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After emancipation, most African Americans remained tethered to agricultural economies, while others migrated to cities seeking better opportunities. Although bioarchaeologists have made significant interventions in researching people of African descent, there are relatively few published comparative studies that address their morbidity and mortality after slavery. This study compares the bioarchaeological evidence for rural and urban southern United States populations to address disparities in health and longevity. It considers the biological effects of racism, including the health impacts of poverty, disease, and malnourishment. Although historians and demographers argue that urban life was especially detrimental to health, the results of this research suggest greater complexity in African American well-being. Whereas urban adults had higher midlife mortality and reduced longevity compared to their rural counterparts, both rural and urban children experienced poor health. Rural child mortality and morbidity varied significantly, suggesting differences in diet and disease exposure across rural communities. With regard to gender, rural and urban women died at younger ages than men. This disparity in mortality is partly attributed to black women's working and reproductive lives within the context of racism and gender inequality. [ABSTRACT FROM AUTHOR]

On account of poor living conditions, African Americans in the United States experience disproportionately high rates of mortality and incarceration compared with Whites. This has profoundly diminished the number of voting-eligible African Americans in the country, costing, as of 2010, approximately 3.9 million African American men and women the right to vote and amounting to a national African American disenfranchisement rate of 13.2%. Although many disenfranchised African Americans have been stripped of voting rights by laws targeting felons and ex-felons, the majority are literally "missing" from their communities due to premature death and incarceration. Leveraging variation in gender ratios across the United States, we show that missing African Americans are concentrated in the country's Southeast and that African American disenfranchisement rates in some legislative districts lie between 20% and 40%. Despite the many successes of the Voting Rights Act and the civil rights movement, high levels of African American disenfranchisement remain a continuing feature of the American polity. [ABSTRACT FROM AUTHOR]

Objective: Describe southern US homicide rates in whites and blacks between 1999 and 2015.Methods: The Centers for Disease Control and Prevention Multiple Cause of Death Files provided mortality rates and 95% confidence intervals (CIs) for non-Hispanic whites (NHW) as well as non-Hispanic blacks and African Americans (NHB).Results: Overall, age-adjusted (1 to ≥85 years) homicide was significantly higher in the South (7.6/100,000, 95% CI 7.6-7.7) than the rest of the United States (4.9/100,000, 95% CI 4.8-4.9) even though the southern rate among NHB (18.7/100,000, 95% CI 18.5-18.8) was lower than the rest of the United States (23.3/100,000, 95% CI 23.1-23.5). The overall southern NHB:NHW mortality rate ratio was 5.1 and 10.6 in the rest of the nation. Homicide rates among NHW men were higher in the South than in each of the other US Census areas, whereas corresponding rates among NHB men were lower. For both men and women the NHB:NHW mortality rate ratio was lower in the South than in any other region. In addition, homicide rates among NHB women in the South were equal to or lower than corresponding rates in the West and Midwest. Finally, higher rates for NHW in metropolitan areas led to overall higher NHW mortality rates and relatively low NHB:NHW rates. Southern NHW had a higher percentage of firearms-related homicides (58.4%) than the corresponding percentage in the rest of the United States (49.8%; P < 0.001). Southern NHB used firearms for 78.8% of homicides compared with 83.9% in the rest of the United States (P < 0.001).Conclusions: The overall high homicide rates in the southern United States were attributable to relatively higher NHW rates than those found in the rest of the country. Further research targeting the role of firearms as well as cultural and other issues could further the understanding of the interrelations of homicide with complex regional and cultural factors. [ABSTRACT FROM AUTHOR]

This study determines convergence of African-American mortality rates in the United States with a particular focus on locational differences. Using county level data during 1968-2015, the convergence rate is higher in the South among regions. While splitting the sample between the Black Belt and non-Black Belt, the higher speed of convergence is obtained in the former, and when splitting the sample between the urban and rural areas, the higher speed of convergence is obtained in the latter. [ABSTRACT FROM AUTHOR]

This review describes stress-related biological mechanisms linking interpersonal racism to life course health trajectories among African Americans. Interpersonal racism, a form of social exclusion enacted via discrimination, remains a salient issue in the lives of African Americans, and it triggers a cascade of biological processes originating as perceived social exclusion and registering as social pain. Exposure to discrimination increases sympathetic nervous system activation and upregulates the HPA axis, increasing physiological wear and tear and elevating the risks of cardiometabolic conditions. Consequently, discrimination is associated with morbidities including low birth weight, hypertension, abdominal obesity, and cardiovascular disease. Biological measures can provide important analytic tools to study the interactions between social experiences such as racial discrimination and health outcomes over the life course. We make future recommendations for the study of discrimination and health outcomes, including the integration of neuroscience, genomics, and new health technologies; interdisciplinary engagement; and the diversification of scholars engaged in biosocial inequities research. [ABSTRACT FROM AUTHOR]

