Medical Matters

 

There is much controversy about race and medicine. Some people and medical scientists feel there are inherent differences in races that cause medical concerns and need to be addressed. Others feel there are no differences. We at Project RACE call for more study into this highly emotional issue. We have recently seen several calls for more study, as outlined below and are pleased to know that progress is being made.

We recently received a notification of a diabetes study. To qualify, it specified you must have Japanese Heritage (being born in Japan or having at least 1 parent or 1 grandparent born in Japan).

I also received a request from 23 and Me because they did my DNA testing and I have a percentage of African descent. They stated that less than 3%* of participants in research studies on genetics of disease are of African descent. More representation from people of African ancestry could lead to advancements in conditions like lupus, type 2 diabetes, and more for this population. They asked me to “Support advancements in genetic discoveries for individuals with African ancestry by completing an online survey.”

Also in the news is that a team of Mayo Clinic researchers found Hispanic-American patients with Alzheimer’s tend to survive significantly longer than other ethno-racial groups. The principal investigator of the study said, “As the field works towards Alzheimer’s therapies, ethno-racial differences should be taken into consideration.”

I recently read an excellent article about race-based medicine by Evelyn Elias that dives deep into population-level genetic differences and their implications for medicine. You can read the entire article here: https://universityobserver.ie/individualised-medicine-its-all-in-the-genes/

 

Susan Graham for Project RACE

 

Photo Credit: Triple Helix Online

Race-based medicine and the multiracial population

Failure of race-based medicine? We aren’t accounting for the unique genetics of biracial and multiracial populations

For several decades in modern medicine history, human race has been used as a constant variable to predict and/or determine our disease risks, biometric profiles, health behaviors and outcomes. It drives many of our medical standards, including clinical guidelines, medical school curricula, and clinical decision support tools and algorithms. This reductionist approach to medicine, however, has proven questionable and risky for biracial and multiracial individuals with high levels of phenotypical (physically-apparent) and genotypical (physically non-apparent) variation.

Some clinical study reports  describe how race-based approaches to health diagnosis and management have led to inaccurate assessments in medical practice, especially in cases of bone marrow transplants for multiracial populations. Susan Graham is the president of Project RACE (Reclassify All Children Equally), an organization advocating for multiracial classification in health care settings for people of two or more races. In an interview with the Genetic Literacy Project, she explained that “a multiracial person’s best chance of bone marrow donor acceptance must take [multi]race into account to get as perfect a match as possible.” That’s why we need to do more, as a society, to expand the number and diversity of bone marrow donors to help solve this issue for multiracial populations, she said.

Race versus genetics: Social constructs or health determinants?

The idea of race as a social construct has been well researched, with some classically defined racial groups experiencing greater hardships – including poor access to health care services – than other racial groups in the US.

Questions also have arisen regarding the use of race as a health determinant, due to recent advancements and novel findings in genomics, ancestry, and medicine.

For instance, single- and multi-gene tests for harmful genetic variations in BRCA1 and BRCA2 are used by doctors to identify people with increased risk of developing breast cancer. As a result, those people undergo closer medical surveillance, take more aggressive prevention measures, and are more likely to receive appropriate treatments when needed.

mutations 9 21 18From an epidemiological standpoint, the concept of race as a determinant of breast cancer diagnosis follows: According to the National Cancer Institute (NCI), American women of Ashkenazi Jewish ethnicity or descent, followed by women of northern European ethnicity or descent, hold the highest prevalence of breast cancer-associated BRCA1 and BRCA2 variations.

This finding may be influenced by personal, social, economic and environmental factors that influence health care service utilization among racially-defined groups.

However, if women of Ashkenazi Jewish and northern European descent in BRCA1 and BRCA2 are overrepresented in genetic databases, then the NCI’s findings are incomplete and warrant investigation to see if larger genetic representations of single race, biracial and multiracial individuals are required for greater epidemiological accuracy. The All of Us research program, sponsored by the National Institute of Health (NIH) and supported by the Precision Medicine Initiative, are examples of steps forward in this direction to increase diversity in genetic health databases.

Stakeholder discussions about race, genetics and clinical guidelines

The graph below displays the number of articles searchable within www.PubMed.gov between 1998-2017 using search phrases “race AND clinical guidelines” and “genetic AND clinical guidelines”. The graph shows that clinical guidelines discussions about genetics have drastically outpaced those about race within the past 20 years.

