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In December 2019, COVID-19 was detected in Wuhan, China, and declared a pandemic in March 2020. The Centers for Disease Control and Prevention (CDC) says it has been detected in nearly 200 countries and is an ongoing concern in the United States. Various reports provided anecdotal evidence that many ethnic minorities and specifically African Americans have become ill and died from COVID-19. Coincidentally, several states have provided data that at least initially corroborate the anecdotes. Narratives and descriptive data were compiled from medical and public health professionals to ascertain whether medical evidence supports the over-representation of state-level total infections and deaths of African Americans. The ramifications are critical for African Americans, non-medical professional, citizens, and also to the reduction and mitigation of the novel coronavirus as an American pandemic. The medical and health policy literature suggests that African Americans are burdened with a disproportionate share of persons contracting and dying due to COVID-19. Authors and witnesses believe that their occupation as essential workers, poverty, health access, government distrust, comorbidities, and Social Determinants of Health (SDH) are important factors for further research. For these reasons, federal funding of a rigorous and robust national public health study of COVID-19 and African Americans is highly recommended and the next logical step to develop mitigation strategies that reduce infection, mortality, and disparate medical outcomes., Author(s): Vincent E. Mangum [sup.1] Author Affiliations: (1) grid.462027.5, 0000 0000 9561 0995, School of Business and Technology, Atlanta Metropolitan State College, , 1630 Metropolitan Parkway, SW, 30310, Atlanta, GA, [...]

Among US racial/ethnic groups, Blacks are at the highest risk of acquiring HIV/ AIDS. In response, the Centers for Disease Control and Prevention (CDC) has launched the Heightened National Response to Address the HIV/AIDS Crisis Among African Americans, which seeks to engage public and nonpublic partners in a synergistic effort to prevent HIV among Blacks. The CDC also recently launched Act Against AIDS, a campaign to refocus attention on the domestic HIV/AIDS crisis. Although the CDC's efforts to combat HIV/AIDS among Blacks have achieved some success, more must be done to address this crisis. New initiatives include President Obama's goal of developing a National HIV/AIDS Strategy to reduce HIV incidence, decrease HIV-related health disparities, and increase access to care, especially among Blacks and other disproportionately affected populations. (Am J Public Health. 2009;99:S351-S359. doi: 10.2105/AJPH.2008.157958)

HIV-related stigma and discrimination negatively impact African Americans living with HIV. Social support theory hypothesizes that social support can serve to protect individuals against the negative effects of stressors, such as discrimination, by leading them to interpret stressful occasions less negatively. This study sought to examine the relationship between perceived social support and perceived HIV stigma among HIV-positive African Americans. A cross-sectional convenience sample of 283 HIV-positive African Americans was recruited from three social service agencies. Bivariate and multivariate regressions were used to determine the variables predicting perceived HIV stigma. The study participants were found to have a wide variety of opinions concerning perceived HIV stigma. Of the three different sources of perceived social support examined (from family, friends and a 'special person'), only perceived social support from friends was found to be related to perceived HIV stigma when controlling for the presence of other relevant factors. High perceived social support from friends was associated with less perceived HIV stigma. Other factors associated with low perceived HIV stigma included a lack of current symptoms of major depression, a longer time since HIV diagnosis and higher education. Information about the beneficial effects of perceived social support from friends and other factors can help to provide guidance to those working to decrease the negative impact of HIV stigma among HIV-positive African Americans.

The purpose of this study was to examine the prevalence of symptoms of psychological distress experienced by African Americans upon self-enrollment in HIV-related mental health care and to compare the symptoms in this sample to the Brief Symptom Inventory (BSI) normative sample, the instrument used in this study to assess symptoms of psychological distress. Data were collected from 575 African Americans living with HIV who self-enrolled at an HIV-related mental health clinic located in a large city in the southeastern United States. Nearly 20% of the sample reported a t score ~ 63 for both somatization and paranoid ideation, a level indicative of a need for further psychological evaluation. Compared to the normative sample, this sample had significantly lower levels (p (0.05) of anxiety, depression, phobic anxiety, interpersonal sensitivity, and global severity index than the normative sample and had significantly higher levels of paranoid ideation and somatization than the normative sample. These results indicate that, overall, African Americans presented for mental health services with lower levels of symptoms of psychological distress than the normative sample. To that end, it is possible that African Americans living with HIV may underreport symptoms of psychological distress or may experience symptoms of psychological distress differently than other individuals. As a result, it is important that HIV-related service providers recognize these patterns of psychological distress and provide appropriate referrals to HIV-related mental health providers.