This article explores the visual representation of the deaths of African Americans Muhammad Ali and Maya Angelou as presented on 150 front pages of America's newspapers. Considered by many as icons for their athletic, entertainment, and/or cultural contributions, Ali and Angelou were both represented in photographs, designs, and written content, which were analyzed in this study using visual semiotics theory as an interpretative framework. The analysis suggests that there are varying levels in the way icons are represented on these front pages. These representations often depend on the perceived societal contributions, type of vocation, and the visual significance of the cultural icon. [ABSTRACT FROM AUTHOR]

Objectives To examine the difference in the association between apolipoprotein ( APO)E allele and overall and cardiovascular mortality between African Americans ( AAs) and European Americans ( EAs). Design Longitudinal, cohort study of 18 years. Setting Biracial urban US population sample. Participants 4,917, 68% AA and 32% EA. Measurements APOE genotype and mortality based on National Death Index. Results A higher proportion of AAs than of EAs had an APOE ε2 allele ( ε2 ε2/ ε2 ε3/ ε2 ε4; 22% vs 13%) and an APOE ε4 allele ( ε3 ε4/ ε4 ε4; 33% vs 24%). After adjusting for known risk factors, the risk of mortality was 19% less with the APOE ε2 allele (hazard ratio ( HR) = 0.81, 95% confidence interval ( CI) = 0.76-0.87), and the risk of cardiovascular mortality was 35% less ( HR = 0.65, 95% CI = 0.58-0.76) than with the ε3 ε3 allele. The risk of mortality was 10% greater with the APOE ε4 allele ( HR = 1.10, 95% CI = 1.04-1.16), and the risk of cardiovascular mortality was 20% greater ( HR = 1.20, 95% CI = 1.07-1.29) than with the ε3 ε3 allele. No difference in the association between APOE allele and mortality was observed between AAs and EAs. Conclusion The APOE ε4 allele increased the risk of overall and cardiovascular mortality, whereas the APOE ε2 allele decreased the risk of overall and cardiovascular mortality. There was no racial difference in the association between these alleles and mortality. [ABSTRACT FROM AUTHOR]

Background: Although the overall life expectancy at birth has increased for both blacks and whites and the gap between these populations has narrowed, disparities in life expectancy and the leading causes of death for blacks compared with whites in the United States remain substantial. Understanding how factors that influence these disparities vary across the life span might enhance the targeting of appropriate interventions.Methods: Trends during 1999-2015 in mortality rates for the leading causes of death were examined by black and white race and age group. Multiple 2014 and 2015 national data sources were analyzed to compare blacks with whites in selected age groups by sociodemographic characteristics, self-reported health behaviors, health-related quality of life indicators, use of health services, and chronic conditions.Results: During 1999-2015, age-adjusted death rates decreased significantly in both populations, with rates declining more sharply among blacks for most leading causes of death. Thus, the disparity gap in all-cause mortality rates narrowed from 33% in 1999 to 16% in 2015. However, during 2015, blacks still had higher death rates than whites for all-cause mortality in all groups aged <65 years. Compared with whites, blacks in age groups <65 years had higher levels of some self-reported risk factors and chronic diseases and mortality from cardiovascular diseases and cancer, diseases that are most common among persons aged ≥65 years.Conclusions and Implications For Public Health Practice: To continue to reduce the gap in health disparities, these findings suggest an ongoing need for universal and targeted interventions that address the leading causes of deaths among blacks (especially cardiovascular disease and cancer and their risk factors) across the life span and create equal opportunities for health. [ABSTRACT FROM AUTHOR]

Background: To determine whether plasma levels of markers of inflammation are predictive of the incidence of cardiovascular disease (CVD), hypertension, or mortality in African Americans with type 1 diabetes mellitus.Methods: A total of 484 African Americans with type 1 diabetes were included. At baseline and 6-year follow-up, a clinical interview and examination were conducted to document CVD and systemic hypertension. Venous blood for glycated hemoglobin and cholesterol was obtained and albumin excretion rate measured. Mortality was assessed annually between baseline and 6-year follow-up by review of the social security death index. Baseline plasma levels of 28 inflammatory biomarkers were measured using multiplex bead analysis system.Results: After adjusting for baseline age and other confounders, African Americans with type 1 diabetes in the highest quartile of plasma interferon-inducible protein 10 (IP-10) were three times more likely to develop CVD than those in the lowest quartile. African Americans with type 1 diabetes in the lowest quartiles of plasma stromal derived factor-1 (SDF-1) had a 75% higher risk of death than patients in the highest quartile, independently of age, low density lipoprotein cholesterol, body mass index, hypertension, and albuminuria.Conclusion: In African Americans with type 1 diabetes, high plasma IP-10 is an independent predictor for incident CVD and low SDF-1 an independent predictor for mortality. [ABSTRACT FROM AUTHOR]

