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Racial gaps in cancer survival - Asking the wrong questions?

JOURNAL OF THE NATIONAL CANCER INSTITUTE 1999年第22期91卷 1912-1913页

作者： Kuska, B

Discusses the issue on increasing racial disparities in cancer survival in the United States. Views of Otis Brawley, head of the National Cancer Institute's Office of Special Populations Research on the issue; Criticisms in healthcare delivery; Assumption on the biological difference between Afro-Americans and white Americans.

关键词：非洲裔美国人/统计学和数值数据欧洲大陆世系人群/统计学和数值数据卫生服务易得程度国立卫生研究院(美国) 肿瘤/死亡率社会经济因素存活率美国/流行病学人类

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Description of a mixed ethnic, elderly population. I. Demography, nutrient energy intakes, and income status

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JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES 1999年第6期54卷 M315-M324页

作者： Prothro, JW Rosenbloom, CA Georgia State Univ Dept Nutr Atlanta GA 30303 USA

Background. Elderly participants in the Title m-C Nutrition Program, 60-103 years of age, were assessed for nutrient/energy intakes, relationship of income status to intakes, and comparison with data from the National Evaluation of the Elderly Nutrition Program (ENP). Method. Nonrandomized volunteers were interviewed in senior centers or in their homes. Chi-square, t test, and ANOVA were used to test for differences in dietary intakes with regard to ethnicity, gender, age, type of meal (congregate dining or home delivered), socialization factor (lived alone or with others), and income status. A new method of looking at diet quality, which conjoins nutrients and energy, was developed for this study. Results. Six percent of the sample had adequate energy and nutrient intakes over a 3-day period;53% were rated tenuous or marginal, and 41% submarginal or inadequate. The Title m-C noon meal provided 38%-44% of the average daily energy intake and 33%-65% of the average intake of selected nutrients. Diets of men were better than those of women (p <.05). Calcium (p < .01) and potassium (p <.05) were higher in diets of female elders above the poverty line than those below. Black women were most affected by poverty, with 92% below the poverty line. A trend was observed for higher intakes of fatty components (total fat, cholesterol, % fat calories) for both men and women in the below-poverty than in above-poverty groups. DeKalb Community Council on Aging subjects had higher intakes of Vitamin A than those in the ENP, but overall most nutrients were higher in both congregate and home delivery clients of ENP. Conclusions. Title III-C Nutrition Programs have been implemented since 1973, and nutrition education is an obligatory component The high incidence of nutrient/energy inadequacy in this study was surprising, but consistent with previous reports. New ways of implementing better food intakes of senior citizens are needed. In addition, research is needed to establish differenc

关键词：非洲裔美国人/统计学和数值数据老年人膳食进食能量摄取欧洲大陆世系人群/统计学和数值数据食品服务老人疗养院收入营养调查营养需要社会经济因素老年人 80以上女(雌)性人类男(雄)性

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Prostate cancer biochemical recurrence stage for stage is more frequent among African-American than white men with locally advanced but not organ-confined disease

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UROLOGY 2000年第2期55卷 246-251页

作者： Powell, IJ Banerjee, M Novallo, M Sakr, W Grignon, D Wood, DP Pontes, JE Wayne State Univ Harper Hosp Dept Urol Detroit MI USA Wayne State Univ Harper Hosp Dept Pathol Detroit MI USA