Related article:  Precision medicine inches along

Similar discussions about multiracial populations, however, have been scant, leaving this area ripe for scientific exploration. “The multiracial population is very new to the concept of precision medicine, as we are still fighting for recognition in medicine and race-based data,” Graham said.

The medical community is lagging in its inclusion of biracial and multiracial Americans, she said.  Multiracial populations seemingly add layers of complexity to standard race-based clinical guidelines.

So, is the medical community really lagging here? Or, are biracial and multiracial patients lumped into single racial categories by clinicians who must adhere to race-based clinical guidelines?

Also, how can members of the medical community effectively engage with growing multiracial populations to improve racially-driven clinical guidelines that may not adequately serve the unique needs of multiracial populations?

Dr. Elizabeth Clayborne is a multiracial emergency medicine physician and educator at the University of Maryland School of Medicine who has worked with the National Human Genome Research Institute to address race, ethnicity and genetics in medicine. She offered her take on the issue: “If a patient is labeled as ‘multiracial,’ they are included in a group that has extreme genetic diversity and no specificity to any particular genetic roots.”

She argued that the use of a simple “multiracial” category is a reductionist and low-value approach to understanding a patient’s disease risk at the genetic level. “This kind of lump-labeling does a disservice to population and personalized health frameworks that rely on geographic ancestry, versus race, to determine disease risk,” she said.

The medical community continues to debate race as an indicator of social and economic factors, which in turn effect health outcomes. “Health disparities that are present within African American/Black patient populations, may be actually be tied to low socioeconomic status, poor diet, lifestyle habits and other non-genetic determinants of health,” she said.

Looking ahead

Although few and far between, discussions about the benefits of precision medicine for multiracial populations continue to emerge among experts in health law, genomics and medical-legal partnerships. Graham expressed hope that “precision medicine may very well help our population become aware of health disparities, which could be critical to our wellness and healthcare in providing useful information.”

Diversity and inclusion in precision medicine and genetic discovery followed by an overhaul of racially driven clinical guidelines and racial labeling in clinical settings appear to be key actions needed to address these health care challenges for multiracial populations.

Dr. Clayborne believes that, as the precision and personalized medicine movement grows – due to advances in genomic sequencing –  the medical community could eventually steer away from racial categories to focus more on individual family history and known genetic markers for disease.

Rachele Hendricks-Sturrup holds a doctor of health science degree and is a freelance health science writer. Follow her at her website or on Twitter @AcesoIngenuity

Genetics and Race

Credit Angie Wang

In 1942, the anthropologist Ashley Montagu published “Man’s Most Dangerous Myth: The Fallacy of Race,” an influential book that argued that race is a social concept with no genetic basis. A classic example often cited is the inconsistent definition of “black.” In the United States, historically, a person is “black” if he has any sub-Saharan African ancestry; in Brazil, a person is not “black” if he is known to have any European ancestry. If “black” refers to different people in different contexts, how can there be any genetic basis to it?

Beginning in 1972, genetic findings began to be incorporated into this argument. That year, the geneticist Richard Lewontin published an important study of variation in protein types in blood. He grouped the human populations he analyzed into seven “races” — West Eurasians, Africans, East Asians, South Asians, Native Americans, Oceanians and Australians — and found that around 85 percent of variation in the protein types could be accounted for by variation within populations and “races,” and only 15 percent by variation across them. To the extent that there was variation among humans, he concluded, most of it was because of “differences between individuals.”

In this way, a consensus was established that among human populations there are no differences large enough to support the concept of “biological race.” Instead, it was argued, race is a “social construct,” a way of categorizing people that changes over time and across countries.

It is true that race is a social construct. It is also true, as Dr. Lewontin wrote, that human populations “are remarkably similar to each other” from a genetic point of view.

But over the years this consensus has morphed, seemingly without questioning, into an orthodoxy. The orthodoxy maintains that the average genetic differences among people grouped according to today’s racial terms are so trivial when it comes to any meaningful biological traits that those differences can be ignored.

The orthodoxy goes further, holding that we should be anxious about any research into genetic differences among populations. The concern is that such research, no matter how well-intentioned, is located on a slippery slope that leads to the kinds of pseudoscientific arguments about biological difference that were used in the past to try to justify the slave trade, the eugenics movement and the Nazis’ murder of six million Jews.

I have deep sympathy for the concern that genetic discoveries could be misused to justify racism. But as a geneticist I also know that it is simply no longer possible to ignore average genetic differences among “races.”

