Genetics, race, ethnicity, and health

Ethnic differences in depression and anxiety among adults with atopic eczema: Population-based matched cohort studies within UK primary care

BACKGROUND

Evidence demonstrates that individuals with atopic eczema (eczema) have increased depression and anxiety; however, the role of ethnicity in these associations is poorly understood. We aimed to investigate whether associations between eczema and depression or anxiety differed between adults from white and minority ethnic groups in the UK.

METHODS

We used UK Clinical Practice Research Datalink GOLD to conduct matched cohort studies of adults (≥18 years) with ethnicity recorded in primary care electronic health records (April 2006-January 2020). We matched (age, sex, practice) adults with eczema to up to five adults without. We used stratified Cox regression with an interaction between eczema and ethnicity, to estimate hazard ratios (HRs) for associations between eczema and incident depression and anxiety in individuals from white ethnic groups and a pooled minority ethnic group (adults from Black, South Asian, Mixed and Other groups).

RESULTS

We identified separate cohorts for depression (215,073 with eczema matched to 646,539 without) and anxiety (242,598 with eczema matched to 774,113 without). After adjusting for matching variables and potential confounders (age, sex, practice, deprivation, calendar period), we found strong evidence (p < 0.01) of ethnic differences in associations between eczema and depression (minority ethnic groups: HR = 1.33, 95% CI = 1.22,1.45; white ethnic groups: HR = 1.15, 95% CI = 1.12,1.17) and anxiety (minority ethnic groups: HR = 1.41, 95% CI = 1.28,1.55; white ethnic groups: HR = 1.17, 95% CI = 1.14,1.19).

CONCLUSIONS

Adults with eczema from minority ethnic groups appear to be at increased depression and anxiety risk compared with their white counterparts. Culturally adapted mental health promotion and prevention strategies should be considered in individuals with eczema from minority ethnic groups.

Incidence of primary large vessel vasculitis in Norfolk, UK from 2011 to 2020

OBJECTIVES

To report the annual incidence of primary large vessel vasculitis (LVV) in the adult population of Norfolk County, UK, including giant cell arteritis (GCA) (in those ≥50 years) and Takayasu arteritis (TAK).

METHODS

Individuals diagnosed by histology or imaging who lived in NR1-NR30 postcode districts were included. Validated criteria from 1990 and 2022 were applied for final classification. Population data were available from the Office of National Statistics, UK.

RESULTS

270 individuals were diagnosed with primary LVV over 4.7 million person-years. The annual incidence (95% CI) of primary LVV was 57.5 (50.8, 64.7)/million person-years in the adult population. 227 and 244 individuals were diagnosed with GCA over ~2.5 million person-years using 1990 and 2022 criteria, respectively. The annual incidence (95% CI) of GCA was 91.6 (80.0, 104.3)/million person-years aged ≥50 years using 1990 criteria and 98.4 (86.4, 111.6)/million person-years aged ≥50 years using 2022 criteria. 13 and 2 individuals were diagnosed with TAK over 4.7 million person-years. The annual incidence (95% CI) of TAK was 2.8 (1.5, 4.7)/million person-years using 1990 criteria and 0.4 (0.0, 1.4)/million person-years using 2022 criteria, in the adult population. The incidence of GCA rose sharply in 2017 coincident with the introduction of a fast-track pathway and fell during the pandemic when the pathway was disrupted.

CONCLUSIONS

This is the first study that reports the incidence of objectively verified primary LVV in the adult population. The incidence of GCA may be affected by the availability of diagnostic pathways. The use of the 2022 classification criteria results in a rise in the classification of GCA and fall in that of TAK.

An Opportunity for Prevention: Associations Between the Life's Essential 8 Score and Cardiovascular Incidence Using Prospective Data from UK Biobank

To investigate the association between the Life's Essential 8 (LE8) score and the incidence of four cardiovascular outcomes (ischemic heart disease, myocardial infarction, stroke, and heart failure [HF]) - separately and as a composite outcome of major adverse cardiovascular events (MACE) - in UK Biobank. 250,825 participants were included in this prospective study. Smoking, non-HDL cholesterol, blood pressure, body mass index, HbA1c, physical activity, diet, and sleep were used to create a modified version of the LE8 score. Associations between the score (both as a continuous score and as quartiles) and outcomes were investigated using adjusted Cox proportional hazard models. The potential impact fractions of two scenarios were also calculated. Over a median follow-up of 10.4 years, there were 25,068 MACE. Compared to individuals in the highest quartile of the score (healthiest), those in the lowest quartile (least healthy) had 2.07 (95% CI: 1.99; 2.16) higher risk for MACE. The highest relative risk gradient of the individual outcomes was observed for HF (HR_{lowest quartile}: 2.67 [95% CI: 2.42; 2.94]). The magnitude of association was stronger in participants below 50 years, women, and ethnic minorities. A targeted intervention that increased, by 10-points, the score among individuals in the lowest quartile could have prevented 9.2% of MACE. Individuals with a lower LE8 score experienced more MACE, driven especially by incident HF. Our scenarios suggested that relevant interventions targeted towards those in the lowest quartile may have a greater impact than interventions producing small equal changes across all quartiles.

Occupational differences in COVID-19 incidence, severity, and mortality in the United Kingdom: Available data and framework for analyses

There are important differences in the risk of SARS-CoV-2 infection and death depending on occupation. Infections in healthcare workers have received the most attention, and there are clearly increased risks for intensive care unit workers who are caring for COVID-19 patients. However, a number of other occupations may also be at an increased risk, particularly those which involve social care or contact with the public. A large number of data sets are available with the potential to assess occupational risks of COVID-19 incidence, severity, or mortality. We are reviewing these data sets as part of the Partnership for Research in Occupational, Transport, Environmental COVID Transmission (PROTECT) initiative, which is part of the National COVID-19 Core Studies. In this report, we review the data sets available (including the key variables on occupation and potential confounders) for examining occupational differences in SARS-CoV-2 infection and COVID-19 incidence, severity and mortality. We also discuss the possible types of analyses of these data sets and the definitions of (occupational) exposure and outcomes. We conclude that none of these data sets are ideal, and all have various strengths and weaknesses. For example, mortality data suffer from problems of coding of COVID-19 deaths, and the deaths (in England and Wales) that have been referred to the coroner are unavailable. On the other hand, testing data is heavily biased in some periods (particularly the first wave) because some occupations (e.g. healthcare workers) were tested more often than the general population. Random population surveys are, in principle, ideal for estimating population prevalence and incidence, but are also affected by non-response. Thus, any analysis of the risks in a particular occupation or sector (e.g. transport), will require a careful analysis and triangulation of findings across the various available data sets.

