Poverty and Death in the United States

1996 ◽  
Vol 26 (4) ◽  
pp. 673-690 ◽  
Author(s):  
Robert A. Hahn ◽  
Elaine D. Eaker ◽  
Nancy D. Barker ◽  
Steven M. Teutsch ◽  
Waldemar A. Sosniak ◽  
...  
Keyword(s):  
Risk Factors ◽  
Black Women ◽  
White Women ◽  
Population Attributable Risk ◽  
White Men ◽  
The United States ◽  
National Sample ◽  
Black And White ◽  
Health And Nutrition ◽  
Cholesterol Levels

The authors conducted a survival analysis to determine the effect of poverty on mortality in a national sample of blacks and whites, 25 to 74 years of age (the first National Health and Nutrition Examination Survey (NHANES-1) and NHANES-I Epidemiologic Follow-up Study). They estimated the proportion of mortality associated with poverty during 1971–1984 and in 1991 by calculating population attributable risk and assessed confounding by major known risk factors (e.g., smoking, cholesterol levels, and physical inactivity). In 1973, 6.0 percent of U.S. mortality among black and white persons 25 to 74 years of age was attributable to poverty; in 1991, the proportion was 5.9 percent. In 1991, rates of mortality attributable to poverty were lowest for white women, 2.2 times as high for white men, 8.6 times as high for black men, and 3.6 times as high for black women. Adjustment for all these potential confounders combined had little effect on the hazard ratio among men, but reduced the effect of poverty on mortality among women by 42 percent. The proportion of mortality attributable to poverty among U.S. black and white adults has changed only minimally in recent decades. The effect of poverty on mortality must be largely explained by conditions other than commonly recognized risk factors.

scholarly journals Black-White Differences in 20-year Trends in Cardiovascular Risk in the United States, 1990-2010

2019 ◽  
Vol 29 (4) ◽  
pp. 587-598 ◽  
Author(s):  
Uchechi A. Mitchell ◽  
Jennifer A. Ailshire ◽  
Jung Ki Kim ◽  
Eileen M. Crimmins
Keyword(s):  
United States ◽  
Risk Factors ◽  
Cardiovascular Risk ◽  
Black Women ◽  
White Women ◽  
Total Population ◽  
White Men ◽  
The United States ◽  
Lipid Lowering ◽  
Black And White

Objective: Improvements in the Black- White difference in life expectancy have been attributed to improved diagnosis and treatment of cardiovascular diseases and declines in cardiovascular disease mortal­ity. However, it is unclear whether race differences in total cardiovascular risk and the prevalence of cardiovascular risk factors have improved in the United States since the 1990s.Design: Serial cross-sectional design.Setting: Data from the 1988-1994, 1999- 2002, and 2009-2012 National Health and Nutrition Examination Survey (NHANES).Methods: We estimated total cardiovascu­lar risk levels, the prevalence of high-risk cardiovascular risk factors and the use of antihypertensive and lipid-lowering drugs among US Black and White men and women to determine whether differential changes occurred from 1990-2010.Results: Total cardiovascular risk declined for all races from 1990-2010. The Black- White difference was only significant in 2000 and sex-specific analyses showed that trends seen in the total population were driven by changes among women. Black and White men did not differ in risk at any time during this period. Conversely, Black women had significantly higher risk than White women in 1990 and 2000; this dif­ference was eliminated by 2010. Improved diagnosis and treatment of high blood pres­sure and high cholesterol reduced risk in the total population; improved blood pressure and lipid profiles among Black women and increasing obesity prevalence among White women specifically contributed to the nar­rowing of the Black-White difference in risk among women.Conclusion: Cardiovascular risk and racial disparities in risk declined among US Whites and Blacks due to greater use and effective­ness of lipid-lowering and antihypertensive medications.Ethn Dis. 2019;29(4):587-598; doi:10.18865/ed.29.4.587

scholarly journals Inequalities in Hypertension and Diabetes in Canada: Intersections between Racial Identity, Gender, and Income

