Racial Differences and Racial Disparities

Taylor, Anne L.

doi:10.1161/circulationaha.115.015358

Cited by 14 publications

(11 citation statements)

References 15 publications

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“…First, biological differences should be considered along with environmental and social factors as important in understanding phenotypic differences across diverse patient populations. 46 Second, we cannot fully understand population-based differences without enhancing the diversity of the populations that are included in genomic studies. 45,47,48 Third, evidence supporting pathogenicity of these SNVs would be strengthened by a prospective study and an understanding of possible familial recurrence and/or segregation.…”

Section: Discussionmentioning

confidence: 99%

Association of Variants in BAG3 With Cardiomyopathy Outcomes in African American Individuals

et al. 2018

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This study demonstrates that genetic variants in BAG3 found almost exclusively in individuals of African ancestry were not causative of disease but were associated with a negative outcome in patients with a dilated cardiomyopathy through modulation of the function of BAG3. The results emphasize the importance of biological differences in causing phenotypic variance across diverse patient populations, the need to include diverse populations in genetic cohorts, and the importance of determining the pathogenicity of genetic variants.

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Section: Discussionmentioning

confidence: 99%

Association of Variants in BAG3 With Cardiomyopathy Outcomes in African American Individuals

et al. 2018

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“…30 Racial differences are independent of social factors, whereas racial disparities result from biases or practices with a systemic origin. Whether our findings may be described as racial differences or racial disparities merits attention.…”

Section: Discussionmentioning

confidence: 99%

Racial Differences in Atrial Fibrillation-Related Cardiovascular Disease and Mortality

et al. 2016

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IMPORTANCE The adverse outcomes associated with atrial fibrillation (AF) have been studied in predominantly white cohorts. Racial differences in outcomes associated with AF merit continued investigation. OBJECTIVE To evaluate the race-specific associations of AF with stroke, heart failure, coronary heart disease (CHD), and all-cause mortality in a community-based cohort. DESIGN, SETTING, AND PARTICIPANTS The Atherosclerosis Risk in Communities (ARIC) Study is a prospective, observational cohort. From 1987 through 1989, the ARIC Study enrolled 15 792 men and women and conducted 4 follow-up examinations (2011–2013) with active surveillance for vital status and hospitalizations. Race was determined by self-report and categorized as white, black, or other. MAIN OUTCOMES AND MEASURES Atrial fibrillation (adjudicated using electrocardiograms, hospital discharge codes, and death certificates), stroke, heart failure, CHD, and mortality. RESULTS After exclusions, 15 080 participants (mean [SD] age, 54.2 [5.8] years; 8290 women [55.5%]; 3831 black individuals [25.4%]) were included in this analysis. During a mean (SD) follow-up of 20.6 (6.2) years, there were 2348 cases of incident AF. The incident rates of AF per 1000 person-years were 8.1 (95%CI, 7.7–8.5) in white individuals and 5.8 (95%CI, 5.2–6.3) in black individuals. The rates of stroke, heart failure, CHD, and mortality were higher in black individuals with AF than white individuals with AF. The association of AF with these outcomes, estimated with rate differences (rate of the end point in those with AF minus the rate in those without AF per 1000 person-years), also differed by race. The rate difference for stroke in individuals with AF was 10.2 (95%CI, 6.6–13.9) in white individuals and 21.4 (95%CI, 10.2–32.6) in black individuals. For heart failure and CHD, the rate differences were 1.5- to 2.0-fold higher in black individuals than white individuals. White individuals with AF had a rate difference of 55.9 (95%CI, 48.1–63.7) for mortality compared with black individuals, who had a rate difference of 106.0 (95%CI, 86.0–125.9). CONCLUSIONS AND RELEVANCE In the prospective ARIC Study, the outcome of AF on the rates of stroke, heart failure, CHD, and mortality was considerably larger in black individuals than white individuals. These results indicate the vulnerability and increased risk in black individuals with AF. Continued investigation of racial differences in AF and its related adverse outcomes are essential to identify and mitigate racial disparities in the treatment of AF.

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“…An important question is whether the differences we found represent biologic, genetic, or epigenetic differences that vary across racial/ethnic groups or whether these represent disparities related to underlying inequalities (42). The Institute of Medicine defines racial and ethnic disparities in terms of “differences in the quality of healthcare that are not due to access-related factors or clinical needs, preferences, and appropriateness of intervention” (1).…”

Section: Discussionmentioning

confidence: 99%

Racial and Ethnic Differences in Heart Failure Readmissions and Mortality in a Large Municipal Healthcare System

Durstenfeld

Ogedegbe

Katz

et al. 2016

JACC: Heart Failure

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Objective To determine whether racial and ethnic differences exist among patients with similar access to care, we examined outcomes after heart failure hospitalization within a large municipal health system. Background Racial and ethnic disparities in heart failure outcomes are present in administrative data, and one explanation is differential access to care. Methods We performed a retrospective cohort study of 8,532 hospitalizations of adults with heart failure at 11 hospitals in New York City from 2007 to 2010. Primary exposure was ethnicity/race, and outcomes were 30- and 90-day readmission and 30-day and one-year mortality. Generalized estimating equations were used to test for association between ethnicity/race and outcomes with covariate adjustment. Results Of included hospitalizations, 4,305 (51%) were for blacks, 2,449 (29%) were for Hispanics, 1,494 (18%) were for whites, and 284 (3%) were for Asians. Compared to whites, blacks and Asians had lower one-year mortality, with adjusted odds ratios (aORs) 0.75 (95% CI 0.59–0.94) and 0.57 (95% CI 0.38–0.85), whereas Hispanics were not significantly different (aOR 0.81: 95% CI 0.64–1.03). Hispanics had higher odds of readmission than whites, with aORs 1.27 (95% CI 1.03–1.57) at 30 days and 1.40 (95% CI 1.15–1.70) at 90 days. Blacks had higher odds of readmission than whites at 90 days (aOR 1.21: 95% CI 1.01–1.47). Conclusions Racial and ethnic differences in outcomes after heart failure hospitalization were present within a large municipal health system. Access to a municipal health system may not be sufficient to eliminate disparities in heart failure outcomes.

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Racial Differences and Racial Disparities

Cited by 14 publications

References 15 publications

Association of Variants in BAG3 With Cardiomyopathy Outcomes in African American Individuals

Association of Variants in BAG3 With Cardiomyopathy Outcomes in African American Individuals

Racial Differences in Atrial Fibrillation-Related Cardiovascular Disease and Mortality

Racial and Ethnic Differences in Heart Failure Readmissions and Mortality in a Large Municipal Healthcare System

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