Objectives. We investigated changes in life expectancy (LE) and cause-specific mortality over time, directly comparing African-descent populations in the United States and the Caribbean. Methods. We compared LE at birth and cause-specific mortality in 6 disease groups between Caribbean countries with a majority (>90%) African-descent population and US African Americans. Results. The LE improvement among African Americans exceeded that of Afro-Caribbeans so that the LE gap, which favored the Caribbean population by 1.5 years in 1990, had been reversed by 2009. This relative improvement among African Americans was mainly the result of the improving mortality experience of African American men. Between 2000 and 2009, Caribbean mortality rates in 5 of the 6 disease groups increased relative to those of African Americans. By 2009, mortality from cerebrovascular diseases, cancers, and diabetes was higher in Afro-Caribbeans relative to African Americans, with a diabetes mortality rate twice that of African Americans and 4 times that of White Americans. Conclusions. The Caribbean community made important mortality reductions between 2000 and 2009, but this progress fell short of African American health improvements in the same period, especially among men. [ABSTRACT FROM AUTHOR]

The Great Migration-the massive migration of African Americans out of the rural South to largely urban locations in the North, Midwest, and West-was a landmark event in US history. Our paper shows that this migration increased mortality of African Americans born in the early twentieth century South. This inference comes from an analysis that uses proximity of birthplace to railroad lines as an instrument for migration. (JEL I12, J15, N31, N32, N91, N92, R23) [ABSTRACT FROM AUTHOR]

Diabetes is the seventh leading cause of death in the United States and disproportionately affects ethnic minorities. While research examining health disparities is well-established, an historical understanding of how the disparities evolved over time may be warranted. This article examined racial differences in prevalence of diabetes and associated mortality in Blacks and Whites during the US Civil War. Data were extracted from the Medical and Surgical History of the War of Rebellion, 1861-1865, representing segregated White and Black Union Forces who served during the war. Data were collapsed by war theater (Atlantic, Central, Pacific). Results by race show that, from 1861 to 1866, the rates of Whites diagnosed with diabetes ranged overall from 0% to .11 % and was distributed throughout the war theaters as: Atlantic 0.3% to .05%; Central 0.3% to .08%, and Pacific 0% to .11%. For Blacks, Atlantic ranged from .02% to .07% and Central .03% to .06%. None were reported for Pacific. Mortality was approximately .01 % for both Blacks and Whites. These data suggest no racial differences in diabetes prevalence and mortality existed between Blacks and Whites during this time, implying that disparities may have evolved more recently. [ABSTRACT FROM AUTHOR]

The article focuses on the higher exposure to death of African Americans than the whites, due to differentials consisting of health and socio-economic status. Topics discussed are disadvantages due to black residential segregation which includes violence, homicide, and allostasis because of spatially concentrated deprivation, other pathways include shortening of telomeres due to environmental stress, and methylation of gene expression due to environmental circumstances.

Remaining controversies on the association between body mass index (BMI) and mortality include the effects of smoking and prevalent disease on the association, whether overweight is associated with higher mortality rates, differences in associations by race and the optimal age at which BMI predicts mortality. To assess the relative risk (RR) of mortality by BMI in Whites and Blacks among subgroups defined by smoking, prevalent disease, and age, 891,572 White and 38,119 Black men and women provided height, weight and other information when enrolled in the Cancer Prevention Study II in 1982. Over 28 years of follow-up, there were 434,400 deaths in Whites and 18,702 deaths in Blacks. Cox proportional-hazards regression was used to estimate multivariable-adjusted relative risks (RR) and 95% confidence intervals (CI). Smoking and prevalent disease status significantly modified the BMI-mortality relationship in Whites and Blacks; higher BMI was most strongly associated with higher risk of mortality among never smokers without prevalent disease. All levels of overweight and obesity were associated with a statistically significantly higher risk of mortality compared to the reference category (BMI 22.5–24.9 kg/m2), except among Black women where risk was elevated but not statistically significant in the lower end of overweight. Although absolute mortality rates were higher in Blacks than Whites within each BMI category, relative risks (RRs) were similar between race groups for both men and women (p-heterogeneity by race  = 0.20 for men and 0.23 for women). BMI was most strongly associated with mortality when reported before age 70 years. Results from this study demonstrate for the first time that the BMI-mortality relationship differs for men and women who smoke or have prevalent disease compared to healthy never-smokers. These findings further support recommendations for maintaining a BMI between 20–25 kg/m2 for optimal health and longevity. [ABSTRACT FROM AUTHOR]