2017 ◽  
Vol 27 (4) ◽  
pp. 371 ◽  
Author(s):  
Thierry Gagné ◽  
Gerry Veenstra
Keyword(s):  
Racial Identity ◽  
Black Women ◽  
Black Men ◽  
White Women ◽  
White Men ◽  
Canadian Community Health Survey ◽  
The United States ◽  
Unequal Distribution ◽  
Community Health Survey ◽  
Using Data

<p>A growing body of research from the United States informed by intersectionality theory indicates that racial identity, gender, and income are often entwined with one another as determinants of health in unexpectedly complex ways. Research of this kind from Canada is scarce, however. Using data pooled from ten cycles (2001- 2013) of the Canadian Community Health Survey, we regressed hypertension (HT) and diabetes (DM) on income in subsamples of Black women (n = 3,506), White women (n = 336,341), Black men (n = 2,806) and White men (n = 271,260). An increase of one decile in income was associated with lower odds of hypertension and diabetes among White men (ORHT = .98, 95% CI (.97, .99); ORDM = .93, 95% CI (.92, .94)) and White women (ORHT = .95, 95% CI (.95, .96); ORDM = .90, 95% CI (.89, .91)). In contrast, an increase of one decile in income was not associated with either health outcome among Black men (ORHT = .99, 95% CI (.92, 1.06); ORDM = .99, 95% CI (.91, 1.08)) and strongly associated with both outcomes among Black women (ORHT = .86, 95% CI (.80, .92); ORDM = .83, 95% CI (.75, .92)). Our findings highlight the complexity of the unequal distribution of hypertension and diabetes, which includes inordinately high risks of both outcomes for poor Black women and an absence of associations between income and both outcomes for Black men in Canada. These results suggest that an intersectionality framework can contribute to uncovering health inequalities in Canada.</p><p><em>Ethn Dis.</em>2017;27(4):371-378; doi:10.18865/ ed.27.4.371. </p>

scholarly journals Association of Resting Heart Rate With Blood Pressure and Incident Hypertension Over 30 Years in Black and White Adults

Hypertension ◽  
2020 ◽  
Vol 76 (3) ◽  
pp. 692-698 ◽  
Author(s):  
Laura A. Colangelo ◽  
Yuichiro Yano ◽  
David R. Jacobs ◽  
Donald M. Lloyd-Jones
Keyword(s):  
Black Women ◽  
Black Men ◽  
Young Adulthood ◽  
White Women ◽  
Middle Age ◽  
White Men ◽  
Resting Heart Rate ◽  
Incident Hypertension ◽  
Black And White ◽  
Hazard Ratios

Few studies have assessed the association of resting heart rate (RHR) through young adulthood with incident hypertension by middle age. We investigated the association between RHR measured over 30 years with incident hypertension in a cohort of young Black and White men and women. A joint longitudinal time-to-event model consisting of a mixed random effects submodel, quadratic in follow-up time, and a survival submodel adjusted for confounders, was used to determine hazard ratios for a 10 bpm higher RHR. Race-sex specific effects were examined in a single joint model that included interactions of race-sex groups with longitudinal RHR. Out of 5115 participants enrolled in year 0 (1985–1986), after excluding prevalent cases of hypertension at baseline, 1615 men and 2273 women were included in the analytic cohort. Hypertension event rates per 1000 person-years were 42.5 and 25.7 in Black and White men, respectively, and 36.2 and 15.3 in Black and White women, respectively. The hazard ratios for a 10 bpm higher RHR were 1.47 (95% CI, 1.23–1.75), 1.51 (95% CI, 1.28–1.78), 1.48 (95% CI, 1.26–1.73), and 1.02, (95% CI, 0.89–1.17) for Black men, White men, White women, and Black women, respectively. Higher RHR during young adulthood is associated with a greater risk of incident hypertension by middle age. The association is similarly strong in Black men, White men, and White women, but absent in Black women, which may suggest racial differences in the effect of sympathetic nervous activity on hypertension among women.

