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

e12599 Background: Higher prevalence of triple negative breast cancer (TNBC) in black women with associated poor outcomes due to various disparities is well documented within a single state. We examine multiple states to better understand the state effect on such differences in incidence and prevalence of TNBC in black women. Methods: Female patients of ages 19 years old and above with breast cancer from the Surveillance, Epidemiology and End Results (SEER) Program across 13 states (608 counties) from 2015 (n = 66,444) and 2016 (n = 66,122) were examined. The relationships between the proportion of black and white women and the rate of patients with different tumor subtypes (luminal A, luminal B, HR-HER2+, and triple negative) were examined at the county level using ordinary least-square regression models. In parallel, due to consideration of various state-specific healthcare policies, socio-cultural norms, and socio-economic disparities, multi-level regression models were applied to examine the nested, random effect of each state on TNBC prevalence in each county. Bonferroni correction was applied to reduce the Type I error caused by repeated use of the same variables in multiple tests. Results: The baseline breast cancer rates between black and white women were similar in the population (0.171% for black and 0.168% for white). Consistent to previous studies, we demonstrate a significant positive correlation (p < 0.001) in TNBC in black females in both years. Surprisingly, when accounted for the random effects on states, 38.2% (2015) and 34.3% (2016) increase in incidence of TNBC in black females were seen, suggestive of state-specific disparity affecting race-specific health. In 2015, other subtypes of breast cancer in both black and white females did not result in significant relationship. Interestingly, in 2016, there was a significant relationship seen between the TNBC rate in white females and the white female population rate only after adjusting for the state effect (p = 0.026). This indicates the impact of non-biological factors such as state-wide health policies. Additionally, HR-HER2+ black females had a significant relationship against respective population rate only after adjusting for the state effect as well (p = 0.0394). For luminal A white females, a 15% decrease in incidence was seen after adjusting for state effect (p = 0.0424). Conclusions: This is the first known across-state examination of breast cancer subtypes by race with random effects on state. This study shows the role of state-specific factors affecting incidence in black and white females and potentially indicates the importance of state-level management for breast cancer on health disparities in addition to race-driven effects. Further studies are needed to elucidate comparable differences between states affecting the rates of various subtypes of breast cancer and thus health outcomes.

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Abstract MP008: Racial Differences in Total, Free, and Bioavailable 25(OH)D and PTH Levels and CVD Risk Among Postmenopausal Women

Circulation ◽

10.1161/circ.135.suppl_1.mp008 ◽

2017 ◽

Vol 135 (suppl_1) ◽

Author(s):

Xi Zhang ◽

Wanzhu Tu ◽

Lesley Tinker ◽

JoAnn E Manson ◽

Simin Liu ◽

...

Keyword(s):

Vitamin D ◽

Cohort Study ◽

Black Women ◽

Postmenopausal Women ◽

Racial Differences ◽

White Women ◽

Sitting Time ◽

Cvd Risk ◽

Black And White ◽

Circulating Levels

Background: Recent evidence suggests that racial differences in circulating levels of free or bioavailable 25(OH)D rather than total 25(OH)D may explain the apparent racial disparities in cardiovascular disease(CVD).However, few prospective studies have directly tested this hypothesis. Objective: Our study prospectively examined black white differences in the associations of total, free, and bioavailable 25(OH)D, vitamin D binding protein (VDBP), and parathyroid hormone (PTH) levels at baseline with incident CVD in a large, multi-ethnic, geographically diverse cohort of postmenopausal women. Method: We conducted a case-cohort study among 79,705 black and non-Hispanic white postmenopausal women aged 50 to 79 years and free of CVD at baseline in the Women’s Health Initiative Observational Study (WHI-OS). We included a randomly chosen subcohort of 1,300 black and 1,500 white noncases at baseline and a total of 550 black and 1,500 white women who developed incident CVD during the follow up. We directly measured circulating levels of total 25(OH)D, VDBP (monoclonal antibody assay), albumin, and PTH and calculated free and bioavailable vitamin D levels. Weighted Cox proportional hazards models were used while adjusting for known CVD risk factors. Results: At baseline, white women had higher mean levels of total 25(OH)D and VDBP and lower mean levels of free and bioavailable 25(OH)D and PTH than black women (all P values < 0.0001). White cases had lower levels of total 25(OH)D and VDBP and higher levels of PTH than white noncases, while black cases had higher levels of PTH than black noncases (all P values < 0.05). There was a trend toward an increased CVD risk associated with low total 25(OH)D and VDBP levels or elevated PTH levels in both US black and white women. In the multivariable analyses, the total, free, and bioavailable 25(OH)D, and VDBP were not significantly associated with CVD risk in black or white women. A statistically significant association between higher PTH levels and increased CVD risk persisted in white women, however. The multivariate-adjusted hazard ratios [HRs] comparing the extreme quartiles of PTH were 1.37 (95% CI: 1.06-1.77; P-trend=0.02) for white women and 1.12 (95% CI: 0.79-1.58; P-trend=0.37) for black women. This positive association among white women was also independent of total, free, and bioavailable 25(OH)D or VDBP. There were no significant interactions with other pre-specified factors, including BMI, season of blood draw, sunlight exposure, recreational physical activity, sitting time, or renal function. Interpretation: Findings from a large multiethnic case-cohort study of US black and white postmenopausal women do not support the notion that circulating levels of vitamin D biomarkers may explain black-white disparities in CVD but indicate that PTH excess may be an independent risk factor for CVD in white women.