Background: The main purpose of this study was to model and analyze the dynamics of cervical cancer mortality rates for African American (Black) and White women residing in 13 states located in the eastern half of the United States of America from 1975 through 2010. Methods: The cervical cancer mortality rates of the Surveillance, Epidemiology, and End Results (SEER) were used to model and analyze the dynamics of cervical cancer mortality. A longitudinal hyperbolastic mixed-effects type II model was used to model the cervical cancer mortality data and SAS PROC NLMIXED and Mathematica were utilized to perform the computations. Results: Despite decreasing trends in cervical cancer mortality rates for both races, racial disparities in mortality rates still exist. In all 13 states, Black women had higher mortality rates at all times. The degree of disparities and pace of decline in mortality rates over time differed among these states. Determining the paces of decline over 36 years showed that Tennessee had the most rapid decline in cervical cancer mortality for Black women, and Mississippi had the most rapid decline for White Women. In contrast, slow declines in cervical cancer mortality were noted for Black women in Florida and for White women in Maryland. Conclusions: In all 13 states, cervical cancer mortality rates for both racial groups have fallen. Disparities in the pace of decline in mortality rates in these states may be due to differences in the rates of screening for cervical cancers. Of note, the gap in cervical cancer mortality rates between Black women and White women is narrowing. [ABSTRACT FROM AUTHOR]

Objective To compare body-mass index (BMI)-related mortality risk in US Blacks vs. Whites as the relationship appears to differ across race/ethnicity groups. Methods Cross-sectional surveys of nationally representative samples of 11,934 Blacks and 59,741 Whites aged 35-75 in the National Health Interview Survey from 1997 to 2002 with no history of cardiovascular disease (CVD) or cancer were pooled. Mortality follow-up was available through 2006. BMI was calculated from self-reported height and weight. We used adjusted Cox regression analysis to adjust for potential confounders. Results Over 9 years of follow-up, there were 4303 deaths (1205 among never smokers). Age-adjusted mortality rates were higher in Blacks compared to Whites at BMI < 25 kg/m2 and showed no increase at higher levels of BMI. In men, adjusted hazard ratios for all-cause death rose in a similar fashion across upper BMI quintiles in Blacks and Whites; in women, however, BMI was positively associated with mortality risk in Whites, but inversely associated in Blacks ( P interaction = 0.01). Racial disparities were amplified in subsidiary analyses that introduced a 12-month lag for mortality or focused on CVD mortality. Conclusions The relationship of elevated BMI to mortality appeared weaker in US Blacks than in Whites, especially among women. [ABSTRACT FROM AUTHOR]

The article discusses the analysis of the homicides in the U.S. for 2007 and 2009. Topics mentioned include the fourth rank as the leading causes of death, the raising of the awareness on disparities and prompt actions that will reduce them, and the comparison of the homicide rates between 2007 and 2009 which found on the great risk among males with non-Hispanic African-Americans with ages from 15-29.

In this article, I examine the black-white crossover in U.S. adult all-cause mortality, emphasizing how cohort effects condition age-specific estimates of mortality risk. I employ hierarchical age-period-cohort methods on the National Health Interview Survey-Linked Mortality Files between 1986 and 2006 to show that the black-white mortality crossover can be uncrossed by factoring out period and cohort effects of mortality risk. That is, when controlling for variations in cohort and period patterns of U.S. adult mortality, the estimated age effects of non-Hispanic black and non-Hispanic white U.S. adult mortality risk do not cross at any age. This is the case for both men and women. Further, results show that nearly all the recent temporal change in U.S. adult mortality risk was cohort driven. The findings support the contention that the non-Hispanic black and non-Hispanic white U.S. adult populations experienced disparate cohort patterns of mortality risk and that these different experiences are driving the convergence and crossover of mortality risk at older ages. [ABSTRACT FROM AUTHOR]

The article discusses results of a study which examined the association of age and race on mortality of patients undergoing dialysis. The study design, setting and participants are discussed. The study showed that African American patients undergoing dialysis have low death rate compared with white patients. When using age and kidney transplantation as competing risks, African American patients have high mortality compared with their white counterparts aged 18 to 30 years. It concludes that African American patients have lower death risk compared with white patients.

