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Updated: Oct 20, 2005

Recommended Reading List

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31

Ethnicity and Dementia

Harwood, D. G. Ownby, R. L.

Curr Psychiatry Rep., 2(1), 40-5.

General

2000
Feb

A large number of studies have examined both the epidemiology and neuropsychiatric manifestations of dementia among older adults. However, there is a relative dearth of studies focusing on ethnic minority elders in the United States. This article reviews the existing empiric literature in the area of ethnicity and dementia. For the purpose of this paper, the focus will be on Hispanics and black Americans, the two most prevalent ethnic minority populations in the United States. This review includes discussion of terminology issues, diagnosis, epidemiology, and clinical features, in addition to caregiver issues. 

32

The Role of Race/Ethnicity in the Epidemiology of Esophageal Cancer

Brown , L. M.

J Assoc Acad Minor Phys.,11(2-3), 32-7.

General

2000

Esophageal cancer is known for its marked variation by geographic region, race, ethnicity, and gender. In the United States, incidence rates for African Americans are more than twice the rates for whites, and rates for whites exceed those for Hispanics, Asian Americans, and Native Americans. In addition, decreases in incidence of squamous cell carcinoma of the esophagus and increases in esophageal adenocarcinoma have been observed over the past several decades. This paper will explore the role of race/ethnicity in the epidemiology of esophageal cancer and the extent to which alcohol, tobacco, diet, and social class may contribute to racial/ethnic differences in incidence and mortality. 

33

Hypertension and Renal Disease in Puerto Ricans

Cangiano, J. L.

Am J Med Sci., 318(6), 369-73.

Latino/a

1999 
Dec

Hypertension and end-stage renal disease (ESRD) constitute a major health threat to Puerto Ricans in the United States and in the Commonwealth. In the Hispanic population of the United States, Puerto Ricans seem to have a worse health status than Mexican- and Cuban Americans. Poverty, language, and lack of education increase the risk of less-than-adequate diagnosis and treatment of hypertension. In the Commonwealth, hypertension is a common problem. Deaths caused by heart disease continue to increase on the island. Although the health care system in Puerto Rico continues to improve, changes in diet, increased social stress, and the high prevalence of diabetes mellitus and obesity may add to the increased death rate from cardiovascular causes. The incidence and prevalence of ESRD in Puerto Rico is as high as in the United States; however, diabetes mellitus seems to be the primary diagnosis in a larger number of patients with ESRD than in the U.S. Preventive and control measures must be urgently taken by public health officials to minimize the impact of these disorders in the health of Puerto Ricans. 

34

Native Women and Cancer

Kaur, J. S. 

Health Care Women Int., 20(5), 445-53.

Special Pop.Women

1999
Sep-Oct

Literature regarding cancer patterns in American Indians and Alaska Native women is reviewed and attention is paid to promising research initiatives to improve cancer prevention and control as well as approaches to enhance exchange of knowledge through a new national resource center. Lung, breast, and colorectal cancer are the leading cause of cancer deaths in American Indians and Alaska Native women. There continues to be a disproportionate death rate from cervical cancer. Enhanced availability for breast and cervical cancer screening in conjunction with community education is showing promising trends toward reversing the patterns of late diagnosis. Communities can benefit from sharing their collective resources in a new national resource center called "Native C.I.R.C.L.E." housed in the Mayo Cancer Center. 

35

Rheumatic Diseases in North America's Indigenous Peoples

Peschken, C. A. Esdaile, J. M.

Semin Arthritis Rheum., 28(6), 368-91.

Native American

1999
June

OBJECTIVES: There are at least 3 million North American Indians and Eskimos in North America. The epidemiology of rheumatic diseases in Native North Americans differs from that described for the remainder of the North American population. An enhanced understanding of rheumatic diseases in these indigenous people may provide valuable clues to the cause of these disorders and improve rheumatologic care. METHODS: The world literature was searched for all reports of rheumatic diseases in North American Indians and Eskimos. The reports were reviewed and the findings summarized by disease process. RESULTS: Many Native American groups have high prevalence rates of rheumatoid arthritis (RA), systemic lupus erythematosus, connective tissue diseases, and spondyloarthropathies. There appears to be a correlation between the pattern of rheumatic diseases in Native North Americans and the patterns of migration and ancestry. In general, Amerind Indians have increased rates of RA and connective tissue disease, while Na-Dene Indians and Eskimos have high rates of spondyloarthropathies. The RA seen in Native Americans is generally severe, seropositive, with an early age of onset, and frequent extraarticular manifestations. Many Native American groups have very high frequencies of the RA shared epitope. The majority of Native American and Eskimo groups also have high frequencies of HLA-B27, and some of the world's highest prevalence rates of spondyloarthropathies are described in these groups. Although some groups show a marked tendency to develop either Reiter's syndrome or ankylosing spondylitis, psoriatic and enteropathic arthritis are rare. CONCLUSIONS: The excess rheumatic disease seen in this population is most likely genetic in origin. Because of the combination of high rates of rheumatic disease and relative genetic homogeneity, Native North Americans represent a singular opportunity to study genetic contributions to rheumatic disease. For clinicians, the index of suspicion for rheumatic diseases in North American Indians and Eskimos should be high, and the severe disease and sometimes atypical presentations kept in mind. 

36

Migrant Populations and the Incidence of Type 1 Diabetes Mellitus: An overview of the literature with a focus on the Spanish-heritage countries in Latin America

Serrano-Rios, M.
Goday, A.
Martinez, L. T.

Diabetes Metab Res Rev., 15(2), 113-32.