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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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Breast Cancer: Factors Associated With Stage at Diagnosis in Black and White Women

JNCI Journal of the National Cancer Institute ◽

10.1093/jnci/85.14.1129 ◽

1993 ◽

Vol 85 (14) ◽

pp. 1129-1137 ◽

Cited By ~ 130

Author(s):

C. P. Hunter ◽

C. K. Redmond ◽

V. W. Chen ◽

D. F. Austin ◽

R. S. Greenberg ◽

...

Keyword(s):

Breast Cancer ◽

White Women ◽

Stage At Diagnosis ◽

Factors Associated ◽

Black And White

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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

Nutrition & Metabolism ◽

10.1186/1743-7075-11-56 ◽

2014 ◽

Vol 11 (1) ◽

pp. 56 ◽

Cited By ~ 6

Author(s):

Liyun Wang ◽

Frank M Sacks ◽

Jeremy D Furtado ◽

Madia Ricks ◽

Amber B Courville ◽

...

Keyword(s):

Insulin Resistance ◽

African American ◽

Racial Differences ◽

White Women ◽

Visceral Adiposity

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Abstract 4428: Similar Response to Spironolactone in Whites and African American Patients with Resistant Hypertension

Circulation ◽

10.1161/circ.118.suppl_18.s_887-d ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Saima Husain ◽

Mari K Nishizaka ◽

Eduardo Pimenta ◽

Krishna K Gaddam ◽

Suzanne Oparil ◽

...

Keyword(s):

African American ◽

Racial Differences ◽

Resistant Hypertension ◽

Plasma Renin ◽

Channel Blockers ◽

Similar Response ◽

Antihypertensive Medications ◽

Plasma Aldosterone Concentration ◽

Black And White ◽

Drug Of Choice

Primary aldosteronism (PA) is a common cause of resistant hypertension with a prevalence of approximately 20%. Spironolactone is the drug of choice for the medical management of patients with PA. Blacks have been reported to have low-renin HTN and respond better to diuretics and calcium channel blockers. Racial differences in response to spironolactone in patients with resistant hypertension have not been previously described. Consecutive subjects referred to the University of Alabama at Birmingham hypertension clinic for resistant hypertension had been evaluated with a plasma aldosterone concentration (PAC), plasma renin activity (PRA), and a 24-hr urine collection for aldosterone, sodium, and potassium during the patient’s usual diet. The BP response to spironolactone was compared retrospectively in patients. For clinical reasons, subjects had been treated with a median dose of 25 mg of spironolactone and the BP response at 6 weeks, 3 and 6 months was compared retrospectively. A total of 117 patients with resistant hypertension were included in the analysis, including 59 white and 58 black subjects. Both groups had a similar number of antihypertensive medications at baseline. PAC, PRA, U-aldo and serum potassium levels were also similar. BP reduction at 6-weeks, 3- and 6-months after treatment with spironolactone was similar in black and white subjects. At 3 months, the mean reduction in systolic BP was −19.5±19.0 and −23.2±20.0 for blacks and whites, respectively (p= 0.321). These data indicate that African American and white subjects with resistant hypertension respond equally well to spironolactone.

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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.

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Multigenerational Attainments, Race, and Mortality Risk among Silent Generation Women

Journal of Health and Social Behavior ◽

10.1177/0022146518784596 ◽

2018 ◽

Vol 59 (3) ◽

pp. 335-351 ◽

Cited By ~ 6

Author(s):

Joseph D. Wolfe ◽

Shawn Bauldry ◽

Melissa A. Hardy ◽

Eliza K. Pavalko

Keyword(s):

Racial Differences ◽

Adult Children ◽

Mortality Risk ◽

White Women ◽

Adult Child ◽

Generation Model ◽

Silent Generation ◽

Black And White ◽

Family Wealth ◽

Mature Women

This study extends health disparities research by examining racial differences in the relationships between multigenerational attainments and mortality risk among “Silent Generation” women. An emerging literature suggests that the socioeconomic attainments of adjacent generations, one’s parents and adult children, provide an array of life-extending resources in old age. Prior research, however, has demonstrated neither how multigenerational resources are implicated in women’s longevity nor how racial disparities faced by Silent Generation women may differentially structure the relationships between socioeconomic attainments and mortality. With data from the National Longitudinal Survey of Mature Women, the analysis provided evidence of a three-generation model in which parent occupation, family wealth, and adult child education were independently associated with women’s mortality. Although we found evidence of racial differences in the associations between parental, personal, and spousal education and mortality risk, the education of adult children was a robust predictor of survival for black and white women.

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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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