Occupational differences in COVID-19 incidence, severity, and mortality in the United Kingdom: Available data and framework for analyses

There are important differences in the risk of SARS-CoV-2 infection and death depending on occupation. Infections in healthcare workers have received the most attention, and there are clearly increased risks for intensive care unit workers who are caring for COVID-19 patients. However, a number of other occupations may also be at an increased risk, particularly those which involve social care or contact with the public. A large number of data sets are available with the potential to assess occupational risks of COVID-19 incidence, severity, or mortality. We are reviewing these data sets as part of the Partnership for Research in Occupational, Transport, Environmental COVID Transmission (PROTECT) initiative, which is part of the National COVID-19 Core Studies. In this report, we review the data sets available (including the key variables on occupation and potential confounders) for examining occupational differences in SARS-CoV-2 infection and COVID-19 incidence, severity and mortality. We also discuss the possible types of analyses of these data sets and the definitions of (occupational) exposure and outcomes. We conclude that none of these data sets are ideal, and all have various strengths and weaknesses. For example, mortality data suffer from problems of coding of COVID-19 deaths, and the deaths (in England and Wales) that have been referred to the coroner are unavailable. On the other hand, testing data is heavily biased in some periods (particularly the first wave) because some occupations (e.g. healthcare workers) were tested more often than the general population. Random population surveys are, in principle, ideal for estimating population prevalence and incidence, but are also affected by non-response. Thus, any analysis of the risks in a particular occupation or sector (e.g. transport), will require a careful analysis and triangulation of findings across the various available data sets.

Parental Depression and Anxiety Associated with Newborn Bloodspot Screening for Rare and Variable-Onset Disorders

The ability to screen newborns for a larger number of disorders, including many with variable phenotypes, is prompting debate regarding the psychosocial impact of expanded newborn bloodspot screening (NBS) on parents. This study compares psychological outcomes of parents of children with a range of NBS/diagnostic experiences, with a particular focus on lysosomal storage disorders (LSDs) and X-linked adrenoleukodystrophy (X-ALD) as representative disorders with complex presentations. An online cross-sectional survey with six domains was completed in 2019 by a volunteer sample of parents with at least one child born between 2013 and 2018. Parents were classified in the analysis stage into four groups based on their child's rare disorder and means of diagnosis. Stress and depression were estimated using dichotomous measures of the depression subscale of the Hospital Anxiety and Depression Scale and the Parental Stress Scale. Logistic regression models were estimated for the relationship between the parent group and stress/depression, controlling for demographic variables (region of the US, income, education, major life events, relationship to the child, number of children, parent age, and race/ethnicity). One hundred seventy-four parents were included in this analysis. Parents of children with an LSD or X-ALD diagnosis clinically may have higher odds of depression (OR: 6.06, 95% CI: 1.64-24.96) compared to parents of children with the same disorders identified through NBS, controlling for covariates. Although a similar pattern was observed for parental stress (OR: 2.85, 95% CI: 0.82-10.37), this did not reach statistical significance. Ethically expanding NBS and genome sequencing require an understanding of the impacts of early detection for complex disorders on families. These initial findings are reassuring, and may have implications as NBS expands. Given our small sample size, it is difficult to generalize these findings to all families. These preliminary trends warrant further investigation in larger and more diverse populations.

Retrofitting home insulation reduces incidence and severity of chronic respiratory disease

To assess whether retrofitting home insulation can reduce the risk of respiratory disease incidence and exacerbation, a retrospective cohort study was undertaken using linked data from a national intervention program. The study population was made up of 1 004 795 residents from 205 001 New Zealand houses that received an insulation subsidy though a national Energy Efficiency and Conservation Authority program. A difference-in-difference model compared changes in the number of prescriptions dispensed for respiratory illness post- insulation to a control population over the same timeframe. New prescribing of chronic respiratory disease medication at follow-up was used to compare incidence risk ratios between intervention and control groups. Chronic respiratory disease incidence was significantly lower in the intervention group at follow-up: odds ratio 0.90 (95% CI: 0.86-0.94). There was also a 4% reduction in medication dispensed for treating exacerbations of chronic respiratory disease symptoms in the intervention group compared with the control group: relative rate ratio (RRR) 0.96 (95% CI: 0.96-0.97). There was no change in medication dispensed to prevent symptoms of chronic respiratory disease RRR: 1,00 (95% CI: 0.99-1.00). These findings support home insulation interventions as a means of improving respiratory health outcomes.

Retrofitting home insulation reduces incidence and severity of chronic respiratory disease

To assess whether retrofitting home insulation can reduce the risk of respiratory disease incidence and exacerbation, a retrospective cohort study was undertaken using linked data from a national intervention program. The study population was made up of 1 004 795 residents from 205 001 New Zealand houses that received an insulation subsidy though a national Energy Efficiency and Conservation Authority program. A difference-in-difference model compared changes in the number of prescriptions dispensed for respiratory illness post- insulation to a control population over the same timeframe. New prescribing of chronic respiratory disease medication at follow-up was used to compare incidence risk ratios between intervention and control groups. Chronic respiratory disease incidence was significantly lower in the intervention group at follow-up: odds ratio 0.90 (95% CI: 0.86-0.94). There was also a 4% reduction in medication dispensed for treating exacerbations of chronic respiratory disease symptoms in the intervention group compared with the control group: relative rate ratio (RRR) 0.96 (95% CI: 0.96-0.97). There was no change in medication dispensed to prevent symptoms of chronic respiratory disease RRR: 1,00 (95% CI: 0.99-1.00). These findings support home insulation interventions as a means of improving respiratory health outcomes.

Ethnic differences in cardiovascular risk: examining differential exposure and susceptibility to risk factors

BACKGROUND

Ethnic differences in cardiovascular disease (CVD) risk have been known for decades, but a systematic exploration of how exposure and susceptibility to risk factors may contribute is lacking. This study aimed to investigate the potential impact of differential exposure and susceptibility between South Asian, Black, and White individuals.

METHODS

This is a population-based prospective cohort study of UK Biobank participants with a median follow-up of 11.3 years. The association between ethnic group and CVD risk was studied. Additional risk factors were then adjusted to examine mediations. Moderation analysis was conducted to identify whether risk factors had a stronger association in the ethnic minority groups. Population attributable fractions were also calculated to quantify the relative contributions of risk factors for each ethnic group.

RESULTS

When adjusted for only age and sex, there was a higher risk of CVD among South Asian (n=8815; HR [95% CI] 1.69 [1.59-1.79]) and Black (n=7526; HR [95% CI] 1.12 [1.03-1.22]) compared with White participants (n=434,809). The excess risk of Black participants was completely attenuated following adjustment for deprivation. Compared with White participants, the associations of BMI, triglycerides, and HbA1c with CVD were stronger in South Asians. Adiposity was attributable to the highest proportion of CVD regardless of ethnicity. Smoking had the second largest contribution to CVD among White and Black participants, and HbA1c among South Asian participants.