We examine whether individual and neighborhood socioeconomic context contributes to black/white disparities in mortality among USA older adults. Using national longitudinal data from the Americans' Changing Lives study, along with census tract information for each respondent, we conduct multilevel survival analyses. Results show that black older adults are disadvantaged in mortality in younger old age, but older black adults have lower mortality risk than whites after about age 80. Both individual SES and neighborhood socioeconomic disadvantage contribute to the mortality risk of older adults but do not completely explain race differences inmortality. The racial mortality crossover persists even after controlling formultilevel SES, suggesting that black older adults experience selective survival at very old ages. Addressing the individual and neighborhood socioeconomic disadvantage of blacks is necessary to reduce mortality disparities that culminate in older adulthood. [ABSTRACT FROM AUTHOR]

Abstract: Background: End-stage renal disease disproportionately affects black persons, but it is unknown when in the course of chronic kidney disease racial differences arise. Understanding the natural history of racial differences in kidney disease may help guide efforts to reduce disparities. Methods: We compared white/black differences in the risk of end-stage renal disease and death by level of estimated glomerular filtration rate (eGFR) at baseline in a national sample of 2,015,891 veterans between 2001 and 2005. Results: Rates of end-stage renal disease among black patients exceeded those among white patients at all levels of baseline eGFR. The adjusted hazard ratios for end-stage renal disease associated with black versus white race for patients with an eGFR ≥90, 60-89, 45-59, 30-44, 15-29, and <15 mL/min/1.73m2, respectively, were 2.14 (95% confidence interval [CI], 1.72-2.65), 2.30 (95% CI, 2.02-2.61), 3.08 (95% CI, 2.74-3.46), 2.47 (95% CI, 2.26-2.70), 1.86 (95% CI, 1.75-1.98), and 1.23 (95% CI, 1.12-1.34). We observed a similar pattern for mortality, with equal or higher rates of death among black persons at all levels of eGFR. The highest risk of mortality associated with black race also was observed among those with an eGFR 45-59 mL/min/1.73m2 (hazard ratio 1.32, 95% CI, 1.27-1.36). Conclusion: Racial differences in the risk of end-stage renal disease appear early in the course of kidney disease and are not explained by a survival advantage among blacks. Efforts to identify and slow progression of chronic kidney disease at earlier stages may be needed to reduce racial disparities. [Copyright &y& Elsevier]

Various studies have reported an inverse association between serum albumin level and incident coronary heart disease (CHD), though biologic mechanisms have not been established. The authors examined the association between serum albumin level and CHD in the Atherosclerosis Risk in Communities cohort, comprising 14,506 White and African-American middle-aged men and women. The mean albumin level in this population was 3.9 g/dl (standard deviation 0.3). During 5.2 years of follow-up, 470 incident CHD events occurred. The hazard ratio for incident CHD associated with a 1-standard deviation decrease in serum albumin level was 1.26 (95% confidence interval (CI): 1.15, 1.38) after adjustment for age, gender, and ethnicity and 1.18 (95% CI: 1.07, 1.30) after additional adjustment for covariates related to CHD. Hazard ratios were similar across gender and ethnic groups. However, there was statistically significant effect modification by smoking status, with hazard ratios of 1.01 (95% CI: 0.84, 1.22) among never smokers, 1.09 (95% CI: 0.92, 1.30) among former smokers, and 1.35 (95% CI: 1.17, 1.54) among current smokers. Further adjustment for factors related to renal disease, nutrition, platelet aggregation, inflammation, use of angiotensin-converting enzyme inhibitors, and hemostasis factors attenuated the albumin-CHD relation only slightly. In this study, serum albumin was inversely associated with incident CHD at the baseline examination in current smokers but not in never or former smokers. Albumin level may be a marker of susceptibility to the inflammatory response that results from smoking. Am J Epidemiol 2000;151:468–77. [ABSTRACT FROM PUBLISHER]

Stroke is the third leading cause of death in US Blacks and is an important cause of mortality and morbidity worldwide. Mortality rates are higher in Blacks than in Whites in the United States at ages below 70 years. In Blacks, advanced age, elevated blood pressure, diabetes mellitus, and smoking are the only risk factors for stroke whose status has been firmly established by published data. More data are needed to assess other likely risk factors of importance for risk stratification and intervention and to determine the fraction of racial differences in stroke that may be explained by risk factor differences. Higher prevalences of hypertension, diabetes, obesity (in women), elevated lipoprotein(a) level, smoking (in men), and low socioeconomic status may contribute to the higher stroke incidence and mortality in US Blacks as compared with Whites. However, further environmental influences must be studied and candidate genes identified before assuming that racial differences can be attributed to inborn susceptibility linked to inheritance of specific genes. Am J Epidemiol 1999; 150: 1266-74. [ABSTRACT FROM PUBLISHER]

The article presents excerpts of a speech by Alan C. Page, Associate Justice of the Supreme Court of Minnesota, that was delivered at Kentucky Wesleyan College in Owensboro, Kentucky, on February 26, 1996 in which he discussed the education of colored children in the U.S., Black poverty, and Black mortality rates.

