Race/Ethnic Issues in Obesity and Obesity-Related Comorbidities

Abstract The prevalence of obesity is increasing among all age and racial groups in the United States. There is, however, a disproportionate rise in the prevalence of obesity among African-Americans and Hispanic/Mexican Americans. Obesity is a major contributor to the insulin resistant syndrome (IRS), a condition of multiple metabolic abnormalities that is a precursor to type 2 diabetes, and confers a high risk for cardiovascular events. The estimated prevalence of IRS is also greater in Mexican Americans and African-Americans than in Caucasians. The IRS is identifiable in children, and as with adults, there are racial differences in its expression even at a young age. The obesity-associated diseases, including diabetes and hypertension, are found at higher rates within the minority races compared with Caucasians. However, there are differences, in that obesity-related hypertension occurs at higher rates among African-Americans, and obesity-related diabetes occurs at higher rates among Mexican Americans. Race/ethnic differences in lifestyle behaviors and economic disadvantage may account for some of the race disparity in obesity-related diseases and disease outcomes. Environmental factors, however, do not explain all of the race disparity in disease expression, indicating that there are genetic/molecular factors that are operational as well.

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Abstract 491: Racial Disparities in the Trends of Acute Myocardial Infarction Outcomes Among Medicaid Patients, 2007-2011

Arteriosclerosis Thrombosis and Vascular Biology ◽

10.1161/atvb.37.suppl_1.491 ◽

2017 ◽

Vol 37 (suppl_1) ◽

Author(s):

Oluwole M Adegbala ◽

Akintunde Akinjero ◽

Samson Alliu ◽

Adeyinka C Adejumo ◽

Emmanuel Akintoye ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

African Americans ◽

Length Of Stay ◽

Hospital Mortality ◽

Racial Disparities ◽

Racial Differences ◽

Length Of Hospital Stay ◽

The United States ◽

Racial Groups

Background: Although, in-hospital mortality from acute myocardial infarction (AMI) have declined in the United States recently, there is a gap in knowledge regarding racial differences in this trend. We sought to evaluate the effect of race on the trends in outcomes after Acute Myocardial Infarction among Medicaid patients in a nationwide cohort from 2007-2011 Methods: We extracted data from the Nationwide Inpatient Sample (NIS) for all hospitalizations between 2007 and 2011 for Medicaid patients aged 45 years or older with principal diagnosis of AMI using ICD-9-CM codes. Primary outcome of this study was all cause in-hospital mortality. We then stratified hospitalizations by racial groups; Whites, African Americans and Hispanics, and assessed the time trends of in-hospital mortality before and after multivariate analysis. Results: The overall mortality from AMI among Medicaid patients declined during the study period (8.80% in 2007 to 7.46% in 2011). In the adjusted models, compared to 2007, in-hospital mortality from AMI for Medicaid patients decreased across the 3 racial groups; Whites (aOR= 0.88, CI=0.70-0.99), African Americans (aOR=0.76, CI=0.57-1.01), Hispanics (aOR=0.87, CI=0.66-1.25). While the length of hospital stay declined significantly among African American and Hispanic with 2 days and 1.76 days decline respectively, the length of stay remained unchanged for Whites. There was non-significant increase in the incidence of stroke across the various racial groups; Whites (aOR= 1.23, CI=0.90 -1.69), African Americans (aOR=1.10, CI=0.73 -1.64), Hispanics (aOR=1.03, CI=0.68-1.55) when compared to 2007. Conclusion: In this study, we found that in-hospital mortality from AMI among Medicaid patients have declined across the racial groups. However, while the length of stay following AMI declined for African Americans and Hispanics with Medicaid insurance, it has remained unchanged for Whites. Future studies are necessary to identify determinants of these significant racial disparities in outcomes for AMI.

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Impact of Race on Mitral Procedure Selection and Short-Term Outcomes of Patients Undergoing Mitral Valve Surgery

The Heart Surgery Forum ◽

10.1532/hsf98.20101124 ◽

2011 ◽

Vol 14 (4) ◽

pp. 221 ◽

Cited By ~ 7

Author(s):

Christina M. Vassileva ◽

Steve Markwell ◽

Theresa Boley ◽

Stephen Hazelrigg

Keyword(s):