Groundbreaking advances in DNA sequencing technology have been made over the last two decades. These advances enable us to measure with exquisite accuracy what fraction of an individual’s genetic ancestry traces back to, say, West Africa 500 years ago — before the mixing in the Americas of the West African and European gene pools that were almost completely isolated for the last 70,000 years. With the help of these tools, we are learning that while race may be a social construct, differences in genetic ancestry that happen to correlate to many of today’s racial constructs are real.

Recent genetic studies have demonstrated differences across populations not just in the genetic determinants of simple traits such as skin color, but also in more complex traits like bodily dimensions and susceptibility to diseases. For example, we now know that genetic factors help explain why northern Europeans are taller on average than southern Europeans, why multiple sclerosis is more common in European-Americans than in African-Americans, and why the reverse is true for end-stage kidney disease.

I am worried that well-meaning people who deny the possibility of substantial biological differences among human populations are digging themselves into an indefensible position, one that will not survive the onslaught of science. I am also worried that whatever discoveries are made — and we truly have no idea yet what they will be — will be cited as “scientific proof” that racist prejudices and agendas have been correct all along, and that those well-meaning people will not understand the science well enough to push back against these claims.

This is why it is important, even urgent, that we develop a candid and scientifically up-to-date way of discussing any such differences, instead of sticking our heads in the sand and being caught unprepared when they are found.

To get a sense of what modern genetic research into average biological differences across populations looks like, consider an example from my own work. Beginning around 2003, I began exploring whether the population mixture that has occurred in the last few hundred years in the Americas could be leveraged to find risk factors for prostate cancer, a disease that occurs 1.7 times more often in self-identified African-Americans than in self-identified European-Americans. This disparity had not been possible to explain based on dietary and environmental differences, suggesting that genetic factors might play a role.

Self-identified African-Americans turn out to derive, on average, about 80 percent of their genetic ancestry from enslaved Africans brought to America between the 16th and 19th centuries. My colleagues and I searched, in 1,597 African-American men with prostate cancer, for locations in the genome where the fraction of genes contributed by West African ancestors was larger than it was elsewhere in the genome. In 2006, we found exactly what we were looking for: a location in the genome with about 2.8 percent more African ancestry than the average.

When we looked in more detail, we found that this region contained at least seven independent risk factors for prostate cancer, all more common in West Africans. Our findings could fully account for the higher rate of prostate cancer in African-Americans than in European-Americans. We could conclude this because African-Americans who happen to have entirely European ancestry in this small section of their genomes had about the same risk for prostate cancer as random Europeans.

Did this research rely on terms like “African-American” and “European-American” that are socially constructed, and did it label segments of the genome as being probably “West African” or “European” in origin? Yes. Did this research identify real risk factors for disease that differ in frequency across those populations, leading to discoveries with the potential to improve health and save lives? Yes.

While most people will agree that finding a genetic explanation for an elevated rate of disease is important, they often draw the line there. Finding genetic influences on a propensity for disease is one thing, they argue, but looking for such influences on behavior and cognition is another.

But whether we like it or not, that line has already been crossed. A recent study led by the economist Daniel Benjamin compiled information on the number of years of education from more than 400,000 people, almost all of whom were of European ancestry. After controlling for differences in socioeconomic background, he and his colleagues identified 74 genetic variations that are over-represented in genes known to be important in neurological development, each of which is incontrovertibly more common in Europeans with more years of education than in Europeans with fewer years of education.

It is not yet clear how these genetic variations operate. A follow-up study of Icelanders led by the geneticist Augustine Kong showed that these genetic variations also nudge people who carry them to delay having children. So these variations may be explaining longer times at school by affecting a behavior that has nothing to do with intelligence.

This study has been joined by others finding genetic predictors of behavior. One of these, led by the geneticist Danielle Posthuma, studied more than 70,000 people and found genetic variations in more than 20 genes that were predictive of performance on intelligence tests.

Is performance on an intelligence test or the number of years of school a person attends shaped by the way a person is brought up? Of course. But does it measure something having to do with some aspect of behavior or cognition? Almost certainly. And since all traits influenced by genetics are expected to differ across populations (because the frequencies of genetic variations are rarely exactly the same across populations), the genetic influences on behavior and cognition will differ across populations, too.