Objectives. We examined the role of family history of diabetes in awareness of diabetes risk factors and engaging in health behaviors. Methods. We conducted a cross-sectional analysis of 1122 African American adults without diabetes who were participants in Project DIRECT (Diabetes Interventions Reaching and Educating Communities Together). Results. After adjustment for age, gender, income, education, body mass index, and perceived health status, African Americans with a family history of diabetes were more aware than those without such a history of several diabetes risk factors: having a family member with the disease (relative risk [RR]=1.09; 95% confidence interval [CI]=1.03, 1.15), being overweight (RR=1.12; 95% CI=1.05, 1.18), not exercising (RR=1.17; 95% CI=1.07, 1.27), and consuming energy-dense foods (RR=1.10; 95% CI=1.00, 1.17). Also, they were more likely to consume 5 or more servings of fruits and vegetables per day (RR=1.31; 95% CI=1.02, 1.66) and to have been screened for diabetes (RR=1.21; 95% CI=1.12, 1.29). Conclusions. African Americans with a family history of diabetes were more aware of diabetes risk factors and more likely to engage in certain health behaviors than were African Americans without a family history of the disease. [ABSTRACT FROM AUTHOR]

The article discusses a study documenting the life-expectancy gap between African Americans and Caucasian Americans. It investigated the discrepancy from 1983-2003. It found that from 1983-1993, the gap increased 0.5 years, but declined 1 year between 1993 and 2003. The primary causes of the increase in the first 10 years were mortalities among African Americans due to human immunodeficiency virus (HIV), homicide, and heart disease. The decrease in mortality among African Americans due to HIV and homicide caused the decline. The author believes that while the gap narrowing is a good beginning, more needs to be done to reduce inequalities, especially in cardiovascular disease care.

This article discusses the mortality rates of African-Americans in the United States. The article notes that the largest increase in life expectancy during the 21st century has occurred among African-Americans, especially African-American females. African-American females gained 0.5 years of life expectancy from 2002 through 2003, and the author attempts to examine why this change occurred. The article provides a graph of mortality levels between Caucasians and African-Americans from ages 85 through 100.

Abstract: Heart failure (HF) is an increasingly prevalent condition contributing to significant morbidity and mortality among African-Americans. The Heart Failure Adherence and Retention Trial (HART) is the largest NHLBI funded behavioral clinical trial of patients with HF (R01 HL65547). The HART trial has recruited approximately 40% minority participants, with 33% being African-American. The purpose of this qualitative study is to conduct an in-depth examination of the subjective experience of African-American participants in the intervention arm of the HART. Five focus groups were conducted with a total of 25 participants. The mean age of those attending was 55 years, with a range between 39 and 82 years, 52% of the participants were female, and 92% were African-American. Participants gained overall general medical knowledge about HF and how HF influenced their own lives. Participants appeared not only to understand the self-management skills that were taught; but also how to apply them. They also demonstrated understanding of the connection between lifestyle and HF. Factors that may promote retention include mutual support, the opportunity to engage in meaningful social activity, and feeling cared for. Factors that may limit retention include anxiety and denial about HF and logistical and emotional barriers to attending groups. Factors with unclear effects on retention include remuneration, ethnicity of the group leader, and the role of religious or spiritual content in meetings. While a number of perceived benefits exist to group participation, there are significant and logistical barriers to retention. Ongoing attention to cultural sensitivity is a likely factor in successful retention of study participants. [Copyright &y& Elsevier]

Aim To determine rates and risk factors for all-cause mortality in African-Americans with Type 1 diabetes from a 3-year observational follow-up study of 725 African-Americans with Type 1 diabetes conducted between 1 January 1999 and 31 December 2001. Methods Date of death was ascertained either from telephone contact with the patient's family or from relatives or on line review of the US Social Security death index. Results Since the initial examination, 131 (18.1%) patients, 60 (20%) men and 71 (17%) women, have died. At the time of death, the mean age of the men was 40.7 ± 10.6 years and that of the women 39.4 ± 10.5 years. The median duration of diabetes at the baseline examination was 8.04 years, interquartile range (IQR) 3.76–15.22 years for men and median 10.54, IQR 4.49–18.36 years for women. Three-year mortality rates were 7.1% for women and 10.6% for men. Age-adjusted mortality rates were not significantly different between men and women. Relative to the general US and the New Jersey African-American population, standardized mortality ratios of African-Americans with Type 1 diabetes were 12 and six times greater for women and men, respectively. Older age, low socio-economic status, low body mass index, high diastolic blood pressure, macroangiopathy, proteinuria, severe diabetic retinopathy and heavy alcohol consumption were independent risk factors for all-cause mortality. In patients with microproteinuria at initial examination, the mortality rate for men was twice that of women. Conclusion Microproteinuria and other potentially modifiable factors, including hypertension, macroangiopathy and heavy alcohol consumption, are independent risk factors for mortality in this ethnic group. [ABSTRACT FROM AUTHOR]

