽

Racial Differences ◽

White Women ◽

Sociodemographic Characteristics ◽

Histologic Type ◽

American Women ◽

Epithelial Cancers ◽

Primary Surgery

Purpose: To investigate disparities in treatment and outcomes between African-American and white women with endometrial cancer. Patients and Methods: We analyzed 1992 to 1998 Surveillance, Epidemiology, and End Results data for 21,561 women with epithelial cancers of the endometrium. Sequential Cox proportional hazard models were used to determine the association between tumor characteristics (stage, grade, and histologic type), sociodemographic characteristics (age and marital status), and treatment (surgery and radiation therapy) and the racial difference in mortality. Results: The unadjusted hazard ratio (HR) for death from endometrial cancer for African-American women compared with white women was 2.57. However, African-American women were significantly more likely to present with advanced-stage disease and have poorly differentiated tumors or tumors with an unfavorable histologic type and were significantly less likely to undergo definitive surgery at all stages of disease. Adjusting for tumor and sociodemographic characteristics lowered the HR for African-American women to 1.80. Further adjustment for the use of surgery reduced the HR to 1.51. The association between surgery and survival was stronger among white women (HR, 0.26) than among African-American women (HR, 0.44). Conclusion: African-American women with endometrial cancer are significantly less likely to undergo primary surgery and have significantly shorter survival than white women with endometrial cancer. Racial differences in treatment are associated with racial differences in survival. The association between use of surgery and survival is weaker among African-American than white women, raising questions about potential racial differences in the effectiveness of surgery.

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Racial differences in 5-year relative survival rates of cervical cancer by stage at diagnosis, between African American (black) and white women, living in the state of Alabama, USA

BMC Cancer ◽

10.1186/s12885-020-07338-7 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Ehsan Abdalla ◽

Roberta Troy ◽

Souleymane Fall ◽

Isra Elhussin ◽

Oyoyo Egiebor-Aiwan ◽

...

Keyword(s):

Cervical Cancer ◽

African American ◽

Racial Differences ◽

White Women ◽

Survival Rates ◽

Relative Survival ◽

The State ◽

Stage At Diagnosis ◽

Black And White ◽

American Black

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Racial Differences in Weight Loss Mediated by Engagement and Behavior Change

Ethnicity & Disease ◽

10.18865/ed.28.1.43 ◽

2018 ◽

Vol 28 (1) ◽

pp. 43 ◽

Cited By ~ 6

Author(s):

Loneke T. Blackman Carr ◽

Carmen Samuel-Hodge ◽

Dianne Stanton Ward ◽

Kelly R. Evenson ◽

Shrikant I. Bangdiwala ◽

...

Keyword(s):

Weight Loss ◽

African American ◽

African American Women ◽

Racial Differences ◽

White Women ◽

Controlled Trial ◽

Face To Face ◽

Weight Control Behaviors ◽

Group Sessions ◽

Hispanic White

Objective: We set out to determine if a primarily Internet-delivered behavioral weight loss intervention produced differential weight loss in African American and non-Hispanic White women, and to identify possible mediators.Design: Data for this analysis were from a randomized controlled trial, collected at baseline and 4-months.Setting: The intervention included monthly face-to-face group sessions and an Internet component that participants were recommended to use at least once weekly.Participants: We included overweight or obese African American and non-Hispanic White women (n=170), with at least weekly Internet access, who were able to attend group sessions.Intervention: Monthly face-to-face group sessions were delivered in large or small groups. The Internet component included automated tailored feedback, self-monitoring tools, written lessons, video resources, problem solving, exercise action planning tools, and social support through message boards.Main outcome measure: Multiple linear regression was used to evaluate race group differences in weight change.Results: Non-Hispanic White women lost more weight than African American women (-5.03% vs.-2.39%, P=.0002). Greater website log-ins and higher change in Eating Behavior Inventory score in non-Hispanic White women partially mediated the race-weight loss relationship.Conclusions: The weight loss disparity may be addressed through improved website engagement and adoption of weight control behaviors. Ethn Dis. 2018;28(1):43-48; doi:10.18865/ed.28.1.43.

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Racial differences in the incidence of BRCA1 and BRCA2 mutations in a cohort of early onset breast cancer patients: African American compared to white women

Journal of Medical Genetics ◽

10.1136/jmg.2005.034744 ◽

2005 ◽

Vol 43 (2) ◽

pp. 133-137 ◽

Cited By ~ 41

Author(s):

B G Haffty

Keyword(s):

Breast Cancer ◽

African American ◽

Cancer Patients ◽

Racial Differences ◽

White Women ◽

Breast Cancer Patients ◽

Early Onset Breast Cancer ◽

Brca1 And Brca2 ◽

Brca2 Mutations ◽

Brca1 And Brca2 Mutations

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Are racial differences in obesity and insulin resistance related to aggressive breast cancer?

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e18157 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e18157-e18157

Author(s):

Emily Gallagher ◽

Derek Leroith ◽

Sheldon M. Feldman ◽

Elisa R. Port ◽

Neil B Friedman ◽

...