You will sometimes hear that any biological differences among populations are likely to be small, because humans have diverged too recently from common ancestors for substantial differences to have arisen under the pressure of natural selection. This is not true. The ancestors of East Asians, Europeans, West Africans and Australians were, until recently, almost completely isolated from one another for 40,000 years or longer, which is more than sufficient time for the forces of evolution to work. Indeed, the study led by Dr. Kong showed that in Iceland, there has been measurable genetic selection against the genetic variations that predict more years of education in that population just within the last century.

To understand why it is so dangerous for geneticists and anthropologists to simply repeat the old consensus about human population differences, consider what kinds of voices are filling the void that our silence is creating. Nicholas Wade, a longtime science journalist for The New York Times, rightly notes in his 2014 book, “A Troublesome Inheritance: Genes, Race and Human History,” that modern research is challenging our thinking about the nature of human population differences. But he goes on to make the unfounded and irresponsible claim that this research is suggesting that genetic factors explain traditional stereotypes.

One of Mr. Wade’s key sources, for example, is the anthropologist Henry Harpending, who has asserted that people of sub-Saharan African ancestry have no propensity to work when they don’t have to because, he claims, they did not go through the type of natural selection for hard work in the last thousands of years that some Eurasians did. There is simply no scientific evidence to support this statement. Indeed, as 139 geneticists (including myself) pointed out in a letter to The New York Times about Mr. Wade’s book, there is no genetic evidence to back up any of the racist stereotypes he promotes.

Another high-profile example is James Watson, the scientist who in 1953 co-discovered the structure of DNA, and who was forced to retire as head of the Cold Spring Harbor Laboratories in 2007 after he stated in an interview — without any scientific evidence — that research has suggested that genetic factors contribute to lower intelligence in Africans than in Europeans.

At a meeting a few years later, Dr. Watson said to me and my fellow geneticist Beth Shapiro something to the effect of “When are you guys going to figure out why it is that you Jews are so much smarter than everyone else?” He asserted that Jews were high achievers because of genetic advantages conferred by thousands of years of natural selection to be scholars, and that East Asian students tended to be conformist because of selection for conformity in ancient Chinese society. (Contacted recently, Dr. Watson denied having made these statements, maintaining that they do not represent his views; Dr. Shapiro said that her recollection matched mine.)

What makes Dr. Watson’s and Mr. Wade’s statements so insidious is that they start with the accurate observation that many academics are implausibly denying the possibility of average genetic differences among human populations, and then end with a claim — backed by no evidence — that they know what those differences are and that they correspond to racist stereotypes. They use the reluctance of the academic community to openly discuss these fraught issues to provide rhetorical cover for hateful ideas and old racist canards.

This is why knowledgeable scientists must speak out. If we abstain from laying out a rational framework for discussing differences among populations, we risk losing the trust of the public and we actively contribute to the distrust of expertise that is now so prevalent. We leave a vacuum that gets filled by pseudoscience, an outcome that is far worse than anything we could achieve by talking openly.

If scientists can be confident of anything, it is that whatever we currently believe about the genetic nature of differences among populations is most likely wrong. For example, my laboratory discovered in 2016, based on our sequencing of ancient human genomes, that “whites” are not derived from a population that existed from time immemorial, as some people believe. Instead, “whites” represent a mixture of four ancient populations that lived 10,000 years ago and were each as different from one another as Europeans and East Asians are today.

So how should we prepare for the likelihood that in the coming years, genetic studies will show that many traits are influenced by genetic variations, and that these traits will differ on average across human populations? It will be impossible — indeed, anti-scientific, foolish and absurd — to deny those differences.

For me, a natural response to the challenge is to learn from the example of the biological differences that exist between males and females. The differences between the sexes are far more profound than those that exist among human populations, reflecting more than 100 million years of evolution and adaptation. Males and females differ by huge tracts of genetic material — a Y chromosome that males have and that females don’t, and a second X chromosome that females have and males don’t.

Most everyone accepts that the biological differences between males and females are profound. In addition to anatomical differences, men and women exhibit average differences in size and physical strength. (There are also average differences in temperament and behavior, though there are important unresolved questions about the extent to which these differences are influenced by social expectations and upbringing.)

How do we accommodate the biological differences between men and women? I think the answer is obvious: We should both recognize that genetic differences between males and females exist and we should accord each sex the same freedoms and opportunities regardless of those differences.