Objectives. To determine whether outcome differences between African-American men (AAM) and white men with prostate cancer (PCa) will still be present if we control for stage in a large cohort of men. It is well established that AAM have a worse outcome from PCa than white men. Methods. We examined 848 consecutive patients who underwent radical prostatectomy at Wayne State University, Karmanos Cancer Institute, between 1991 and 1995. The mean follow-up was 34 months (range 1.5 to 75). We included men with Gleason score 7 (4 + 3) with those men with Gleason score 8 to 10 for racial/ethnic comparisons. Results. AAM and white men diagnosed with organ-confined PCa demonstrated similar prostate-specific antigen (PSA) levels, Gleason grade, and biochemical recurrence. However, AAM diagnosed with non-organ-confined disease demonstrated higher PSA levels and a higher incidence of recurrence than did white men with non-organ-confined disease. There was a trend toward AAM having a greater proportion of high-grade lesions than white men when PCa was not organ confined. The evidence suggests that the difference in recurrence among AAM versus white men is based on pretreatment PSA, grade, extracapsular extension, and positive surgical margins. Seminal vesicle invasion predicted a worse prognosis equally for both AAM and white men. Conclusions. A difference in biochemical recurrence was not detected between AAM and white men with organ-confined PCa after radical prostatectomy. PSA was higher in AAM than in white men with pathologically locally advanced PCa, and the biochemical recurrence was greater, AAM had a greater percentage of high Gleason grade lesions compared with white men, and this difference approached statistical significance. We hypothesize that AAM have a more rapid growth rate of PCa, which may be responsible for these clinical findings. Further investigations of the biology of PCa are needed to understand these findings. (C) 2000, Elsevier Science Inc.

关键词：非洲裔美国人/统计学和数值数据卡方分布队列研究无病生存欧洲大陆世系人群/统计学和数值数据随访研究肿瘤侵润肿瘤复发局部/血液肿瘤分期预后比例危险度模型前列腺特异抗原/血液前列腺切除术前列腺肿瘤/血液前列腺肿瘤/人种学前列腺肿瘤/病理学前列腺肿瘤/外科学人类男(雄)性

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Description of a mixed ethnic, elderly population. II. Food group behavior and related nonfood characteristics

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JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES 1999年第6期54卷 M325-M328页

作者： Prothro, JW Rosenbloom, CA Georgia State Univ Dept Nutr Atlanta GA 30303 USA

Background Elderly persons 60-103 years of age, who were participants in a Title III-C Nutrition Program, provided information regarding weekly frequencies of food group consumption, weekend meals and snack patterns, and several nonfood items that may affect food intakes. Methods. Nonrandomized volunteers were interviewed in senior centers or in their homes. Chi-square, t test, and Pearson's product moment correlations were used to assess differences in the population sample with regard to six independent variables: ethnicity, gender, type meal (congregate or home delivered), age, proportion of noon meal usually eaten, and socialization fac tor (lived alone or with others). Results. White subjects ate more fruits, dairy products, and weekend snacks than black subjects. White elders also consumed more caffeine, had larger incomes, and more often had sufficient money to buy food. Black subjects ate more pasta and desserts, and in sickness more often had help available. Men consumed more meats, dairy products, eggs, and starchy foods than women. There were no gender differences in income, but men ate more weekend meals in restaurants, spent more money weekly for food, more often were able to shop for food and leave home without assistance, and reported greater pleasure associated with eating. Home delivery clients ate more desserts and Sunday snacks and more frequently ate breakfast on the weekend than congregate clients. Congregate clients had more money to buy food, were better able to shop for and prepare food and more frequently had help available in sickness. Young-old (<75 yr) and old-old (greater than or equal to 75 yr) clients showed no difference in consumption of any of the food groups. Persons who usually ate all or most of the noon meal more frequently experienced preasurability in eating, reported less anorexia, and had larger intakes of the vegetable and pasta groups. Persons living with others ate more meats, pasta, and desserts, spent more weekly for fo

关键词：非洲裔美国人/统计学和数值数据老年人膳食/统计学和数值数据进食欧洲大陆世系人群/统计学和数值数据偏食食品服务营养调查社会经济因素美国老年人 80以上女(雌)性人类男(雄)性

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A multiethnic study of the predictors of macrosomia

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DIABETES EDUCATOR 1999年第6期25卷 925-933页

作者： Hardy, DS [o_1]13511 Country Green Court Houston TX77059.