CONCLUSIONS

Adiposity is an important risk factor for CVD regardless of ethnicity. Ethnic inequalities in CVD incidence may be best tackled by targeting interventions according to ethnic differences in risk profiles.

Educational note: types of causes

We explore the different types of causes that are commonly investigated by epidemiologists. We first distinguish between causes which are events (including actions) and causes which are states. Second, we distinguish between modifiable and non-modifiable states. This yields three types of causes: fixed states (non-modifiable), dynamic states (modifiable) and events (including actions). Different causes may have different characteristics: the methods available to study them, the types of possible biases, and therefore the types of evidence needed to infer causality, may differ according to the specific cause-effect relationship under study. Nevertheless, there are also substantial commonalities. This paper is intended to improve understanding of the different types of causes, and the different types of causality, that underpin epidemiological practice.

Discourse on culture in research on immigrant and migrant workers' health

BACKGROUND

Health and safety researchers and practitioners have proposed that cultural differences help explain inequalities between foreign and native-born workers. While cultural explanations for inequalities have long been debated in other fields, there exists little critique of cultural discourses in occupational health.

METHODS

This article examines and discusses the discourse on culture in 107 articles on immigrant or migrant workers' health published between 2011 and 2015. For each article, passages on culture were identified and analysed for both the context and the manner in which culture was discussed.

RESULTS

The discourse on culture was found to be generally simplistic, individualistic, and uncritical, intentionally or unintentionally supporting the worldview that workers' "otherness" is both cause of inequalities and target for interventions.

CONCLUSION

The article argues that empirical, theoretical and interdisciplinary work is needed to document the mechanisms and pathways that underlie health and safety inequalities by foreign-born status.

Role of lifestyle behaviours in the ethnic pattern of poor health outcomes in Leicester, England: analysis of a survey data set

OBJECTIVES

Mediation analyses were conducted to explore the contribution of lifestyle behaviours in the ethnic pattern of poor health outcomes in Leicester, England.

STUDY DESIGN

Cross-sectional study.

METHODS

The study used data on 1959 participants from the Leicester Health and Well-being Survey (2015). Lifestyle behaviours were physical activity, diet, smoking and alcohol drinking. Poor health outcomes were the presence of long-term illness and poor self-reported health.

RESULTS

Poor health outcomes were less common in Black and Minority Ethnic groups (BMEs) than Whites. Smoking was less common in BMEs than Whites. Poor health outcomes were more common in ex-smokers and current smokers than never smokers. Health outcomes were associated with smoking even after adjusting for ethnicity. The association of ethnicity and health outcomes reduced after adjusting for smoking, suggesting that the effect was mediated by smoking.

CONCLUSIONS

In Leicester, Whites had poorer health outcomes than BMEs, which were not mediated by physical activity, diet and alcohol drinking but were mediated by smoking.

Tendência e desigualdade na completude da informação sobre raça/cor dos óbitos de idosos no Sistema de Informações sobre Mortalidade no Brasil, entre 2000 e 2015

A qualidade da informação sobre raça/cor é condição necessária para conhecer o impacto da desigualdade na mortalidade. O objetivo deste trabalho é analisar a tendência e a desigualdade na completude da raça/cor dos óbitos de idosos no Sistema de Informações sobre Mortalidade (SIM) entre 2000 e 2015 no Brasil. Analisa-se a completude dessa variável por diferentes abrangências geográficas, a raça/cor mais afetada pela má completude e a associação entre a excelência do preenchimento da raça/cor com a territorialidade e a condição socioeconômica dos municípios. Os dados dos óbitos de idosos provêm do SIM, e as informações de população, dos Censos e estimativas do Ministério da Saúde. Estima-se a variação percentual da proporção da incompletude. A variação percentual de pretos/pardos foi estimada entre 2000 e 2010 para o SIM e Censos. Estima-se regressão logística simples e ajustada (IC95%), tendo, como desfecho excelente, completude da raça/cor e, como resposta, variáveis territoriais e socioeconômicas. Encontrou-se acentuada melhora da qualidade do preenchimento no período, especialmente até 2006, sendo excelente a média nacional desde 2007. Nota-se desigualdade territorial em nível municipal. Municípios de IDH baixo/médio, com alta proporção de pobreza e desigualdade tiveram menor chance de ter excelente completude. O modelo ajustado mostra que a região e o tamanho do município são as características que explicam a excelente qualidade da variável raça/cor. Municípios do Nordeste e de pequeno porte têm menos chance de excelente completude. Conclui-se que raça/cor no SIM tem qualidade para ser utilizada nos estudos de desigualdade da mortalidade dos idosos, salvo exceções em nível municipal.

How differing methods of ascribing ethnicity and socio-economic status affect risk estimates for hospitalisation with infectious disease

Significant ethnic and socio-economic disparities exist in infectious diseases (IDs) rates in New Zealand, so accurate measures of these characteristics are required. This study compared methods of ascribing ethnicity and socio-economic status. Children in the Growing Up in New Zealand longitudinal cohort were ascribed to self-prioritised, total response and single-combined ethnic groups. Socio-economic status was measured using household income, and both census-derived and survey-derived deprivation indices. Rates of ID hospitalisation were compared using linked administrative data. Self-prioritised ethnicity was simplest to use. Total response accounted for mixed ethnicity and allowed overlap between groups. Single-combined ethnicity required aggregation of small groups to maintain power but offered greater detail. Regardless of the method used, Māori and Pacific children, and children in the most socio-economically deprived households had a greater risk of ID hospitalisation. Risk differences between self-prioritised and total response methods were not significant for Māori and Pacific children but single-combined ethnicity revealed a diversity of risk within these groups. Household income was affected by non-random missing data. The census-derived deprivation index offered a high level of completeness with some risk of multicollinearity and concerns regarding the ecological fallacy. The survey-derived index required extra questions but was acceptable to participants and provided individualised data. Based on these results, the use of single-combined ethnicity and an individualised survey-derived index of deprivation are recommended where sample size and data structure allow it.

Polymorphism of R353Q (rs6046) in factor VII and the risk of myocardial infarction: A systematic review and meta-analysis

OBJECTIVE

Genetic components substantially contribute to the development of myocardial infarction (MI), and R353Q polymorphism (rs6046) in FVII gene has been suspected to be associated with the risk of MI.

METHODS

A meta-analysis was conducted on the links between R353Q polymorphism and the susceptibility of MI. A comprehensive literature search was performed on 8 electronic databases. The main effects of the genotypes were estimated using a logistic regression approach. The odds ratios with 95% confidence intervals were calculated using the conventional summary method meta-analysis. The possible sources of heterogeneity among the included studies were explored using meta-regression analysis and subgroup analysis.

RESULTS

A total of 18 eligible case-control studies, comprising of 4701 cases and 5329 controls, were included. No overall statistical relationship was identified between R353Q and MI by any of the genetic models. The meta-regression demonstrated that the Asian population, body mass index (BMI) category, and diabetes affected the heterogeneity. In addition, subgroup analyses showed that heterogeneities were identified in Asian population and BMI category, which highly agree with the results of meta-regression.