African Americans ◽

Mitral Valve ◽

Hospital Mortality ◽

Racial Differences ◽

The United States ◽

Racial Groups ◽

Short Term ◽

Mitral Repair ◽

Procedure Selection ◽

Baseline Characteristics

Background: Racial disparity with respect to mitral valve (MV) surgery has been documented; however, previous reports have been limited by small numbers, focus on patients undergoing MV replacement only, or comparison of African-American patients to white patients. Using more recent data from the largest all-payer database in the United States, we examined whether type of mitral procedure performed was influenced by race and whether racial differences exist in baseline characteristics and short-term outcomes of patients undergoing mitral repair or replacement for MV disease.Methods: Using the 2005-2007 National Inpatient Sample (NIS) Database, we identified patients ? 30 years of age who underwent MV repair or replacement, excluding ischemic and congenital MV disease. Patients were stratified into 4 racial groups: whites, African-Americans, Hispanics, and others. The 4 groups were compared with respect to baseline characteristics, type of MV procedure (repair versus replacement), and short-term outcomes.Results: Non-whites comprised 22.3% (7818 out of 35,074) of the patients and were generally younger, more often on Medicaid and from urban locations, and more often presented on an urgent/emergent basis. African-Americans and Hispanics tended to be less affluent and have a higher Charlson comorbidity index. MV repair was performed in 45.8% of the patients overall. The racial groups differed significantly with respect to the proportion of patients receiving repair. Hispanics were 2 times more likely to have MV replacement compared to whites (odds ratio [OR] = 2.06, 95% confidence interval [CI] = 1.52-2.80, P = .0001), and African-Americans were more than 1.5 times more likely to have replacement compared to whites (OR = 1.69, 95% CI = 1.35-2.11). Following adjustment for baseline characteristics, there was no difference with respect to race for in-hospital mortality or likelihood of repair, but differences between groups persisted for length of stay and discharge location. African-Americans and Hispanics were more likely than whites to have a prolonged hospitalization.Conclusions: African-Americans and Hispanics present for MV surgery with worse preoperative profiles and undergo mitral repair less often compared to whites. Although in-hospital mortality was not influenced by race, African-Americans and Hispanics had a more protracted hospital course even following adjustment. The disparity in mitral procedure selection among racial groups was present only prior to adjustment for important baseline characteristics. Nevertheless, this racial difference reflects current reality in surgical practice and identifies an important area for future improvement in the care of patients with valvular heart disease.

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Examining Racial Discrimination’s Association With Depressive Symptoms Through Metadehumanization Among African Americans: Does Racial Identity Matter?

Journal of Black Psychology ◽

10.1177/0095798420983664 ◽

2020 ◽

pp. 009579842098366

Author(s):

Yara Mekawi ◽

Natalie N. Watson-Singleton

Keyword(s):

Depressive Symptoms ◽

Racial Identity ◽

African Americans ◽

Racial Discrimination ◽

Indirect Effect ◽

Social Cognitive ◽

Empirical Work ◽

The United States ◽

Racial Groups ◽

Social Cognitive Theories

Though considerable empirical work has documented the ways in which African Americans are dehumanized by other racial groups, there is no research examining how perceiving dehumanization (i.e., metadehumanization) is associated with the mental health of African Americans. In this study, we examined the indirect effect of racial discrimination on depressive symptoms through metadehumanization and explored whether this indirect effect was contingent on racial identity (i.e., centrality, private regard). African American students completed measures in a university lab located in the Midwestern region of the United States ( N = 326; Mage = 19.7, 72.4% women). We found that the degree to which racial discrimination was indirectly associated with depressive symptoms through metadehumanization was contingent on racial identity dimensions. Specifically, the indirect effect of racial discrimination on depressive symptoms through metadehumanization was only significant for individuals who were relatively higher on centrality and private regard. This research suggests that the role of metadehumanization is stronger among African Americans who strongly identify with and have positive views of their racial group. We discuss these results in the context of social cognitive theories.

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Ethnicity and Antipsychotic Response

Annals of Pharmacotherapy ◽

10.1177/106002809703101114 ◽

1997 ◽

Vol 31 (11) ◽

pp. 1360-1369 ◽

Cited By ~ 55

Author(s):

Edyta J Frackiewicz ◽

John J Sramek ◽

John M Herrera ◽

Neil M Kurtz ◽

Neal R Cutler

Keyword(s):

African Americans ◽

Environmental Factors ◽

Racial Differences ◽

Future Research ◽

Racial Groups ◽

Prescribing Practices ◽

Data Synthesis ◽

Medline Search ◽

Study Selection ◽

And Control

OBJECTIVE: To review the data generated by studies examining interethnic/racial differences in response to antipsychotics. DATA SOURCES: A MEDLINE search (1966-19%) identified all articles examining differences in antipsychotic response among Caucasians, Asians, Hispanics, and African-Americans, as well as articles evaluating postulated mechanisms for these differences. STUDY SELECTION: All abstracts, studies, and review articles were evaluated. DATA SYNTHESIS: Ethnic/racial differences in response to antipsychotic medications have been reported and may be due to genetics, kinetic variations, dietary or environmental factors, or variations in the prescribing practices of clinicians. Studies suggest that Asians may respond to lower doses of antipsychotics due to pharmacokinetic and pharmacodynamic differences. Research relevant to African-Americans is limited, but some studies suggest that differences in this group may be due to clinician biases and prescribing practices, rather than to pharmacokinetic or pharmacodynamic variability. CONCLUSIONS: Future research directed at validating the hypotheses that different ethnic/racial groups show variations in response to antipsychotics should focus on homogenous ethnic groups, use recent advances in pharmacogenetic testing, and control for such variables as observer bias, gender, disease chronicity, dietary and environmental factors, and exposure to enzyme-inducing and -inhibiting agents. Clinicians should be aware that potential interethnic/racial differences in pharmacodynamics and pharmacokinetics may exist that can alter response to antipsychotics.