scholarly journals Race by Sex Differences in Depression Symptoms and Psychosocial Service Use Among Non-Hispanic Black and White Patients With Lung Cancer

2014 ◽  
Vol 32 (2) ◽  
pp. 107-113 ◽  
Author(s):  
Lara Traeger ◽  
Sheila Cannon ◽  
Nancy L. Keating ◽  
William F. Pirl ◽  
Christopher Lathan ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Sex Differences ◽  
Black Women ◽  
Service Use ◽  
White Women ◽  
White Men ◽  
Depression Symptoms ◽  
Black And White ◽  
Psychosocial Service ◽  
Black Patients

Purpose This study examined race by sex differences in depression symptoms and psychosocial service use (pastors, social workers, mental health workers, support groups) among patients with lung cancer. Patients and Methods The multiregional Cancer Care Outcomes Research and Surveillance study surveyed black and white adults with stages I to III lung cancer (n = 1,043) about depression symptoms, interest in help for mood, and psychosocial service use. Multivariable logistic regression was used to evaluate race/sex differences in depression symptoms (modified Center for Epidemiologic Studies Depression Scale ≥ 6) and psychosocial service use, independent of demographic, clinical, psychosocial, and behavioral covariates. Results A total of 18.2% screened positive for depression symptoms. This proportion was highest among black men (24.7%), followed by white women (20.6%), black women (15.8%), and white men (15.0%). In adjusted analyses, white women showed greater risk for depression symptoms relative to black women (P = .01) and white men (P = .002), with no other differences among groups. Black patients were less likely than white patients to receive desired help for mood from their doctors (P = .02), regardless of sex. Among all patients, black women were most likely to have contact with pastoral care and social work. Conclusion Race and sex interacted to predict risk of depression symptoms. Covariates accounted for elevated risk among black men. White women showed greater risk than black women and white men, independent of covariates. Black patients may experience greater barriers to receiving help for mood from their doctors. Race by sex differences in contact with psychosocial services highlight potential differences in the extent to which services are available, acceptable, and/or sought by patients.

scholarly journals Searching beyond the Lamppost to Reduce Breast Cancer Disparities

2021 ◽  
Vol 18 (3) ◽  
pp. 1186
Author(s):  
Sarah Gehlert ◽  
Marion Kavanaugh-Lynch ◽  
Senaida Fernandez Poole
Keyword(s):  
Breast Cancer ◽  
Black Women ◽  
White Women ◽  
The United States ◽  
Cancer Disparities ◽  
Black And White ◽  
Asian Pacific Islander ◽  
Asian Pacific ◽  
Pacific Islander Women ◽  
Breast Cancer Disparities

Racial and ethnic differences in breast cancer occur by race/ethnicity in both incidence and mortality rates. Women of lower socioeconomic status likewise have poorer outcomes. When race alone is considered, incidence rates in the United States are highest among White women (130.8 per 100,000), with Black women close behind (126.7 per 100,000). Incidence is lowest among Asian/Pacific Islander women, at 93.2 per 100,000. Mortality differences are more pronounced, with Black women 40% more likely to die from breast cancer than White women (28.4 per 100,000 and 20.3 per 100,000, respectively). Mortality rates for Asian/Pacific Islander women (11.5 per 100,000) are far lower than for Black and White women. When age is considered, additional differences between Black and White women appear, in part accounted for by types of breast cancer experienced. Women of other racial/ethnic groups and socioeconomic status have received less scientific attention. In this article, we provide a brief overview of the evidence for social determinants of breast cancer and argue that the current reliance on race over racism and ethnicity contributes to our inability to eliminate breast cancer disparities in the United States and elsewhere in the world. We suggest alternatives to the current approach to research in breast cancer disparities.