CONCLUSIONS

The current meta-analysis suggested that R353Q polymorphism was not associated with the MI risk. Asian population, BMI category, and diabetes might be related to the incidence of MI. However, large-scale, case-control studies with rigorous designs are essential to provide accurate evidence.

Risk and protective factors for noncommunicable chronic diseases in adolescents by race/skin color: National Adolescent School-Based Health Survey

Introduction:

The race/skin color is an important predictor of health status of the population, as well as a marker of social inequalities.

Objective:

The aim of this paper was to describe the prevalence of the main risks and the protective factors for chronic diseases in schoolchildren, according to race/skin color differences.

Methods:

Data from the National Adolescent School-Based Health Survey (2012) were used. This is a cross-sectional study carried out in public and private schools. Prevalences were calculated according to the distribution by race/skin color. Prevalence ratios adjusted for age and maternal schooling were analyzed.

Results:

White adolescents were younger, studied more frequently in private schools and had mothers with higher levels of education in comparison to the other students. Consumption of beans and fruits was higher among black, brown, and indigenous participants. Physical activity was more frequent among indigenous people. Experimentation with alcohol was higher among white adolescents. Indigenous students reported greater physical violence. Asian and black adolescents reported experiencing greater bullying.

Conclusion:

Minimizing racial and ethnic disparities in health is necessary to disease prevention and health promotion among adolescents.

Association between race/skin color and premature birth: a systematic review with meta-analysis

OBJECTIVE

To analyze the association between race/skin color and the occurrence of prematurity.

METHODS

Meta-analysis with observational studies, selected by a systematic review in the bibliographic databases Medline and Biblioteca Virtual da Saúde with the descriptors: “Race or ethnic group” and “ethnicity and health” associated with the words “infant premature” and “obstetric labor premature”. Articles published in the period from 2010 to 2014, of the observational epidemiological type, in Portuguese, English and Spanish, were included. Articles that did not have abstracts or that were review articles, theses, dissertations, and editorials were excluded. We adopted the relative risk and their respective confidence intervals (95%CI) as measures of effect, obtained through the random effect model and represented by the forest plot type graph. The Egger test and the Newcastle-Ottawa scale, respectively, were used to analyze possible publication biases and the quality of the studies.

RESULTS

Of the 926 articles identified, 17 were eligible for the study. Of the 17 full texts published, seven were retrospective cohort studies, nine were cross-sectional studies, and one was a case-control study. Except for one study, the others reported a positive association between race/color of skin and prematurity. Compared with full-term newborns, the relative risk of the combined effect in those born preterm was 1.51 (95%CI 1.39-1.69). The funnel chart suggested publication bias.

CONCLUSIONS

The present meta-analysis indicated a positive association for the risk of prematurity according to race/skin color.

Differentials in risk factors for chronic non-communicable diseases from the race/color standpoint

This article aims to analyze the differences between the prevalence of risk factors of non-communicable chronic disease by race/color. It is a cross-sectional study using data from a telephone survey of 45,448 adults. Prevalence ratios for chronic disease risk factors by race/color were calculated. After adjustments were made for education and income, race/color differences persisted. Among afro-descendant and mulatto women and mulatto men a higher prevalence ratio was identified of physical activity at work and physical activity at home. Afro-descendant women and mulatto men indulged in less physical inactivity. Mulatto men and women showed a lower prevalence of smoking and consumption of 20 cigarettes daily and lower consumption of fruit and vegetables. A higher consumption of full-fat milk with and beans was observed among afro-descendant and mulatto men. Afro-descendant women had a lower prevalence of drinking and driving. Afro-descendant women and men ate more meat with fat and afro-descendant men suffered more from hypertension. Differences in risk factors by race/color can be explained by cultural aspects, by not fully adjustable socioeconomic differences that determine less access to goods and less opportunities for the afro-descendant population.

Moving toward holistic wellness, empowerment and self-determination for Indigenous peoples in Canada: Can traditional Indigenous health care practices increase ownership over health and health care decisions?

OBJECTIVES

This study aimed to understand the role that traditional Indigenous health care practices can play in increasing individual-level self-determination over health care and improving health outcomes for urban Indigenous peoples in Canada.

METHODS

This project took place in Vancouver, British Columbia and included the creation and delivery of holistic workshops to engage community members (n = 35) in learning about aspects of traditional health care practices. Short-term and intermediate outcomes were discussed through two gatherings involving focus groups and surveys. Data were transcribed, reviewed, thematically analyzed, and presented to the working group for validation.

RESULTS

When participants compared their experiences with traditional health care to western health care, they described barriers to care that they had experienced in accessing medical doctors (e.g., racism, mistrust), as well as the benefits of traditional healing (e.g., based on relationships, holistic approach). All participants also noted that they had increased ownership over their choices around, and access to, health care, inclusive of both western and traditional options. They stressed that increased access to traditional health care is crucial within urban settings.

CONCLUSIONS

Self-determination within Indigenous urban communities, and on a smaller scale, ownership for individuals, is a key determinant of health for Indigenous individuals and communities; this was made clear through the analysis of the research findings and is also supported within the literature. This research also demonstrates that access to traditional healing can enhance ownership for community members. These findings emphasize that there is a continued and growing need for support to aid urban Indigenous peoples in accessing traditional health care supports.

The operationalization of race and ethnicity concepts in medical classification systems: issues of validity and utility

This article looks at the operationalization of race and ethnicity concepts in medical classification systems, notably the main bibliographical databases of MEDLINE and EMBASE. In particular, an attempt is made to assess recent changes, including the impact of the 2004 major changes to the MeSH headings for race and ethnic groups, and the introduction of 'Continental Population Groups'. The underlying conceptual basis of the typologies, their relevance for capturing specific population groups, and their overall usefulness in appraising the literature on ethnic/racial disparities in health are examined. The bibliographical database thesauri reveal the pervasiveness of the notion of the biological basis of health differences by race/ethnicity as well as continuing use of antiquated racial terminology. Their system-oriented terminology is likely to limit the effectiveness of retrieval by users who may lack knowledge of their hierarchical structures.

Assessing Differences in Mortality Rates and Risk Factors Between Hispanic and Non-Hispanic Patients With Cystic Fibrosis in California

BACKGROUND

Over the past 30 years, therapeutic advances have extended the median lifespan of patients with cystic fibrosis (CF). Hispanic patients are a vulnerable subpopulation with a high prevalence of risk factors for worse health outcomes. The consequences of these differences on health outcomes have not been well described. The objective of this study was to characterize the difference in health outcomes, including mortality rate, between Hispanic and non-Hispanic patients with CF.