It is clear from the inequities that persist between women and men in our society that fulfilling these aspirations in practice is a challenge. Yet conceptually it is straightforward. And if this is the case with men and women, then it is surely the case with whatever differences we may find among human populations, the great majority of which will be far less profound.

An abiding challenge for our civilization is to treat each human being as an individual and to empower all people, regardless of what hand they are dealt from the deck of life. Compared with the enormous differences that exist among individuals, differences among populations are on average many times smaller, so it should be only a modest challenge to accommodate a reality in which the average genetic contributions to human traits differ.

It is important to face whatever science will reveal without prejudging the outcome and with the confidence that we can be mature enough to handle any findings. Arguing that no substantial differences among human populations are possible will only invite the racist misuse of genetics that we wish to avoid.

Minorities At Risk

Doctors’ textbooks lack diversity, minorities at risk for lower-quality care: study

When light-skinned bodies are shown as the norm, physicians might miss signs on patients with dark skin tone, the UBC study explains.

According to a recent study from UBC, a lack of diversity in medical textbooks could put racial minorities at risk for lower-quality care.

“What we found is that the representation of race in these medical textbooks is proportional to the population, but the representation of skin tone is not,” said University of Toronto PhD student Patricia Louie, the study’s lead author.

Louie explained that if doctors aren’t able to recognize certain diseases in particular racial groups, it could lead to the lower-quality care for patients with darker skin tones.

“If doctors associate certain skin tones with a particular racial group — for example, if doctors read a skin tone as a light patient, this might result in marginalization of patients with darker skin tones or racial minorities,” Louie said.

Teams from U of T and UBC collaborated to produce the study, which was published in the journal Social Science and Medicine.

To produce the findings, the group analyzed the race and skin tone of more than 4,000 human images in four medical textbooks: Atlas of Human Anatomy, Bates’ Guide to Physical Examination & History Taking, Clinically Oriented Anatomy and Gray’s Anatomy for Students.

They found that proportion of dark skin tones represented in all four books was was small. In Atlas, for example, less than one per cent of images featured dark-skinned subjects, compared to about eight per cent in Bates’, about one per cent in Clinically, and about five per cent in Gray’s.

Over 70 per cent of the images in Clinically and 88 per cent of those in Gray’s depicted people with light skin tones, while Atlas featured almost no skin tone diversity whatsoever.

The researchers went on to point out that some cancers, such as breast, cervical, colon, lung and skin cancer, are higher than average for African-American people due to late diagnoses.

“Because students don’t see how skin cancer presents itself on darker-skinned people, they might not be prepared to recognize skin cancer on [such] patients, and this could lead to inequities in medical treatment,” Louie said.

She explained that it’s imperative that doctors are trained to treat the bodies of all patients, and that medical school curriculum plays a large role in ensuring equal treatment.

UBC sociology professor and study co-author Rima Wilkes agreed, saying in a statement that the findings highlight a need for greater diversity in the teaching tools used by medical schools.

“Physicians are required to recognize diseases in patients with a variety of different skin tones,” Wilkes said. “When light-skin-toned bodies are shown as the norm, physicians might miss signs on patients with dark skin tone because they do not know how these abnormalities will present,” she said.

Several American studies on health care inequities point to biased care in medical practice, including racial bias in pain assessment and treatment; late-stage diagnosis of melanoma for dark-skinned patients versus light-skinned patients; and disproportionately low documentation of family breast cancer history for African-American women compared to white women.

A study published in June 2006 by the journal JAMA Dermatology found that of 1690 melanoma cases reported between 1997 and 2002, late-stage diagnosis was more common among Hispanic and non-Hispanic black patients  compared with non-Hispanic white patients.

The study concluded that the rates of advanced-stage diagnosis among Hispanic and black patients suggests sub-par prevention efforts in minority populations.

A second study published in 2016 by the National Academy of Scientists revealed that a significant number of medical students hold false beliefs about biological differences between black and white patients.

The study concluded that this can produce racial bias in pain perception among black patients, which can lead to bias in pain treatment recommendations.

© 2018 Global News, a division of Corus Entertainment Inc.

Medical Matters

How Much Does African-American Race Play a Role in Stroke Risk?