This paper employs syndemics theory to explain high rates of sexually transmitted disease among inner city African American and Puerto Rican heterosexual young adults in Hartford, CT, USA. Syndemic theory helps to elucidate the tendency for multiple co-terminus and interacting epidemics to develop under conditions of health and social disparity. Based on enhanced focus group and in-depth interview data, the paper argues that respondents employed a cultural logic of risk assessment which put them at high risk for STD infection. This cultural logic was shaped by their experiences of growing up in the inner city which included: coming of age in an impoverished family, living in a broken home, experiencing domestic violence, limited expectations of the future, limited exposure to positive role models, lack of expectation of the dependency of others, and fear of intimacy. Keywords: Syndemics; Sexually transmitted diseases; Young adults; African American; Puerto Rican; Political economy

Relatives' critical and intrusive behavior with patients, patients' odd or unusual thinking with relatives, and the course of schizophrenia were examined. Seventy-one African American and White patients (each with 1 relative) completed 2 problem-solving discussions. Relatives' critical and intrusive behavior with patients and patients' odd or unusual thinking with relatives were assessed, and patients were followed for 2 years. For African American patients, high levels of relatives' critical and intrusive behavior were associated with better outcome. For White patients, low levels of both relatives' critical and intrusive behavior and patients' odd or unusual thinking with relatives were associated with better outcome. The results suggest that during family interactions, seemingly negative behaviors may be perceived as a sign of caring and concern by African Americans. For Whites, the combination of patients' odd or unusual thinking with relatives and relatives' critical and intrusive behavior toward patients may be especially predictive of an adverse course. Keywords: schizophrenia, expressed emotion, racial and ethnic differences, problem-solving interactions

Byline: Amy Yan (1), Anna Mekikian (1), Mohsen Bazargan (2), Gangadarshni Chandramohan (1,3) Keywords: Urinary tract infection; Minority; African-Americans; Hispanic; Follow-up Abstract: Urinary tract infection (UTI) is one of the common bacterial infections in children and may lead to substantial morbidity. This study examines (1) the frequency of the performance of follow-up urine cultures and imaging studies for children diagnosed with UTI and (2) the relationship of the demographic and insurance status of patients with the management and follow-up of UTI. We conducted a retrospective chart review of children with first-time documented UTI at six different county medical center satellite outpatient clinics and hospital-based pediatric outpatient walk-in clinics, serving an indigent minority community, from January 1998 to December 2000. We identified 144 children with confirmed UTI. Of 144 subjects in our study, 44% had follow-up urine cultures and 43% of these children showed continued infection after a full course of antibiotics. Renal ultrasonography and voiding cystourethrogram were performed in 53% and 39% of children, respectively. Of those patients who did not receive follow-up imaging, 67% had no documentation for follow-up appointments. However, in 29% of cases attempts had been made to contact patients who were scheduled for follow-up, but they did not return for the studies. These data suggest there is a significant failure rate for the follow-up of pediatric UTI. There is need for educational intervention among pediatricians who provide medical care to ethnically diverse underserved, often uninsured, minority children. This intervention should reinforce compliance with the standard recommendations for appropriate UTI follow-up studies and imaging and provide realistic strategies for achieving recommended outcomes in these high-risk populations. Author Affiliation: (1) Department of Pediatrics, Charles R. Drew University of Medicine and Science, 1731 East 120th Street, Los Angeles, CA 90059, USA (2) Research Centers in Minority Institutions, Charles R. Drew University of Medicine and Science, Los Angeles, California, USA (3) UCLA School of Medicine, Los Angeles, California, USA Article History: Registration Date: 14/07/2004 Received Date: 06/01/2004 Accepted Date: 15/06/2004 Online Date: 14/10/2004

Hemolytic anemia is a forme fruste of systemic lupus erythematosus (SLE), being observed months or even years before the onset of other clinical manifestations in some patients. We hypothesized that hemolytic anemia in those SLE-affected patients would identify a group of SLE pedigrees that share a high degree of genetic homogeneity. From 160 multiplex SLE pedigrees, we sought evidence for linkage in 35 (16 African-American, 17 European-American, and 2 Hispanic) who had at least one SLE-affected patient with hemolytic anemia. Significant linkage was present at 11q14 in the 16 African-American pedigrees, yielding a maximum two-point logarithm of odds (LOD) score of 4.5 at D11S2002. The segregation pattern of SLE in these African-American pedigrees suggested a dominant mode of inheritance and, when maximized across penetrance and disease allele frequencies, produced a multipoint LOD of 4.7. Multipoint analysis yielded a multipoint heterogeneity LOD score of 3.6 ([alpha] = 0.63), again with maximum LOD at D11S2002. Finally, markers typed 7 centimorgans to either side of D11S2002 achieved LOD scores of 3 or better by using the maximized model, supporting linkage to 11q14. Clearly, pedigree ascertainment based on select clinical manifestations is an important tool, capable of revealing otherwise cryptic genetic linkages in complex genetic diseases. Thus, we show strong evidence for an SLE susceptibility gene, SLEH1, near D11S2002 in African-American pedigrees multiplex for SLE that have at least one SLE-affected patient with hemolytic anemia.