PURPOSE This study examined predictors of macrosomia in a multiethnic sample of 213 low-income women diagnosed with gestational diabetes mellitus (GDM) after week 24 of their pregnancy. METHODS Medical records were reviewed retrospectively. Variables examined were mother's height, weight history, educational level, age at diagnosis, weeks at diagnosis and delivery, type of diabetes, mean fasting blood glucose (FBC), and infant's weight, sex, and Apgar scores. RESULTS Fifty-one percent of babies were macrosomic. Weight gain, nonpregnant weight, weight at delivery, FBG, and Apgar scores at 1 minute were associated with macrosomia, especially in Hispanic women. Logistic regression revealed that nonpregnant weight was the strongest predictor of macrosomia. CONCLUSIONS Nonobese GDM mothers with optimal weight gain but with high FBG levels >90 mg/dL may be at risk for macrosomia. The major concerns with obese GDM mothers are nonpregnant weight and high blood glucose levels, in this order. Education for women with GDM should target these risk factors to decrease macrosomia.

关键词：非洲裔美国人/统计学和数值数据糖尿病妊娠/血液糖尿病妊娠/并发症糖尿病妊娠/人种学教育程度欧洲大陆世系人群/统计学和数值数据巨大胎儿/人种学西班牙裔美国人/统计学和数值数据生活方式 Logistic模型贫困/统计学和数值数据试验预期值回顾性研究危险因素得克萨斯女(雌)性人类妊娠

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Race and differences in breast cancer survival in a managed care population

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JOURNAL OF THE NATIONAL CANCER INSTITUTE 1999年第17期91卷 1487-1491页

作者： Yood, MU Johnson, CC Blount, A Abrams, J Wolman, E McCarthy, BD Raju, U Nathanson, DS Worsham, M Wolman, SR Henry Ford Hlth Sci Ctr Josephine Ford Canc Ctr Detroit MI 48202 USA Henry Ford Hlth Sci Ctr Ctr Clin Effectiveness Detroit MI USA Bristol Myers Squibb Wallingford CT USA Henry Ford Hlth Sci Ctr Dept Biostat & Res Epidemiol Detroit MI 48202 USA Henry Ford Hlth Sci Ctr Dept Pathol Detroit MI 48202 USA Henry Ford Hlth Sci Ctr Dept Surg Detroit MI 48202 USA George Mason Univ Dept Syst Engn & Operat Res Fairfax VA 22030 USA Uniformed Serv Univ Hlth Sci Dept Pathol Bethesda MD 20814 USA

Background African-American women with breast cancer have poorer survival than European-American women. After adjustment for socioeconomic variables, survival differences diminish but do not disappear, possibly because of residual differences in health care access, biology, or behavior. This study compared breast cancer survival in African-American and European-American women with similar health care access. Methods: We measured survival in women with breast cancer who are served by a large medical group and a metropolitan Detroit health maintenance organization where screening, diagnosis, treatment, and follow-up are based on standard practices and mammography is a covered benefit. We abstracted data on African-American and European-American women who had been diagnosed with breast cancer from January 1986 through Apl il 1996 (n = 886) and followed these women for survival through April 1997 (137 deaths). Results: African-American women were diagnosed at a later stage than were European-American women, Median follow-up was 50 months. Five-year survival was 77% for African-American and 84% for European-American women, The crude hazard ratio for African-American women relative to European-American women was 1.6 (95 % confidence interval [CI] = 1.1-2.2), Adjusting only for stage, the hazard ratio was 1.3 (95% CI = 0.9-1.9). Adjusting only for sociodemographic factors (age, marital status, and income), the hazard ratio was 1.2 (95% CI = 0.8-1.9). After adjusting for age, marital status, income, and stage, the hazard ratio was 1.0 (95 % CI = 0.7-1.5), Conclusion: Among women with similar medical care access since before their diagnoses, we found ethnic differences in stage of breast cancer at diagnosis, Adjustment for this difference and for income, age, and marital status resulted in a negligible effect of race on survival.

关键词：非洲裔美国人/统计学和数值数据年龄因素乳腺肿瘤/诊断乳腺肿瘤/人种学乳腺肿瘤/死亡率欧洲大陆世系人群/统计学和数值数据卫生服务易得程度收入管理医疗规划/统计学和数值数据婚姻状况密执安/流行病学比值比存活率城市卫生成年人老年人女(雌)性人类中年人

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Race and outcomes: Is this the end of the beginning for minority health research?