METHODS

This study is a retrospective analysis of CF Foundation Patient Registry data of California residents with CF, diagnosed during or after 1991, from 1991 to 2010. Ethnicity was self-reported. The primary outcome was mortality. Hazard ratios were estimated from a Cox regression model, stratified by sex, and adjusted for socioeconomic status, clinical risk factors, and year of diagnosis.

RESULTS

Of 1,719 patients, 485 (28.2%) self-identified as Hispanic. Eighty-five deaths occurred, with an overall mortality rate of 4.9%. The unadjusted mortality rate was higher among Hispanic patients than among non-Hispanic patients (9.1% vs 3.3%, P < .0001). Compared with non-Hispanic patients, Hispanic patients had a lower survival rate 18 years after diagnosis (75.9% vs 91.5%, P < .0001). Adjusted for socioeconomic status and clinical risk factors, Hispanic patients had an increased rate of death compared with non-Hispanic patients (hazard ratio, 2.81; 95% CI, 1.70-4.63).

CONCLUSIONS

Hispanic patients with CF have a higher mortality rate than do non-Hispanic patients, even after adjusting for socioeconomic status and clinical severity. Further investigation into the mechanism for the measured difference in lung function will help inform interventions and improve the health of all patients with CF.

Racial disparities in outcomes after cardiac surgery: the role of hospital quality

Patients from racial and ethnic minorities experience higher mortality after cardiac surgery compared to white patients, both during the early postoperative phase as well as long term. A number of factors likely explain poor outcomes in black and minority patients, which include differences in biology, comorbid health conditions, socioeconomic background, and quality of hospital care. Recent evidence suggests that a major factor underlying excess mortality in these groups is due to their over-representation in low-quality hospitals, where all patients regardless of race have worse outcomes. In this review, we examine the factors underlying racial disparities in outcomes after cardiac surgery, with a primary focus on the role of hospital quality.

Exploring the cancer risk perception and interest in genetic services among Indigenous people in Queensland, Australia

OBJECTIVE

The purpose of this study is to explore the levels of interest among Indigenous people with cancer in identifying cancer risk in their family and seeking genetic counselling/testing.

DESIGN AND SETTING

A cross-sectional survey of Indigenous cancer patients recruited from four major treating hospitals in Queensland. Participants' family history of cancer and interest in genetic counselling/testing was sought using a structured questionnaire.

RESULTS

Overall, 73.0% of 252 participants reported having a family history of cancer; of those, 52.8% had at least one first-degree relative with cancer. A total of 68.3% of participants indicated concern about relatives being affected by cancer and 54.4% of participants indicated they would like to assess the cancer risk in their family with a specialist. Concern was associated with willingness to discuss the risk of cancer with a specialist (p<0.001).

CONCLUSIONS

Indigenous cancer patients do have a family history of cancer and appear willing to undergo genetic counselling/investigation. It is of great concern that this population could miss the benefits of the technological advances in health care, creating a much larger disparity in health outcomes.

IMPLICATIONS

Health service providers should not assume that Indigenous cancer patients will not follow their recommendations when referred to genetic counselling/investigation services.

Correspondence between overweight and socioeconomic and demographic indicators in the adult Brazilian population

OBJECTIVE: To verify the correlation between overweight and socioeconomic and demographic indicators among Brazilian adults, using data from the Brazilian Household Budget Survey from 2008/2009. METHODS: We analyzed the joint relationships between overweight and socioeconomic and demographic indicators in the Brazilian adult population (99,532,672 individuals), through the multiple correspondence analysis technique. RESULTS: The featured profile of the Brazilian adult population with regard to overweight was correlated with ages from 30 years of the most developed and economically social geographic regions of Brazil; however between genders, the correlation was in the opposite direction in the variables income, education, and subjective issues about life conditions related to food and nutrition security. CONCLUSION: By the joint relationship between overweight and selected demographic and socioeconomic indicators, the urgency of the development of strategies and/or preventive public health programs of health problems with overweight in the Brazilian adult population is suggested.

The contribution of biogeographical ancestry and socioeconomic status to racial/ethnic disparities in type 2 diabetes mellitus: results from the Boston Area Community Health Survey

PURPOSE

Racial/ethnic disparities in the incidence of type 2 diabetes mellitus (T2DM) are well documented, and many researchers have proposed that biogeographical ancestry (BGA) may play a role in these disparities. However, studies examining the role of BGA on T2DM have produced mixed results to date. Therefore, the objective of this research was to quantify the contribution of BGA to racial/ethnic disparities in T2DM incidence controlling for the mediating influences of socioeconomic factors.

METHODS

We analyzed data from the Boston Area Community Health Survey, a prospective cohort with approximately equal numbers of black, Hispanic, and white participants. We used 63 ancestry-informative markers to calculate the percentages of participants with West African and Native American ancestry. We used logistic regression with G-computation to analyze the contribution of BGA and socioeconomic factors to racial/ethnic disparities in T2DM incidence.

RESULTS

We found that socioeconomic factors accounted for 44.7% of the total effect of T2DM attributed to black race and 54.9% of the effect attributed to Hispanic ethnicity. We found that BGA had almost no direct association with T2DM and was almost entirely mediated by self-identified race/ethnicity and socioeconomic factors.

CONCLUSIONS

It is likely that nongenetic factors, specifically socioeconomic factors, account for much of the reported racial/ethnic disparities in T2DM incidence.

Jewish mortality reconsidered

It is known that mortality of Jews is different from the mortality of the populations that surround them. However, the existence of commonalities in mortality of different Jewish communities across the world has not received scholarly attention. This paper aims to identify common features of the evolution of Jewish mortality among Jews living in Israel and the Diaspora. In the paper the mortality of Jews in Israel is systematically compared with the mortality of the populations of developed countries, and the findings from the earlier studies of mortality of Jews in selected Diaspora communities are re-examined. The outcome is a re-formulation and extension of the notion of the 'Jewish pattern of mortality'. The account of this pattern is based on the consistently low level of behaviourally induced mortality, the migration history of Jewish populations and the enduring influence of early-life conditions on mortality at older ages.

Genomics in primary care practice

This article discusses the clinical utility of genomic information for personalized preventive care of a healthy adult. Family health history is currently the most applicable genomic predictor for common, multifactorial diseases, and can also show patterns that suggest an inherited high susceptibility to a particular form of cancer or other disease. Both bloodline ancestry and shared environmental factors are important predictors for many disease states. DNA and family history analyses give information that is probabilistic, not deterministic. Therefore, family history can highlight behavioral, social, or cultural risk factors that can be modified to prevent diseases.

Racial disparities in left main stenting: insights from a real world inner city population

BACKGROUND

Left main coronary artery (LMCA) disease is associated with significant cardiovascular mortality. The data on patient characteristics' predicting outcomes after LMCA revascularization is sparse.