Black-White Differences in Ischemic Stroke Risk Factor Burden in Young Adults

Stroke ◽  
2021 ◽  
Author(s):  
Elizabeth M. Aradine ◽  
Kathleen A. Ryan ◽  
Carolyn A. Cronin ◽  
Marcella A. Wozniak ◽  
John W. Cole ◽  
...  
Keyword(s):  
Young Adults ◽  
Ischemic Stroke ◽  
Black Women ◽  
Black Men ◽  
White Women ◽  
Population Attributable Risk ◽  
White Men ◽  
Attributable Risk ◽  
Black Patients ◽  
Population Attributable Risk Percent

Background and Purpose: Although the US Black population has a higher incidence of stroke compared with the US White population, few studies have addressed Black-White differences in the contribution of vascular risk factors to the population burden of ischemic stroke in young adults. Methods: A population-based case-control study of early-onset ischemic stroke, ages 15 to 49 years, was conducted in the Baltimore-Washington DC region between 1992 and 2007. Risk factor data was obtained by in-person interview in both cases and controls. The prevalence, odds ratio, and population-attributable risk percent (PAR%) of smoking, diabetes, and hypertension was determined among Black patients and White patients, stratified by sex. Results: The study included 1044 cases and 1099 controls. Of the cases, 47% were Black patients, 54% were men, and the mean (±SD) age was 41.0 (±6.8) years. For smoking, the population-attributable risk percent were White men 19.7%, White women 32.5%, Black men 10.1%, and Black women 23.8%. For diabetes, the population-attributable risk percent were White men 10.5%, White women 7.4%, Black men 17.2%, and Black women 13.4%. For hypertension, the population-attributable risk percent were White men 17.2%, White women 19.3%, Black men 45.8%, and Black women 26.4%. Conclusions: Modifiable vascular risk factors account for a large proportion of ischemic stroke in young adults. Cigarette smoking was the strongest contributor to stroke among White patients while hypertension was the strongest contributor to stroke among Black patients. These results support early primary prevention efforts focused on smoking cessation and hypertension detection and treatment.

scholarly journals Racial Variation in Stroke Risk Among Women by Stroke Risk Factors

Stroke ◽  
2019 ◽  
Vol 50 (4) ◽  
pp. 797-804 ◽  
Author(s):  
Monik C. Jiménez ◽  
JoAnn E. Manson ◽  
Nancy R. Cook ◽  
Ichiro Kawachi ◽  
Sylvia Wassertheil-Smoller ◽  
...  
Keyword(s):  
Risk Factors ◽  
Black Women ◽  
Racial Disparities ◽  
White Women ◽  
Stroke Risk ◽  
The United States ◽  
Incidence Rates ◽  
Rate Difference ◽  
Stroke Risk Factors ◽  
Causal Pathway

Background and Purpose— In the United States, black Americans exhibit a greater risk of stroke and burden of stroke risk factors than whites; however, it is unclear whether these stroke risk factors influence stroke risk differently across racial groups. Methods— In total, 126 018 participants of the Women’s Health Initiative (11 389 black and 114 629 white women), free of stroke and coronary heart disease at baseline (1994–1998), were followed through 2010. Participants completed baseline clinical exams with standardized measurements of blood pressure and anthropometrics, medication inventory and self-reported questionnaires on sociodemographics, behaviors/lifestyle, and medical history. Incident total, ischemic and hemorrhagic strokes were updated annually through questionnaires with medical record confirmation. Rate differences (per 100 000 person-years) and hazard ratios (HR) based on multivariable Cox models and were estimated. Results— Over a median of 13 years, 4344 stroke events were observed. Absolute incidence rates were higher in black than white women in each age group. In age-adjusted analyses, the risk of stroke was significantly higher among black compared with white women (HR=1.47, 95% CI, 1.33–1.63); adjustment for stroke risk factors, which may be on the causal pathway, attenuated the estimate. Racial disparities were greatest among women 50 to <60 years (HR=3.48; 95% CI, 2.31–5.26; rate difference =99) and diminished with increasing age (60 to <70 HR=1.80; 95% CI, 1.50–2.16; rate difference =107; ≥70 years: HR=1.26; 95% CI, 1.10–1.43; rate difference =87; P interaction <0.001). Black women 50 to <60 years remained at significantly higher risk than white women after adjustment for stroke risk factors (HR=1.76; 95% CI, 1.09–2.83). Conclusions— There was a moderately greater risk of total stroke among black compared with white women; however, racial disparities were greatest among women aged 50 to <60 years. Interventions targeted at younger black women may provide the greatest benefit in reducing disparities.