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Is the Association of Diabetes With Uncontrolled Blood Pressure Stronger in Mexican Americans and Blacks Than in Whites Among Diagnosed Hypertensive Patients?

American Journal of Hypertension ◽

10.1093/ajh/hpt109 ◽

2013 ◽

Vol 26 (11) ◽

pp. 1328-1334 ◽

Cited By ~ 9

Author(s):

Xuefeng Liu ◽

Ping Song

Keyword(s):

Blood Pressure ◽

Racial Differences ◽

Mexican Americans ◽

The United States ◽

Linear Regression Models ◽

Uncontrolled Blood Pressure ◽

Hypertensive Patients ◽

Health And Nutrition ◽

Multistage Design ◽

Hispanic White

Abstract BACKGROUND Clinical evidence shows that diabetes may provoke uncontrolled blood pressure (BP) in hypertensive patients. However, racial differences in the associations of diabetes with uncontrolled BP outcomes among diagnosed hypertensive patients have not been evaluated. METHODS A total of 6,134 diagnosed hypertensive subjects aged ≥20 years were collected from the National Health and Nutrition Examination Survey 1999–2008 with a stratified multistage design. Odds ratios (ORs) and relative ORs of uncontrolled BP and effect differences in continuous BP for diabetes over race/ethnicity were derived using weighted logistic regression and linear regression models. RESULTS Compared with participants who did not have diabetes, non-Hispanic black participants with diabetes had a 138% higher chance of having uncontrolled BP, Mexican participants with diabetes had a 60% higher chance of having uncontrolled BP, and non-Hispanic white participants with diabetes had a 161% higher chances of having uncontrolled BP. The association of diabetes with uncontrolled BP was lower in Mexican Americans than in non-Hispanic blacks and whites (Mexican Americans vs. non-Hispanic blacks: relative OR = 0.55, 95% confidence interval (CI) = 0.37–0.82; Mexican Americans vs. non-Hispanic whites: relative OR = 0.53, 95% CI = 0.35–0.80) and the association of diabetes with isolated uncontrolled systolic BP was lower in Mexican Americans than in non-Hispanic whites (Mexican Americans vs. non-Hispanic whites: relative OR = 0.62, 95% CI = 0.40–0.96). Mexican Americans have a stronger associaton of diabetes with decreased systolic BP and diastolic BP than non-Hispanic whites, and a stronger association of diabetes with decreased diastolic BP than non-Hispanic blacks. CONCLUSIONS The association of diabetes with uncontrolled BP outcomes is lower despite higher prevalence of diabetes in Mexican Americans than in non-Hispanic whites. The stronger association of diabetes with BP outcomes in whites should be of clinical concern, considering they account for the majority of the hypertensive population in the United States.

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Factors Underlying Racial Disparities in Sepsis Management

Healthcare ◽

10.3390/healthcare6040133 ◽

2018 ◽

Vol 6 (4) ◽

pp. 133

Author(s):

Matthew DiMeglio ◽

John Dubensky ◽

Samuel Schadt ◽

Rashmika Potdar ◽

Krzysztof Laudanski

Keyword(s):

Racial Disparities ◽

Racial Differences ◽

Minority Groups ◽

The United States ◽

Racial Groups ◽

Sepsis Management ◽

Treatment Protocols ◽

Common Causes ◽

Standardized Treatment ◽

Wide Variability

Sepsis, a syndrome characterized by systemic inflammation during infection, continues to be one of the most common causes of patient mortality in hospitals across the United States. While standardized treatment protocols have been implemented, a wide variability in clinical outcomes persists across racial groups. Specifically, black and Hispanic populations are frequently associated with higher rates of morbidity and mortality in sepsis compared to the white population. While this is often attributed to systemic bias against minority groups, a growing body of literature has found patient, community, and hospital-based factors to be driving racial differences. In this article, we provide a focused review on some of the factors driving racial disparities in sepsis. We also suggest potential interventions aimed at reducing health disparities in the prevention, early identification, and clinical management of sepsis.