METHODS

A retrospective study of 227 patients with LMCA disease documented on coronary angiography from March 2000 to December 2008. Data included demographic variables, co-morbidities, cardiac function, and medications. Race was self-identified. The study outcome was a composite end-point including myocardial infarction (MI) and all-cause mortality. Cox proportional hazard analysis was performed to study the effect of various patient attributes including race and gender on the composite end-point.

RESULTS

Baseline characteristics were specifically compared between individuals who had the study outcome versus those who did not. Mean age was higher in the group with study outcomes when compared to the group without any outcomes (64.3 ± 11.8 years versus 59.2 ± 13.6 years; p = 0.013). After the final multivariate regression analysis, only African American (AA) race and age were found to be independent predictors of adverse cardiac outcome at the end of the first year (race-hazard ratio (HR) 3.82, 95% confidence interval (CI) 1.38-10.62, p = 0.010; age-HR 1.08, 95% CI 1.04-1.13, p < 0.001) and at the end of the study (race-HR 2.71, 95% CI 1.44-5.10, p = 0.002; age-HR 1.03, 95% CI 1.01-1.08, p = 0.017).

CONCLUSION

In our study of patients with unprotected LMCA disease, AA race, and age were significantly predictive of poor prognosis following revascularization, while gender had no predictive value in prognosticating cardiovascular mortality.

A narrative literature review of the development of obesity in infancy and childhood

This narrative review explains the development of excess weight gain in babies and children. It takes a life course approach which includes genetics, pre-conception, pregnancy, infancy and childhood. The paper focuses on feeding behaviours, physical activity, parental influences and the wider social and environmental context. Risk factors which can cumulatively lead to excess childhood weight gain include: under- or overweight during pregnancy; the presence of diabetes during pregnancy; low or high birth weight; having obese parents; early weaning; prolonged formula feeding; rapid weight gain in the first year; disinhibited eating patterns and the consistent availability of energy dense food at home; feeding practices which are not responsive to the child's cues; insufficient sleep among preschool children; sedentary parents; low parental education; living in poor socio-economic circumstances; absence, or perceived absence, of safe play areas; parents who lack time or confidence to authoritatively parent; environments where there is poor access to affordable lower energy dense foods; and parents who do not accept that excess weight is a health problem. Recommendations for health professionals are made.

Genetic research and aboriginal and Torres Strait Islander Australians

While human genetic research promises to deliver a range of health benefits to the population, genetic research that takes place in Indigenous communities has proven controversial. Indigenous peoples have raised concerns, including a lack of benefit to their communities, a diversion of attention and resources from non-genetic causes of health disparities and racism in health care, a reinforcement of "victim-blaming" approaches to health inequalities, and possible misuse of blood and tissue samples. Drawing on the international literature, this article reviews the ethical issues relevant to genetic research in Indigenous populations and considers how some of these have been negotiated in a genomic research project currently under way in a remote Aboriginal community. We consider how the different levels of Indigenous research governance operating in Australia impacted on the research project and discuss whether specific guidelines for the conduct of genetic research in Aboriginal and Torres Strait Islander communities are warranted.

Exercise intervention in New Zealand Polynesian peoples with type 2 diabetes: Cultural considerations and clinical trial recommendations

The Maori and Pacific Islands peoples of New Zealand suffer a greater burden of type 2 diabetes mellitus (T2DM) and associated comorbidities than their European counterparts. Empirical evidence supports the clinical application of aerobic and resistance training for effective diabetes management and potential remission, but few studies have investigated the effectiveness of these interventions in specific ethnic cohorts. We recently conducted the first trial to investigate the effect of prescribed exercise training in Polynesian people with T2DM. This article presents the cultural considerations undertaken to successfully implement the study. The research procedures were accepted and approved by cultural liaisons and potential participants. The approved methodology involved a trial evaluating and comparing the effects of two, 16-week exercise regimens (i.e. aerobic training and resistance training) on glycosylated haemoglobin (HbA1c), related diabetes markers (i.e. insulin resistance, blood lipids, relevant cytokines and anthropometric and hemodynamic indices) and health-related quality of life. Future exercise-related research or implementation strategies in this cohort should focus on cultural awareness and techniques to enhance participation and compliance. Our approach to cultural consultation could be considered by researchers undertaking trials in this and other ethnic populations suffering an extreme burden of T2DM, including indigenous Australians and Americans.

Concepts of race and ethnicity among health researchers: patterns and implications

OBJECTIVES

This study adds to the discussion of appropriate categories of analysis in health research. We contribute data based on actual interviews about the concepts of race and ethnicity, conducted among a broad range of US health researchers.

DESIGN

In-person qualitative interviews were conducted with 73 scientists at two health research institutions, one that focused on public health research, and one that focused on research about a specific disease. This represents a larger and more interdisciplinary sample of health researchers than has been previously interviewed about these topics.

RESULTS

We identify a core model of how race and ethnicity are understood. The respondents were confused about the concepts of race and ethnicity and their link to genetic differences between populations; many treated these concepts as interchangeable and genetically based. Although ethnicity was considered somewhat more socially constructed, it was often felt to cause unhealthy behavior. In addition, the situation is not improving; the younger health researchers tended to put a stronger emphasis on the genetic aspects of race than did the older health researchers.

CONCLUSION

Unlike reviews of how these concepts are used in scientific publications in which race and ethnicity are often undefined, our face-to-face interviews with these researchers allowed an understanding of their concepts of race and ethnicity. Building on their actual perspectives, these data suggest alternative approaches to formal and continuing educational training for health researchers. We recommend beginning with discussions of human diversity, and then moving on to what race and ethnicity are - and are not.

Demographic differences in stage at diagnosis and cervical cancer survival in New Zealand, 1994-2005

OBJECTIVE

To investigate ethnic, socioeconomic, and urban/rural differences in stage at diagnosis and cervical cancer survival in New Zealand.

METHODS

The study involved 1594 cervical cancer cases registered during 1994-2005. Cox regression was used to estimate adjusted cervical cancer mortality hazard ratios (HRs).

RESULTS

Māori and Pacific women had higher death rates than Other (predominantly European) women, with age and year of diagnosis adjusted HRs of 2.15 (95% CI 1.68-2.75) and 1.98 (95% CI 1.25-3.13), respectively, whereas Asian women had a lower (nonstatistically significant) risk (0.81, 95% CI 0.47-1.42). Adjustment for stage reduced the HR in Māori to 1.62 (95% CI 1.25-2.09), but there was little change for Pacific or Asian women. These patterns varied over time: for cases diagnosed during 1994-1997, the HR for Māori women was 2.34 (95% CI 1.68-3.27), which reduced to 1.83 (95% CI 1.29-2.60) when adjusted for stage; for cases diagnosed during 2002-2005, the corresponding estimates were 1.54 (95% CI 0.75-3.13) and 0.90 (95% CI 0.43-1.89). Socioeconomic status and urban/rural residence had only marginal effects.