The purpose of the study was to examine racial and ethnic disparities in all-cause mortality, and deaths stemming from 8 of the leading causes in the United States. It was hypothesized that African Americans and other disadvantaged minorities will experience higher overall risks of deaths than whites. Data employed were from the U.S. National Longitudinal Mortality Study to estimate the effect of race on all-cause and specific cause-specific mortality. Statistical methods used included Cox proportional hazards regression. It was observed that African Americans had mortality risks that were 15% higher than whites. Asians and Hispanics had lower overall mortality risks than whites. African Americans had much higher mortality risks than whites on three of the leading causes of death. It was concluded that the observed effect of African American race on mortality cannot be explained by socioeconomic and demographic factors alone. Lower Hispanic mortality was explained within the framework of immigration. Other reasons for the observed effect of race on mortality were explored in the study. [ABSTRACT FROM AUTHOR]

Background: Patients hospitalized with community acquired pneumonia (CAP) have a substantial risk of death, but there is evidence that adherence to certain processes of care, including antibiotic administration within 8 hours, can decrease this risk. Although national mortality data shows blacks have a substantially increased odds of death due to pneumonia as compared to whites previous studies of short-term mortality have found decreased mortality for blacks. Therefore we examined pneumonia-related processes of care and short-term mortality in a population of patients hospitalized with CAP. Methods: We reviewed the records of all identified Medicare beneficiaries hospitalized for pneumonia between 10/1/1998 and 9/30/1999 at one of 101 Pennsylvania hospitals, and randomly selected 60 patients at each hospital for inclusion. We reviewed the medical records to gather process measures of quality, pneumonia severity and demographics. We used Medicare administrative data to identify 30-day mortality. Because only a small proportion of the study population was black, we included all 240 black patients and randomly selected 720 white patients matched on age and gender. We performed a resampling of the white patients 10 times. Results: Males were 43% of the cohort, and the median age was 76 years. After controlling for potential confounders, blacks were less likely to receive antibiotics within 8 hours (odds ratio with 95% confidence interval 0.6, 0.4-0.97), but were as likely as whites to have blood cultures obtained prior to receiving antibiotics (0.7, 0.3-1.5), to have oxygenation assessed within 24 hours of presentation (1.6, 0.9-3.0), and to receive guideline concordant antibiotics (OR 0.9, 0.6-1.7). Black patients had a trend towards decreased 30-day mortality (0.4, 0.2 to 1.0). Conclusion: Although blacks were less likely to receive optimal care, our findings are consistent with other studies that suggest better risk-adjusted survival among blacks than among whites. Further study is needed to determine why this is the case. [ABSTRACT FROM AUTHOR]

Examines the association of body mass index (BMI) and mortality in African-American men and women. Patient characteristics; Evidence for increased mortality at low BMI than high BMI; U-shaped trend between BMI and mortality in both African-American and white women; Difference in death rates between African-Americans and whites.

Background: African-Americans generally have lower survival rates from colon cancer than Caucasian Americans. This disparity has been attributed to many sources, including diagnosis at later disease stage and other unfavorable disease features, inadequate treatment, and socioeconomic factors. The randomized clinical trial setting ensures similarity in disease stage and a uniform treatment plan between blacks and whites. In this study, we evaluated survival and related end points for African-American and Caucasian patients with colon cancer participating in randomized clinical trials of the National Surgical Adjuvant Breast and Bowel Project (NSABP) to determine whether outcomes were less favorable for African-Americans.Methods: The study included African-American (n = 663) or Caucasian (n = 5969) patients from five serially conducted, randomized clinical trials of the NSABP. We compared recurrence-free survival, disease-free survival (recurrence, new primary cancer, or death), and survival (death from any cause) between blacks and whites by using statistical modeling to account for differences in patient and disease characteristics between the groups. Statistical tests were two-sided.Results: Dukes' stage and number of positive lymph nodes were remarkably similar between African-American and Caucasian patients in each trial. Over all trials combined, an 8% (95% confidence interval [CI] = -6% to 25%; P =.27) excess risk of colon cancer recurrence that was not statistically significant was observed for blacks. A greater disparity in survival was seen, with blacks experiencing a statistically significant 21% (95% CI = 6%-37%; P =.004) greater risk of death. Treatment efficacy appeared similar between the groups.Conclusions: While the overall survival prognosis was less favorable for African-Americans compared with Caucasians in these trials, other outcomes measured were considerably more similar than those seen in the population at large, suggesting that earlier detection and adjuvant therapy could appreciably improve colon cancer prognosis for African-Americans. Continued investigations into causes of the deficits noted are warranted. [ABSTRACT FROM AUTHOR]