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Genetics of Hypertension in African Americans and Others of African Descent

International Journal of Molecular Sciences ◽

10.3390/ijms20051081 ◽

2019 ◽

Vol 20 (5) ◽

pp. 1081 ◽

Cited By ~ 13

Author(s):

Mihail Zilbermint ◽

Fady Hannah-Shmouni ◽

Constantine Stratakis

Keyword(s):

United States ◽

African Americans ◽

African Descent ◽

The United States ◽

Racial Groups ◽

Angiotensin System ◽

The Public ◽

Low Renin Hypertension ◽

Gated Channel ◽

G Protein Coupled

Hypertension is the leading cause of cardiovascular disease in the United States, affecting up to one-third of adults. When compared to other ethnic or racial groups in the United States, African Americans and other people of African descent show a higher incidence of hypertension and its related comorbidities; however, the genetics of hypertension in these populations has not been studied adequately. Several genes have been identified to play a role in the genetics of hypertension. They include genes regulating the renin-aldosterone-angiotensin system (RAAS), such as Sodium Channel Epithelial 1 Beta Subunit (SCNN1B), Armadillo Repeat Containing 5 (ARMC5), G Protein-Coupled Receptor Kinase 4 (GRK4), and Calcium Voltage-Gated Channel Subunit Alpha1 D (CACNA1D). In this review, we focus on recent genetic findings available in the public domain for potential differences between African Americans and other populations. We also cover some recent and relevant discoveries in the field of low-renin hypertension from our laboratory at the National Institutes of Health. Understanding the different genetics of hypertension among various groups is essential for effective precision-guided medical therapy of high blood pressure.

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Selling Servitude, Captivating Consumers

Journal of Global Slavery ◽

10.1163/2405836x-00101005 ◽

2016 ◽

Vol 1 (1) ◽

pp. 72-112

Author(s):

Amanda Brickell Bellows

Keyword(s):

African Americans ◽

Racial Differences ◽

The United States ◽

Marketing Strategies ◽

Urban Migration ◽

Marketing Tactics ◽

Important Distinction ◽

Migration Patterns ◽

American Slavery ◽

Emancipation Era

After the abolition of Russian serfdom and American slavery in 1861 and 1865, respectively, businesses played an important role in molding popular attitudes about post-emancipation integration processes in Russia and the United States through visual representations of serfs, peasants, slaves, and freedpeople in advertisements. Both American and Russian companies developed parallel marketing strategies by constructing advertisements that depicted African Americans and peasants in positions of servitude, which appealed to consumers who were nostalgic for an idealized rural, pre-industrial and pre-emancipation era during an age of rapid industrialization, urbanization, and geographic expansion. But Russian and American companies also pursued divergent marketing tactics that beg further consideration. While US businesses predominantly disparaged African Americans in racialized caricatures, Russian businesses sometimes depicted peasants in positions of equality relative to other citizens. What accounts for this disparity? This article examines newspaper ads, posters, broadsides, and ephemera from collections at Russian and American archives, and argues that apart from perceived racial differences in the case of US ads, dissimilarities between Russian and American population compositions, urban migration patterns, and distinct notions of national identity also explain this important distinction.

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Myo-inositol supplementation as a preventive consideration for gestational diabetes mellitus

Hellenic Journal of Obstetrics and Gynecology ◽

10.33574/hjog.1935 ◽

2020 ◽

Vol 19 (1) ◽

pp. 45-50

Author(s):

George Asimakopoulos ◽

Panagiotis Antsaklis ◽

Mariana Theodora ◽

Michael Sindos ◽

Alexandros Rodolakis ◽

...

Keyword(s):

Diabetes Mellitus ◽

Insulin Resistance ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Current Evidence ◽

Insulin Resistant ◽

Improve Insulin Resistance ◽

Prevalence Of Obesity ◽

Ovarian Syndrome

Gestational diabetes mellitus (GDM) is defined as impaired glucose tolerance with onset or first recognition during pregnancy, which is characterized by increased insulin resistance. GDM affects about 10% of pregnancies and its prevalence is rising worldwide mainly due to the advancing maternal age and the increased prevalence of obesity. GDM is associated with pregnancy-related maternal and fetal morbidity (both antenatal and perinatal). Traditional treatments for the GDM include diet and, if it is necessary, insulin. However, the percentage of macrosomic newborns does not appear to be significantly reduced. Safe and effective preventive interventions are therefore, needed in an attempt to lower the incidence of gestational diabetes. Myo-inositol has been suggested to improve insulin resistance in women with insulin resistant syndromes such as GDM, polycystic ovarian syndrome, type 2 diabetes and metabolic syndrome. Several studies report a significant decrease in GDM incidence in women at risk for GDM comparing to the placebo group. However, the option of myo-inositol supplementation needs to be further explored as the current evidence is relatively limited.

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