CONCLUSIONS

There were major ethnic differences in cervical cancer survival in New Zealand that were only partly explained by stage at diagnosis. These patterns varied over time, with postdiagnostic factors playing an important role in the high Māori mortality rates in the 1990s, but in more recent years, the excess mortality in Māori women appeared to be almost entirely due to stage at diagnosis, indicating that ethnic differences in access to and uptake of screening and treatment of premalignant lesions may have been playing a major role.

Risk factors for community-acquired pneumonia in pre-school-aged children

AIM

To identify risk factors for children developing and being hospitalised with community-acquired pneumonia.

METHODS

Children <5 years old residing in urban Auckland, New Zealand were enrolled from 2002 to 2004. To assess the risk of developing pneumonia, children hospitalised with pneumonia (n= 289) plus children with pneumonia discharged from the Emergency Department (n= 139) were compared with a random community sample of children without pneumonia (n= 351). To assess risk of hospitalisation, children hospitalised with pneumonia were compared with the children discharged from the Emergency Department. Adjusted odds ratio (OR) with 95% confidence intervals (CIs) were used to estimate the risk of pneumonia and hospitalisation with pneumonia.

RESULTS

After adjustment for season, age and ethnicity there was an increased risk of pneumonia associated with lower weight for height (OR 1.28, 95% CI 1.10-1.51), spending less time outside (1.96, 1.11-3.47), previous chest infections (2.31, 1.55-3.43) and mould in the child's bedroom (1.93, 1.24-3.02). There was an increased risk of pneumonia hospitalisation associated with maternal history of pneumonia (4.03, 1.25-16.18), living in a more crowded household (2.87, 1.33-6.41) and one with cigarette smokers (1.99, 1.05-3.81), and mould in the child's bedroom (2.39, 1.25-4.72).

CONCLUSIONS

Lower quality living environments increase the risk of pneumonia and hospitalisation with pneumonia in New Zealand. Poorer nutritional status may also increase the risk of pneumonia. Improving housing quality, decreased cigarette smoke exposure and early childhood nutrition may reduce pneumonia disease burden in New Zealand.

Physical function mitigates the adverse effects of being thin on mortality in a free-living older Taiwanese cohort

OBJECTIVES

To examine the significance of underweight and physical function as well as their interaction on mortality in the aged.

DESIGN

Prospective cohort.

SETTING

The Elderly Nutrition and Health Survey in Taiwan during 1999-2000.

PARTICIPANTS

Total of 1435 representative free-living elders (739 men and 696 women).

MEASUREMENTS

Body composition was assessed by various anthropometrics. Physical function score (PF, ranged 0-100) was derived from the SF-36(®). Death by December 31, 2006 was the outcome measure.

RESULTS

After 7.9 (median: 7.0) years follow-up, 381 (223 men, 158 women) of 1435 eligible participants had died. Those with the lowest PF (<45) had 3.43 (hazards ratio (HR), 95% confidence interval (CI) = 2.20-5.36) times the all-cause mortality risk of the highest PF (≥58). Interactions for PF and BMI (P =0.02) and for PF and wrist circumference (P =0.09) on death were found after controlling for potential confounders. Jointly, compared to normal-BMI-highest-PF, the greatest HR for death occurred where BMI <18.5 kg/m2 was combined with the lowest-PF after covariate adjustments (HR = 8.67, 95% CI = 3.77-20.0). Similarly, the lowest arm muscle circumference (MAMC)-PF had a HR of 5.22 compared to mid-MAMC-highest-PF. However, percent and absolute body fat, estimated by bioelectrical impedance, was comparable to non-sarcopenic individuals.

CONCLUSION

Thin elderly Taiwanese with sarcopenia, and less skeleton, are at the most risk of death, especially if physical function is limited.

A simple food quality index predicts mortality in elderly Taiwanese

OBJECTIVES

To assess the relative predictive ability for mortality of the Overall Dietary Index-Revised (ODI-R) and the Dietary Diversity Score (DDS) among representative Taiwanese aged 65 and older.

DESIGN

Prospective cohort.

SETTING

The Elderly Nutrition and Health Survey in Taiwan during 1999-2000.

PARTICIPANTS

One thousand seven hundred forty three (860 men and 883 women).

MEASUREMENTS

Dietary quality measures, the ODI-R (0-100) and DDS (0-6) were based on 24-hour dietary recall and a food frequency questionnaire at baseline. Death by National Death Registry up to 2008 was the outcome measure.

RESULTS

During follow-up, 624 subjects died. The survivors had both significantly higher (P <0.001) ODI-R (66.9 vs. 63.6) and DDS (4.69 vs. 4.30) than the deceased. The two indices were correlated (r=0.46). After adjustment for potential covariates, the hazard ratios (HR) (95% CI) were 0.63 (0.42-0.97), 0.71 (0.49-1.04) and 0.53 (0.37-0.76) for those whose ODI-R scores were 60-65, 65-70, >70, respectively, compared to those whose ODI-R scores were > 50 (P for trend <0.001). For DDS, the multi-variable HRs (95% CI) were 0.74 (0.55-1.00), 0.52 (0.38-0.72) and 0.50 (0.31-0.81) for those whose DDS were 4, 5, 6, respectively, compared to those whose DDS were ≤3 (P for trend<0.001). Total cancer, diabetes mortalities and pneumonia were similarly benefited according to trends.

CONCLUSION

ODI-R ≥ 60, and DDS ≥ 4 are predictors of all-cause and cause-specific mortalities. Of the two, DDS is the more predictive. Nutrition policy could be informed and clinical practice enhanced by these population relevant food-health relationships.

Self-reported pregnancy and access to primary health care among sexually experienced New Zealand high school students

PURPOSE

To determine the prevalence of self-reported pregnancy among sexually experienced high school students, and the association between teenage pregnancy and access to primary health care.

METHODS

Between March and October 2007, 96 high schools throughout New Zealand participated in Youth'07, a cross-sectional Health and Wellbeing survey. The dataset included 2,620 (1,217 females and 1,403 males) year 9 through 13 students who reported ever having sexual intercourse and responded to a question about whether they had ever been pregnant or ever caused a pregnancy.

RESULTS

Nationwide, 10.6% of sexually experienced high school students self-reported that they had been pregnant (11.6%) or caused a pregnancy (9.9%). Māori (15.3%) and Pacific Island (14.1%) students had the highest self-reports of pregnancy. Foregone health care was reported by 24.2% of sexually experienced students. Students who self-reported pregnancy reported greater difficulty accessing health care (41.7% vs. 20.6%; odds ratio: 2.6); however, when they accessed care, the majority received confidential care (67.4%) as compared with pregnancy-inexperienced peers (51.6%). Concern about privacy was the most common reason for not accessing health care. Other barriers included uncertainty about how to access care and lack of transportation (all p values < .05).