MINNEAPOLIS – Even though young African-Americans are at three times greater risk of a first stroke than their white counterparts, they may not be at a higher risk for a second stroke, according to a study published in the January 20, 2016, online issue of Neurology®, the medical journal of theAmerican Academy of Neurology. The study is one of the first of its kind to look at race and second stroke risk. “The interaction between black race and age appears to be remarkably different for the risk of first versus second stroke,” said study author George Howard, DrPH, with the University of Alabama at Birmingham. “There was very little difference in race for the risk of a second stroke.” The study involved 29,682 people from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study. Of those, 2,993 people had a history of stroke at the start of the study. Over the seven years of the study, 301 of them had a second stroke. Of the 26,689 people who had never had a stroke when the study began, 818 people experienced a first stroke during the study. The researchers found that among those without a stroke at the start of the study, African-Americans were 2.7 times more likely to have a stroke than the white participants at age 45, however, there was no difference at age 85. Race did not appear to increase second stroke risk for African-American participants at any age. “Almost all of the ‘traditional’ risk factors for a first stroke proved to also be a risk factor for a second stroke, suggesting that controlling these risk factors may help avoid both conditions,” said Howard. “These risk factors include heart disease, high blood pressure, diabetes, smoking, irregular heartbeat and others.” The study was supported by the National Institute of Neurological Disorders and Stroke. To learn more about stroke, visit http://www.aan.com/patients.

The American Academy of Neurology, an association of 30,000 neurologists and neuroscience professionals, is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimer’s disease, stroke, migraine, multiple sclerosis, concussion, Parkinson’s disease and epilepsy.

For more information about the American Academy of Neurology, visithttp://www.aan.com or find us on Facebook, Twitter, Google+ andYouTube.

IMPORTANT Medical News!

Public Release: 

Health care, research failing to adapt to US’s growing multiracial population

University of Illinois at Urbana-Champaign

IMAGE
IMAGE: Data collection methods in research and health care settings have lagged behind in adapting to the rapidly growing population of multiracials, according to studies led by University of Illinois social… view more

Credit: Photo by L. Brian Stauffer

CHAMPAIGN, Ill. — Multiracial people who change their racial identity from a single race to multiracial over time may be healthier than their minority peers who consistently identify as monoracial, new research suggests.

Despite the U.S.’s rapidly growing population of multiracial individuals, researchers and health care systems continue to use outdated approaches to racial categorization that force people to classify themselves as monoracial, which may be masking the incidence of health conditions and obscuring disparities in health care access and utilization among multiracial populations, a University of Illinois scholar said.

Social work professor Karen M. Tabb Dina is the lead author of two recent studies that explored issues of racial identity and its impact on health care access and utilization among nearly 8,000 U.S. young people.

The subjects in both of Tabb Dina’s studies were participants in the National Longitudinal Study of Adolescent Health, one of the first surveys to allow respondents to identify themselves as multiracial using two or more racial categories, Tabb Dina said.

Participants in the Adolescent Health survey were asked about their racial background during the first wave of data collection in 1994 and again during the third wave, conducted in 2002.

Of the 7 percent of participants identified as multiracial at either wave, only 20 percent of these people selected the same racial categories both times, Tabb Dina found.

The remaining 80 percent of multiracials were either diversifiers – who switched from monoracial initially to multiracial later – or consolidators, who selected multiple racial categories originally, but switched to a single category later.

While the overwhelming majority (92 percent) of respondents consistently identified as monoracial, 2 percent of this group switched from one racial category to another, Tabb Dina found.

Diversifiers were more likely to rate their health status as “good,” “very good” or “excellent” compared with their minority monoracial peers, Tabb Dina and her colleagues found in a related study, published recently in Ethnicity and Health.

When comparing these same samples’ access to and utilization of health services in 2008, when participants’ ages ranged from 24-33, Tabb Dina found that multiracial individuals of black-white or black-Native American ancestry were significantly less likely to utilize primary care health services – disparities that remained even when Tabb Dina adjusted for health insurance status.

Co-authors on that paper were Christopher R. Larrison and Shinwoo Choi, both of the University of Illinois; and Hsiang Huang, of Harvard Medical School.

Although the Pew Research Center recently reported that the U.S. population of mixed-race adults is growing three times faster than the rest of the population as a whole, health care providers and researchers have been slow to adapt their data-collection methods to this racial diversity, Tabb Dina said.

“Even now, in 2015, medical record systems only allow patients to identify themselves using one racial category,” Tabb Dina said.

Health researchers automatically recode mixed-race patients into the least-status group, Tabb Dina said. For example, patients who indicate they are black and Native American are recoded as Native American.