Explores the possible reasons for the higher cancer rates experienced by Southern-born black Americans, especially those who migrated to the Northeast and Midwest, than by black Americans who were born, and who died, outside the South. Age-specific death rates for regions of birth and residence.

Discusses the effect of society and being in a new environment on the mortality rate of African Philadelphians' mortality during the colonial period. Unfamiliarity with the climate; Presence of Eurasian servants; Maltreatment received from social superiors; Death ratio with those of European Americans; Diet on the basis of their preferred role in society.

Tests the the region-of-birth and region-of-death homicide hypotheses by examining homicide deaths among black Americans during the period 1971-1991. Two historical hypotheses on homicide; Suggested hypothesis from the research; Implications of the research results.

Presents age- and sex-specific death rates for 1979-83 for black residents of Suffolk County, New York for all causes of death and for diabetes mellitus, ischemic heart disease, and cerebrovascular disease. Comparison with white residents; Socioeconomic characteristics of blacks and whites in Suffolk; Proportional mortality ratios.

The article presents a paper that evaluates the quality of vital statistics and census data for estimating African-American mortality. Demographers are certain that a serious difficulty in estimating African-American mortality levels results from age misreporting, especially at the older ages. The seriousness of this problem was revealed clearly in a direct matching of 1960 death certificates to records from the 1960 Census of Population. In only 44.7% of nonwhite male and 36.9% of nonwhite female matched cases was the same year of age reported in the census as on the death certificate. So, in the paper, the investigators have employed intercensal cohort comparisons and extinct generation estimates to demonstrate that conventionally constructed African-American death rates may be seriously flawed as early as age 50. Using the crude death rate at ages 50 + for 1978-1982 in conjunction with estimated growth rates and two model life table systems, the investigators have estimated black age-specific death rates in 1978-1982. The results suggest that if a racial crossover in death rates occurs, the age pattern of mortality among African-Americans must be far outside the range observed in populations with more accurate data.

Examines the sensitivity of mortality estimates of enslaved African-Americans in the United States. Debate over the standard of living of enslaved Africans in the Americas; Calculation of different life tables for African-Americans; African mortality in the Caribbean; Reconstruction of African-American mortality; Measurement of illegal slave trade.

Examines the effect of known risk factors on the excess mortality of black adults in the U.S. Comparison of mortality rate ratios before and after adjustment for different risk factors for black and white adults; Decrease in rate ratio of mortality for blacks and whites among persons 35 to 54 years old; Adjustment for six risk factors, namely smoking, systolic blood pressure, cholesterol level, body mass index, alcohol intake and diabetes.

The author reflects on the arguments regarding racism in the health care reform programs in the U.S. She discusses several inadequacies of the health care system that impacts the issue in racism, including higher mortality rate for African American babies compared to white babies, the higher rate of lung cancer for black men, and a shorter life expectancy of black women. She believes that any programs that don't address the issue on race will not erase the racial disparities in health care.

Large differences between the age patterns of mortality as reflected in official U.S. life tables exist for whites and Negroes. However, the quality of the data underlying the tables for Negroes may be so defective that it is questionable if these life tables provide an accurate representation of the patterns of mortality actually experienced by Negroes. Alternative hypotheses concerning the differences are examined. However, comparisons of the official life tables after adjustment for major sources of error with model life tables suggest that the age patterns of mortality for American Negroes do in fact differ from those of the whites. This difference implies the need to develop additional families of model life tables. [ABSTRACT FROM AUTHOR]

The article presents data on overdoses of prescription opioid pain relievers (OPR) in the U.S. from 1999-2008. A total of 36,450 deaths attributed to drug overdose was reported in 2008. OPR overdose death rate among non-Hispanic whites and American Indians/Alaska Natives was higher than death rates in African Americans and Hispanic whites. Persons aged 35-54 years were found to be the highest with drug overdose death rates. Oversode death rates were prevalent in Nebraska, New Mexico and Oklahoma, while the highest OPR sales were centered in the Southeast and the Northwest. OPR-related overdose death rates, sales and substance abuse treatment admissions increased from 1999-2008.