CONCLUSIONS

Self-reported pregnancy among sexually active high school students in New Zealand is high and ethnic disparities exist. Being pregnant or causing a pregnancy is associated with difficulty accessing health care. Further research is needed to identify drivers for ethnic differences and determine what the cause-and-effect relationship between teenage pregnancy and access to health care looks like.

TRAF1/C5, eNOS, C1q, but not STAT4 and PTPN22 gene polymorphisms are associated with genetic susceptibility to systemic lupus erythematosus in Turkey

A significant source of variability in the literature on systemic lupus erythematosus (SLE) susceptibility genes has been the inability to replicate genetic findings across different racial or ethnic groups. We investigated whether a single nucleotide polymorphism (SNP) of the STAT4 (rs7574865), PTPN22 (rs2476601), TRAF1/C5 (rs10818488), and C1q (rs292001) genes as well as the 27-bp VNTR polymorphism on intron 4 of eNOS, previously associated with SLE in other populations, are also associated with SLE risk in Turkey. A group of 158 SLE patients and 155 healthy controls were included in this study. A genetic association of the TRAF1/C5, C1q, and eNOS gene polymorphism, but not of STAT4 and PTPN22, was found to confer a degree of risk for SLE. These data highlight the importance of comparative studies in different populations to confirm the previously detected genetic associations.

Poorer outcome in Polynesian patients with prostate cancer treated with definitive conformational radiation therapy

PURPOSE

To compare freedom from biochemical failure (FFBF) of French Polynesian (FP) and Native European (NE) prostate cancer patients after definitive conformal radiotherapy (RT).

PATIENTS AND METHODS

Data were reviewed from medical records of 152 consecutive patients (46 FP and 106 NE) with clinically localised prostate cancer treated with definitive RT. Neoadjuvant androgen deprivation therapy (ADT) was used in 22% of cases. Definition for biochemical failure was a rise by 2 ng/mL or more above the nadir prostate-specific antigen (PSA) level. The median follow-up was 34 months.

RESULTS

In comparison to NE patients, FP patients were younger (p=0.002) with a higher low-risk proportion (p=0.06). Probability of 5-year FFBF was 77% in the NE cohort and 58.0% in the FP cohort (p=0.017). Univariate analysis showed that FP ethnicity was associated with worse prognosis in high-risk tumours (p=0.004). Cox multivariate analysis showed that factors associated with FFBF were risk category (p<0.017), and FP origin (p=0.03), independently of ADT and radiation dose.

CONCLUSION

FP ethnicity was an independent prognostic factor for biochemical relapse after definitive conformal RT for prostate cancer.

Spatial distribution of mortality by homicide and social inequalities according to race/skin color in an intra-urban Brazilian space

INTRODUCTION

In Brazil, deaths by external causes rank first in the mortality statistics. Nevertheless, studies which investigate the relationship between mortality by external causes and race/skin color are scarce.

OBJECTIVES

To evaluate the relative contribution of race/skin color to the spatial distribution of mortality by homicide in Salvador, state of Bahia, Brazil, in the period 1998 - 2003.

MATERIAL AND METHODS

This is a spatial aggregate study including secondary data on 5,250 subjects, using a unit of analysis called the "weighting area" (WA). Annual average death rates by homicide were estimated. The Global and Local Moran Index were used to evaluate the presence of spatial autocorrelation and the Conditional Auto Regressive (CAR) model was employed to evaluate the referred effect, using the R statistical package.

RESULTS

Global and Local Moran's I tests were significant. CAR regression showed that the predicted mortality rate increases when there is a growth in the proportion of black males aged between 15 and 49 years. Geometrically weighted regression (GWR) showed a very small variation of the local coefficients for all predictors.

CONCLUSION

We demonstrated that the interrelation between race, violence and space is a phenomenon which results from a long process of social inequality. Understanding these interactions requires interdisciplinary efforts that contribute to advancement of knowledge that leads to more specific Public Health interventions.

Does racism affect health? Evidence from the United States and the United Kingdom

Blacks have worse overall health than whites in both the United States and the United Kingdom. However, the relative difference in health between the two groups within each cultural context differs between each context. In this article, we attempt to glean insights into these health disparities. We do so by first examining what is currently known about differences in morbidity and mortality for blacks and whites in the United States and the United Kingdom. We then turn to medical examination data by race and country of birth in an attempt to further untangle the complex interplay of socioeconomic status (SES), race, and racism as determinants of health in the United States and the United Kingdom. We find that (1) longer exposure of blacks to the recipient country is a risk for mortality in the United States but not in the United Kingdom; (2) adjustment for SES matters a good deal for mortality in the United States, but less so in the United Kingdom; (3) morbidity indicators do not paint a clear picture of black disadvantage relative to whites in either context; and (4) were one to consider medical examination data alone, differences between the two groups exist only in the United States. Taken together, we conclude that it is possible that the "less racist" United Kingdom provides a healthier environment for blacks than the United States. However, there remain many mysteries that escape simple explanation. Our findings raise more questions than they answer, and the health risks and health status of blacks in the United States are much more complex than previously thought.

Disparities by ethnicity, language, and immigrant status in occupational health experiences among Las Vegas hotel room cleaners

OBJECTIVE

We examined disparities in workers' occupational health experiences.

METHODS

We surveyed 941 unionized Las Vegas hotel room cleaners about their experiences with work-related pain and with employers, physicians, and workers' compensation. Data were analyzed for all workers and by ethnicity, language, and immigrant status.

RESULTS

Hispanic and English as second language (ESL) workers were more likely than their counterparts to report work-related pain and, along with immigrant workers, to miss work because of this pain. Hispanic, ESL, and immigrant workers were not consistently at a disadvantage with regard to their own responses to work-related pain but were so with respect to reported responses by workers' compensation, physicians, and employers.

CONCLUSIONS

There are indications of disparities in occupational health experiences within this job title. The use of different group classifications, while implying different mechanisms, produced similar results.

Arterial hypertension in the elderly of Bridgetown, Barbados: prevalence and associated factors

OBJECTIVE

To determine the prevalence of and investigate factors associated with hypertension among elderly Barbadians.

METHOD

This was a cross-sectional, population-based household survey. A total of 1,508 persons aged 60 and older were examined. The occurrence of hypertension was assessed by the following question: "Do you take any medication for high blood pressure?"

RESULTS

The prevalence of hypertension was 29.9% in men and 45.9% in women. Multivariable analysis (the hierarchical model) showed that alcohol consumption, arthritis, heart attack, and self-reported health presented, in women, an association with hypertension (p < .05). Obesity and diabetes were associated with hypertension in both genders.

DISCUSSION

Sociodemographic variables, sedentary lifestyles, and smoking did not have a noticeable role in the chosen model for the determination of hypertension. Obesity was an especially noteworthy risk factor due to its high prevalence as well as the possibility of the latter being altered through intervention.