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JOURNAL OF THE NATIONAL CANCER INSTITUTE 1999年第22期91卷 1908-1909页

作者： Brawley, OW Freeman, HP NCI Off Special Populat Res Off Director Bethesda MD 20892 USA N Gen Hosp New York NY USA

Focuses on the minority health research in the United States. Increase in the cancer mortality disparity between Afro-Americans and white Americans; 1993 National Institutes of Health Revitalization Act; Representation of minority cancer patients in the National Cancer Institution-sponsored cooperative group clinical treatment trails.

关键词：非洲裔美国人/统计学和数值数据抗肿瘤药/治疗应用化学疗法辅助临床医学/标准结肠肿瘤/药物疗法结肠肿瘤/人种学结肠肿瘤/外科学欧洲大陆世系人群/统计学和数值数据国立卫生研究院(美国) 存活率分析存活率治疗结果美国/流行病学人类

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Age at presentation of African-American and Caucasian breast cancer patients

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JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS 1999年第3期188卷 237-240页

作者： El-Tamer, MB Wait, RB SUNY Hlth Sci Ctr Brooklyn NY 11203 USA

Background: The purpose of this study was to compare the age at presentation of Black-American (Caribbean-American and African-American) and Caucasian breast cancer patients. Study Design: We reviewed the records of all breast cancer patients seen at King's County Hospital Center and SUNY Health Science Center at Brooklyn between 1982 and 1995. The patients were stratified based on ethnicity. Age distribution, median, and mean ages are compared for Black-American and Caucasian patients. Results: The median age, mean age, and standard deviation for 1,632 African-American patients was 54, 54.17, and 13.11 years, respectively, whereas for 671 Caucasians patients it was 62, 60.35, and 13.85 years, respectively. Using the Student's t-test for equality of means there is a statistically significant difference in the mean age of presentation for the 2 ethnic groups with a p < 0.001 and a 95% confidence interval for difference (4.960, 7.405). More than one-third (37.7%) of Black-American breast cancer patients present younger than 50 years of age compared with 24.7% for Caucasians. Conclusions: The younger age at presentation of Black-American breast cancer patients ought to be considered while setting screening guidelines for that group of women. (J Am Cell Surg 1999;188:237-240. (C) 1999 by the American College of Surgeons).

关键词：非洲裔美国人/统计学和数值数据年龄分布乳腺肿瘤/流行病学乳腺肿瘤/人种学欧洲大陆世系人群/统计学和数值数据发病率美国/流行病学青少年成年人老年人老年人 80以上女(雌)性人类中年人

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Familial aggregation of end-stage renal failure: aetiological implications

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NEPHROLOGY DIALYSIS TRANSPLANTATION 1999年第2期14卷 295-297页

作者： Freedman, BI Wake Forest Univ Bowman Gray Sch Med Med Ctr Winston Salem NC 27157 USA Wake Forest Univ Bowman Gray Sch Med Dept Internal Med Nephrol Winston Salem NC 27157 USA

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Prevalence of coronary artery disease, ischemic stroke, peripheral arterial disease, and coronary revascularization in older African-Americans, Asians, Hispanics, whites, men, and women

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AMERICAN JOURNAL OF CARDIOLOGY 1999年第8期84卷 932-+页

作者： Ness, J Aronow, WS Mt Sinai Sch Med Dept Geriatr & Adult Dev New York NY USA

The prevalence of coronary artery disease and of peripheral arterial disease was similar in older African-Americans, Asians, Hispanics, and whites, and the prevalence of ischemic stroke was lower in older whites than in older African-Americans and Hispanics. The prevalence of coronary revascularization in older persons with coronary artery disease was lower in African-Americans than in whites and Hispanics and was lower in women than in men.

关键词：非洲裔美国人/统计学和数值数据方差分析亚裔美国人/统计学和数值数据卡方分布冠心病/人种学欧洲大陆世系人群/统计学和数值数据西班牙裔美国人/统计学和数值数据心肌血管重建术外周血管疾病/人种学患病率回顾性研究美国/流行病学老年人老年人 80以上女(雌)性人类男(雄)性

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