“By recoding race, we’re probably masking the actual health patterns that we need to uncover,” Tabb Dina said. “We’re not tapping into these patterns and not thinking creatively on how we can address racial and ethnic health disparities. Looking carefully at how people identify themselves can give us more insight into what the underlying problems are and how they differ across racial and ethnic groups.”

Developing more nuanced approaches to racial categorization is essential to learning how multiracial individuals interact with the health care system and to addressing usage and outcome disparities, Tabb Dina said.

RACE MATTERS

RACE MATTERS

Racial disparities in medical outcomes have emerged as an important topic in quality healthcare. Differences in outcomes have been associated with socioeconomic status, but new data are emerging that indicate certain cancers may have differing biology based on ethnicity. Below are links for some of those studies.

Inflammation, Race, and Atrial Fibrillation

http://www.practiceupdate.com/journalscan/21305/2/2?elsca1=emc_enews_daily-digest&elsca2=email&elsca3=practiceupdate_cardio&elsca4=cardiology&elsca5=newsletter&rid=NTk3MzgyODQ0ODIS1&lid=10332481

Genetic Differences Between Primary Breast Cancer Among Black and White Women

http://www.practiceupdate.com/journalscan/21601/2/0?elsca1=emc_enews_daily-digest&elsca2=email&elsca3=practiceupdate_onc&elsca4=oncology&elsca5=newsletter&rid=NTk3MzgyODQ0ODIS1&lid=10332481

Comparative Effectiveness of ACE Inhibitor–Based Treatment on Cardiovascular Outcomes in Hypertensive Blacks vs Whites

http://www.practiceupdate.com/c/29626/2/2/?elsca1=emc_enews_daily-digest&elsca2=email&elsca3=practiceupdate_cardio&elsca4=cardiology&elsca5=newsletter&rid=NTk3MzgyODQ0ODIS1&lid=10332481

Effect of African-American Race on Tumor Recurrence After Radical Cystectomy for Urothelial Carcinoma of the Bladder

 http://www.practiceupdate.com/c/29430/2/0/?elsca1=emc_enews_daily-digest&elsca2=email&elsca3=practiceupdate_uro&elsca4=urology&elsca5=newsletter&rid=NTk3MzgyODQ0ODIS1&lid=10332481

 Blacks fare worse than whites after heart attacks

http://www.reuters.com/article/2015/09/14/us-health-racedisparity-heart-attacks-idUSKCN0RE27I20150914

 

 

 

Medical Monday

Thyroid disease risk varies among blacks, Asians, whites

An analysis that included active military personnel finds that the rate of the thyroid disorder Graves disease is more common among blacks and Asian/Pacific Islanders compared with whites, according to a study in the April 16 issue of JAMA.

Donald S. A. McLeod, F.R.A.C.P., M.P.H., of the QIMR Berghofer Medical Research Institute, Queensland, Australia and colleagues studied all U.S. active duty military, ages 20 to 54 years, from January 1997 to December 2011 to determine the rate of Graves disease and Hashimoto thyroiditis (a progressive autoimmune disease of the thyroid gland) by race/ethnicity. Cases were identified from data in the Defense Medical Surveillance System, which maintains comprehensive records of inpatient and outpatient medical diagnoses among all active-duty military personnel. The relationship between Graves disease and race/ethnicity has previously not been known.

During the study period there were 1,378 cases of Graves disease in women and 1,388 cases in men and 758 cases of Hashimoto thyroiditis in women and 548 cases in men. Compared with whites, the incident rates for Graves disease was significantly higher among blacks and Asian/Pacific Islanders. In contrast, Hashimoto thyroiditis incidence was highest in whites and lowest in blacks and Asian/Pacific Islanders.

The authors write that the differences in incidence by race/ethnicity found in this study may be due to different environmental exposures, genetics, or a combination of both.

Source: Science Daily

Medical Monday

CDC: Cancer Incidence and Survival Improve; Racial Disparities Persist

 

Medical Monday

Racial Differences May Necessarily Affect Eye Care

Written by
Jonathan Temte MD, MS, PhD
 We are confronted with diversity on a daily basis in the practice of medicine. Patients present for evaluation of symptoms or for preventive care. The health professional takes in myriad strands of information in routine decision-making. In a broader sense, this is encompassed in the concept of personalized medicine: customized interventions based on one’s genetic makeup and/or lifestyle choices. Personalized medicine has now become sufficiently mainstream to be featured in the recent State of the Union address. Two recent papers highlight this concept for the eye care professional.1-2