Uterine cancer histology and stage at presentation in black and white women: A cohort study of 488,000 patients.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 6089-6089
Author(s):  
Mary Kathryn Abel ◽  
Cheng-I Liao ◽  
Kathleen M. Darcy ◽  
Chunqiao Tian ◽  
Amandeep Kaur Mann ◽  
...  
Keyword(s):  
Black Women ◽  
White Women ◽  
Clear Cell ◽  
Uterine Cancer ◽  
The United States ◽  
Advanced Stage ◽  
Cancer Statistics ◽  
Black And White ◽  
Chi Squared ◽  
Serous Tumors

6089 Background: Although mortality among black women diagnosed with uterine cancer is higher than in white women, the reason for this difference is not completely understood. We proposed to investigate the differences in the incidence and presentation of uterine cancer histology among black women compared to white women. Methods: Data were obtained from the United States Cancer Statistics (USCS) and the National Cancer Database (NCDB) between 2004 and 2016. Chi-squared tests were used for statistical analyses. Results: Of 488,811 patients with uterine cancer, 411,904 (84.3%) were white and 51,093 (10.5%) were black. Based on USCS data, the incidence of endometrioid carcinoma in white women was 19.63 (per 100,000 per year) compared to 12.53 in black women. However, the incidence of high-risk histologies was higher in black women, particularly for serous tumors (3.32 vs. 1.29), clear cell tumors (0.59 vs. 0.31), carcinosarcoma (2.88 vs. 1.05), and leiomyosarcoma (1.02 vs. 0.48). Using the NCDB database, we evaluated the proportion of these histologies based on race. Compared to white women, black women have a higher proportion of serous (14.2% vs. 5.6%), clear cell (2.4% vs. 1.3%), carcinosarcoma (12.3% vs. 4.5%), and leiomyosarcoma (4.3% vs. 1.7%). black women were less likely to have endometrioid (52.7% vs. 75.9%) and mucinous (0.4% vs. 0.8%) tumors. In addition, black women were more likely to have stage III or IV disease at presentation when all histological subtypes were combined (22.8% vs. 17.7%). However, of those with endometrioid and grade 1 tumors, black women did not have more advanced stage at presentation compared to white women (3.8% vs. 4.7%). Conclusions: Compared to white women, black women are more likely to be diagnosed with serous, clear cell, carcinosarcoma, and leiomyosarcomas at a more advanced stage upon presentation, but they are less likely to have endometrioid tumors. More research is needed to understand why this disparity exists.

Abstract P108: Association of Forced Expiratory Volume (1 Second) with Incidence of Atrial Fibrillation: The Atherosclerosis Risk in Communities (ARIC) Study

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Jingjing Li ◽  
Sunil K Agarwal ◽  
Alvaro Alonso ◽  
Saul Blecker ◽  
Alanna M Chamberlain ◽  
...  
Keyword(s):  
Risk Factors ◽  
Black Women ◽  
Black Men ◽  
White Women ◽  
White Men ◽  
Population Based ◽  
Forced Expiratory Volume ◽  
Atherosclerosis Risk In Communities ◽  
Atherosclerosis Risk