Latino/a

1999 Mar-Apr

Type 1 diabetes mellitus (DM) is a 'chronic' autoimmune disorder leading to the destruction of the pancreatic beta cell. The natural history of diabetes includes a long subclinical (prediabetes) period. The pathogenesis is multifactorial and characterized by the interaction of environmental factors, with predisposing genes, most of which are associated with the HLA DR DQ loci. The relatively recent development of worldwide incidence registries for Type 1 DM has allowed us to compare the epidemiological results obtained in most parts of the world. This approach is particularly valuable in analyzing the effects of migration of populations from one area of the world where the incidence of Type 1 DM is different (usually lower) to a new geographic setting. Properly designed migrant studies may be valuable in uncovering whether the genetic background remains more important than the new 'exposure' as illustrated by the Sardinian migration to Lazio and Lombardy. The presence of some putative 'protective' environmental exposures or the absence of those prevalent in the country of origin may explain the usually lower Type 1 DM incidence observed in most countries (Chile, Peru, Mexico) sharing a 'Spanish caucasoid genetic pool', and even in relatively genetically homogeneous groups such as Japanese populations migrating to Hawaii. In fact, the disease is caused by both genetic and environmental factors and to convince the scientific community of this fact is a primary responsibility for epidemiologists. 

37

Natural History of Growth Hormone Receptor Deficiency

Rosenbloom, A. L.
Martinez, V.
Kranzier, J. H.
Bachrach, L. K.
Rosenfeld, R. G.
Guevara-Aguirre, J. 

Acta Paediatr Suppl., 88(428), 153-6, discussion 157.

General

1999 
Feb

This review discusses the natural history of growth hormone receptor deficiency (GHRD) in relation to epidemiology, mortality, growth, certain aspects of body composition, and intellectual development. The majority of affected individuals are of Semitic origin and 90% come from the Indian peninsula, the Middle East, or elsewhere in the Mediterranean. There is a twofold increased mortality before the age of 7 years for children with GHRD. Affected adults may have increased cardiovascular risk resulting from increased total cholesterol and low-density lipoprotein cholesterol, unrelated to adiposity or insulin resistance. Intrauterine growth is affected minimally, if at all. Within a genetically homogeneous population in Ecuador, postnatal growth effects are as variable as in a large genetically heterogeneous population. There is no influence of parental heights. Areal bone mineral density is reduced in adults with GHRD, but estimated volumetric bone density (bone mineral apparent density) is normal. Intellectual development is unaffected by GHRD. 

38

The Health Status of American Indians and Alaska Natives: 2 lessons for cancer educators

Mahoney, M. C.
Michalek, A. M.

J Cancer Educ., 14(1), 23-7.

Native American

1999
Spring

Malignant disease is largely unrecognized as a leading cause of death among American Indians and Alaska Natives (AI/ANs). Published studies of cancer incidence, cancer mortality, and cancer survival are highlighted to present an overview on the epidemiology of cancer among Native peoples. Cancer incidence and mortality have demonstrated steady increases among AI/ANs during a relatively limited time frame, as well as unique patterns of site-specific cancers. Cancer-survival data reveal that Native peoples have the poorest survival of any racial group for all cancer sites combined and for eight of the ten leading sites. Opportunities to educate health care providers, through continuing medical education programs and focused conferences for postdoctoral and current medical trainees, can be used to enhance cultural sensitivity and to examine ethnic differences in cancer patterns. Enhancement of recognition of the unique cancer patterns among AI/AN populations may lead to improved identification of at-risk individuals and more effective cancer screening programs within Native communities. 

39

Hormone Replacement Therapy for African American Women: Missed opportunities for effective intervention

Nicholson, W. K.
Brown, A. F.
Gathe, J.
Grumbach, K.
Washington, A. E.
Perez-Stable, E. J.

Menopause, 6(2), 147-55.

Special Pop.Women

1999
Summer

OBJECTIVES: Because of the potential benefits and risks of hormone replacement therapy (HRT), information about the efficacy of HRT in different groups of women is important to patients and providers. The objectives of this study were to review the evidence on the benefits and risks of HRT in African American women and to present a quantitative analysis of the potential reduction in mortality from osteoporotic fractures and coronary heart disease and the potential increase in risk of breast and endometrial cancer. METHODS: A MEDLINE search of English-language observational studies and clinical trials on the effects of HRT on osteoporotic fractures and coronary heart disease (CHD) was conducted for the time period from 1966 to September 1998. Using available CHD mortality data for African American women and white women, potential reductions in mortality with HRT were explored for African American and white women. RESULTS: In the 30 studies on CHD and HRT, African American women were known to comprise only 173 (0.1%) of 148,437 participants. In 11 studies of HRT and osteoporotic fractures, only 128 (0.4%) of 40,299 participants were known to be African American women. An analysis of CHD mortality by decade intervals indicated that African American women, aged 55 to 64, are more likely to die from CHD each year than white women. Despite a lower incidence of breast and endometrial cancer among African American women, the mortality rates of African American women with these cancers is higher compared with white women. CONCLUSIONS: With the higher underlying CHD mortality rate among African American women, HRT is an important potential preventive therapy. The absence of African American women and other non-white women from clinical studies of HRT makes it difficult to fully assess the risks and benefits of HRT in this group of women. 

40

African American Women and Diabetes: A sociocultural context

Rajaram, S. S. Vinson, V.

J Health Care Poor Underserved, 9(3), 236-47.

Special Pop.Women

1998 
Aug

Diabetes is the fourth leading cause of death among African American women. One in four black women (23.4 percent) older than age 55 has diabetes. In evaluating the experience of black women with diabetes, an understanding of their social context is essential. Resulting from historical and sociocultural factors, black women have relatively lower income and education levels and consequently, poorer health and restricted access to quality health care. In a sense, being black, female, elderly, and chronically ill places this group in quadruple jeopardy. Tackling the problem of diabetes among African American women is a public health priority and requires a multilevel approach.