Keyword(s):

Breast Cancer ◽

Insulin Resistance ◽

Black Women ◽

Racial Differences ◽

White Women ◽

Fasting Blood Glucose ◽

Prognostic Index ◽

Nottingham Prognostic Index ◽

Insulin Resistant ◽

Aggressive Breast Cancer

e18157 Background: Black women are more likely to die of breast cancer and develop more aggressive subtypes than white women. Black women are also more likely to be obese and have insulin resistance than white women. Insulin resistance has been associated with faster tumor growth but has not been studied as a potential mediator of racial disparities in women with breast cancer. We hypothesized that black women would present with more aggressive breast cancer and this would be associated with obesity and insulin resistance. Methods: We recruited 1017 (80% white, 20% black) women with new primary breast cancer, measured fasting blood glucose and insulin, body mass index (BMI), triple negative breast cancer (TNBC) & Nottingham prognostic index (NPI). We classified aggressive breast cancer as NPI > 4.4. We calculated insulin resistance scores (HOMA) and classified insulin resistance as HOMA > 2.8. Patients self-identified race. Results: Of 1017 women, average age was 58 years (SD = 12.0). 373 (37%) were stage 2+ at time of diagnosis; 19% had an NPI > 4.4. Black women presented with higher stage of cancer than white women (stage 2+: 45% vs 35%; p = 0.01), more TNBC than white women (10% vs 5%, p = 0.01), were more insulin resistant (24% vs 11%, p < .0001), had higher BMI (31.4kg/m2 vs 26.6 kg/m2; p < .0001) and NPI > 4.4 (29% vs. 17%, p = 0.0002) than white women. HOMA score was positively but not significantly associated with NPI score (r = 0.05; p = 0.1). Multivariate mediation regression model suggested that HOMA_IR does not mediate the effect from black race to higher NPI score (β = 0.01; 95%CI: -0.017 to 0.039). Conclusions: In women with newly diagnosed breast cancer, black women are more likely to be obese, have higher HOMA & NPI scores than white women. While these data are consistent with the hypothesized relationship of hyperinsulinemia promoting more aggressive breast cancer, to date, insulin resistance does not appear to mediate the effect of race and poor prognostic breast cancer.

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Patient Involvement in Surgery Treatment Decisions for Breast Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2005.06.217 ◽

2005 ◽

Vol 23 (24) ◽

pp. 5526-5533 ◽

Cited By ~ 228

Author(s):

Steven J. Katz ◽

Paula M. Lantz ◽

Nancy K. Janz ◽

Angela Fagerlin ◽

Kendra Schwartz ◽

...

Keyword(s):

Breast Cancer ◽

Decision Making ◽

African American ◽

Surgical Treatment ◽

Los Angeles ◽

African American Women ◽

Racial Differences ◽

Patient Involvement ◽

White Women ◽

Treatment Decisions

Purpose High rates of mastectomy and marked regional variations have motivated lingering concerns about overtreatment and failure to involve women in treatment decisions. We examined the relationship between patient involvement in decision making and type of surgical treatment for women with breast cancer. Methods All women with ductal carcinoma-in-situ and a 20% random sample of women with invasive breast cancer aged 79 years and younger who were diagnosed in 2002 and reported to the Detroit and Los Angeles Surveillance, Epidemiology, and End Results registries were identified and surveyed shortly after receipt of surgical treatment (response rate, 77.4%; n = 1,844). Results Mean age was 60.1 years; 70.2% of the women were white, 18.0% were African American, and 11.8% were from other ethnic groups. Overall, 30.2% of women received mastectomy as initial treatment. Most women reported that they made the surgical decision (41.0%) or that the decision was shared (37.1%); 21.9% of patients reported that their surgeon made the decision with or without their input. Among white women, only 5.3% of patients whose surgeon made the decision received mastectomy compared with 16.8% of women who shared the decision and 27.0% of women who made the decision (P < .001, adjusted for clinical factors, predisposing factors, and number of surgeons visited). However, this association was not observed for African American women (Wald test 10.0, P = .041). Conclusion Most women reported that they made or shared the decision about surgical treatment. More patient involvement in decision making was associated with greater use of mastectomy. Racial differences in the association of involvement with receipt of treatment suggest that the decision-making process varies by racial groups.

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Racial Disparities in Disability Among Older Adults

Journal of Aging and Health ◽

10.1177/0898264314534892 ◽

2014 ◽

Vol 26 (8) ◽

pp. 1261-1279 ◽

Cited By ~ 7

Author(s):

Roland J. Thorpe ◽

Rachael McCleary ◽

Jenny R. Smolen ◽

Keith E. Whitfield ◽

Eleanor M. Simonsick ◽

...

Keyword(s):

African American ◽

Health Disparities ◽

Racial Disparities ◽

African American Women ◽

Racial Differences ◽

Low Income ◽

White Women ◽

African American Men ◽

Urban Sample ◽

Functional Advantage

Objective: Persistent and consistently observed racial disparities in physical functioning likely stem from racial differences in social resources and environmental conditions. Method: We examined the association between race and reported difficulty performing instrumental activities of daily living (IADL) in 347 African American (45.5%) and Whites aged 50 or above in the Exploring Health Disparities in Integrated Communities–Southwest Baltimore, Maryland Study (EHDIC-SWB). Results: Contrary to previous studies, African Americans had lower rates of disability (women: 25.6% vs. 44.6%, p = .006; men: 15.7% vs. 32.9%; p = .017) than Whites. After adjusting for sociodemographics, health behaviors, and comorbidities, African American women (odds ratio [OR] = 0.32, 95% confidence interval [CI] = [0.14, 0.70]) and African American men (OR = 0.34, 95% CI = [0.13, 0.90]) retained their functional advantage compared with White women and men, respectively. Conclusion: These findings within an integrated, low-income urban sample support efforts to ameliorate health disparities by focusing on the social context in which people live.

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