Objective: To investigate the association between low forced expiratory volume in 1 second (FEV 1 ) and incident atrial fibrillation (AF) in a population-based cohort. Background: Impaired FEV 1 , a complex measure indicating genetic, developmental, obstructive and restrictive airway disease, musculoskeletal function, and motivation, has been inconsistently associated with an increased risk of cardiovascular disease mortality. Also, extant reports do not provide separate estimates for African Americans, who surprisingly have lower AF incidence than Caucasians. Methods: We examined 15,282 middle-aged African Americans (26%) and Caucasians, men (45%) and women from four U.S. communities enrolled in the Atherosclerosis Risk in Communities (ARIC) cohort study. Lung volumes by standardized spirometry and information on covariates were collected on these participants at the baseline visit (1987-1989). Prevalent AF cases were excluded by 12-lead ECG at baseline. Incident AF was defined as the first event identified from the following: ICD codes for AF from hospital discharge records or death certificates, or ECGs performed during three triennial follow-up visits. Results: Over an average follow-up of 17.5 years, a total of 1,733 (11%) participants developed new-onset AF. The rate of incident AF increased monotonically and inversely by tertiles of FEV 1 in each of the 4 gender-race strata. The unadjusted average incidence rates of AF per 100 person years of follow up by tertiles of FEV 1 (from lowest to highest tertile) were 13.6, 8.3, and 5.7 for white men; 8.7, 4.5, and 3.4 for white women; 8.2, 5.5, and 3.8 for black men; 6.9, 4.1, and 2.4 for black women. After multivariable adjustment for traditional cardiovascular disease risk factors and height, hazard ratios (95% CI) of AF comparing the lowest with the highest tertile of FEV 1 were 1.44 (1.16,1.78) among white men, 1.45 (1.12, 1.87) among white women, 1.81 (1.09, 3.02) among black men, and 1.84(1.20, 2.82) among black women. The trend estimate for per 1 Standard-Deviation lower FEV 1 for the corresponding race and gender groups were 1.21 (1.12, 1.32), 1.38 (1.25, 1.54), 1.45 (1.18, 1.76), and 1.35 (1.12, 1.63), respectively. The above associations were observed across all smoking status categories (current, former, and never). The association between low lung function and incidence of AF was similarly unchanged after exclusion of participants with heart failure (n = 689) or CHD (n = 558) at baseline. The hazard of AF was about 50% higher among those with FEV1/FVC ratio below 0.7. Conclusions: In this large population-based cohort study with a long term follow-up, reduced FEV 1 is strongly associated with a higher AF risk, independent of race, gender, smoking, and several other CVD risk factors. These findings suggest the need for research on mechanisms underlying the observed association to seek broader opportunities for prevention of AF.

The Educational Gradient in Physiological Dysregulation: A Cross-Country Investigation

2018 ◽  
pp. 478-498
Author(s):  
Dana A. Glei ◽  
Noreen Goldman ◽  
Maxine Weinstein
Keyword(s):  
Black Women ◽  
Inverse Relationship ◽  
White Women ◽  
White Men ◽  
Black And White ◽  
Educational Differences ◽  
Physiological Dysregulation ◽  
Cross Country ◽  
The Relationship ◽  
Educational Gradient

The chapter first reviews extant literature on educational gradients in physiological dysregulation. Prior studies suggested there is an inverse relationship between education and risk, although the association may be weaker at the oldest ages and stronger among whites than blacks; the educational gradient may differ by country; and sex differences in the educational gradient may depend on the context. The chapter then presents new comparative analyses of the relationship between physiological dysregulation and education based on data from five countries (United States, England, Russia, Costa Rica, and Taiwan). Large educational differences were found in dysregulation in Russia, US white men, US black women, and English white women. The finding that the educational differential among US women is larger for blacks than for whites appears to be sensitive to how one defines “high” education. Using race-specific cutoffs, the education gradient did not differ significantly between black and white women.

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