Byline: Susan A. Zeisel (1,2), Joanne E. Roberts (1,3,4), Margaret Burchinal (1,5), Eloise Neebe (1), Frederick W. Henderson (1,6) Keywords: otitis media; middle ear fluid; infants; preschoolers Abstract: Objective: Otitis media with effusion (OME) is a common health care problem for children. The purpose of this study was to examinefactors that place children at risk for OME such as age, type of child care, number of people in the household, and smoking in thehousehold. Methods: Eighty-six African American children, enrolled in center-based child care in infancy, entered the study at a mean age of 8.2 months and were followed prospectively until 48 months of age. Ear status was documented biweekly using pneumatic otoscopy and tympanometry. Data on risk factors were collected every 6 months. Results: Results indicated that children had a marked decrease in the proportion of time with OME between 6 and 48 months. The rate of OME decline was faster in the first 2.5 years than in subsequent years. Children in center-based child care showed a slightly slower rate of decline than did children in non-center-based care. Longitudinal analysis indicated that the age of the child and the number of other children in the household were significant predictors of OME. For each additional child under 12 years of age in the home, there was a 2% increase in the proportion of time with OME. Conclusion: While attendance in group child care predicted a risk for OME, children's age and the number of other children in the household were still contributing risk factors for OME. Author Affiliation: (1) Frank Porter Graham Child Development Institute, University of North Carolina, Chapel Hill, North Carolina (2) School of Nursing, University of North Carolina, Chapel Hill, North Carolina (3) Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (4) Division of Speech and Hearing Sciences, University of North at Chapel Hill, Chapel Hill, North Carolina (5) Department of Psychology, University of North at Chapel Hill, Chapel Hill, North Carolina (6) School of Medicine, University ofNorth Carolina at Chapel Hill, Chapel Hill, North Carolina Article History: Registration Date: 04/10/2004

Black cancer patients have the same outcome as white cancer patients provided they receive the same treatments, according to researchers who analyzed 54 studies covering 189,877 white patients and 32,004 black patients with 14 different cancers. This supports the idea that black cancer patients have higher mortality rates because they do not receive adequate treatment, not because there is some biological difference between the races., Context in recent years a theory that cancer biology is different in blacks and whites has gained prominence in reaction to epidemiologic observations that blacks have poorer survival than whites, even when diagnosed with cancer of similar severity. Yet, few studies have evaluated whether lower-quality treatment and shorter overall life expectancy due to a greater burden of other illnesses may explain the survival discrepancy. Objective To estimate the magnitude of overall and cancer-specific survival differences between blacks and whites who receive comparable treatment for similar-stage cancer. Data Sources We searched MEDLINE for English-language articles published from 1966 to January 2002 that reported on overall survival for black and white patients treated similarly for cancer. Study Selection The abstracts or titles for 891 citations were independently examined by 2 authors. The full text was retrieved if the abstract mentioned both black and white patients, made some comment regarding either similarity of treatment received or presented an analysis based on the treatment received, and commented on survival. Studies were included if they included data for at least 10 black and 10 white patients; specified the cohort ascertainment method and what measures were undertaken to minimize loss to follow-up; summarized survival of both blacks and whites using actuarial measures; presented outcomes within stage, adjusted for stage, or based on cohorts with balanced stage distributions; and specified that blacks and whites in the study received similar treatment. We identified 89 unique cohorts in 54 articles that met our inclusion criteria. Data Extraction Overall survival rates and hazard ratios (HRs) for death for blacks relative to whites were calculated. These were subsequently adjusted for rates of death due to causes other than the cancer under study to determine cancer-specific survival and cancer-specific HRs. Data Synthesis Results represent 189877 white and 32004 black patients with 14 different cancers. Compared with whites, blacks had an overall excess risk of death (HR, 1.16; 95% confidence interval [Cl], 1.12-1.20). After correction for deaths due to other causes, the cancer-specific HR was 1.07 (95% Cl, 1.02-1.13). Of the 14 cancers, blacks were at a significantly higher risk of cancer-specific death only for cancer of the breast, uterus, or bladder. Conclusions Only modest cancer-specific survival differences are evident for blacks and whites treated comparably for similar-stage cancer. Therefore, differences in cancer biology between racial groups are unlikely to be responsible for a substantial portion of the survival discrepancy. Differences in treatment, stage at presentation, and mortality from other diseases should represent the primary targets of research and interventions designed to reduce disparities in cancer outcomes.

Systemic lupus erythematosus (SLE) is an autoimmune disorder characterized by production of autoantibodies against intracellular antigens including DNA, ribosomal P, Ro (SS-A), La (SS-B), and the spliceosome. Etiology is suspected to involve genetic and environmental factors. Evidence of genetic involvement includes: associations with HLA-DR3, HLA-DR2, Fc[Gamma] receptors (Fc[Gamma]R) IIA and IIIA, and hereditary complement component deficiencies, as well as familial aggregation, monozygotic twin concordance > 20%, [[Lambda].sub.s] > 10, purported linkage at 1q41-42, and inbred mouse strains that consistently develop lupus. We have completed a genome scan in 94 extended multiplex pedigrees by using model-based linkage analysis. Potential [[log.sub.10] of the odds for linkage (lod) > 2.0] SLE loci have been identified at chromosomes 1q41, 1q23, and 11q14-23 in African-Americans; 14q11, 4p15, 11q25, 2q32, 19q13, 6q26-27, and 12p12-11 in European-Americans; and 1q23, 13q32, 20q13, and 1q31 in all pedigrees combined. An effect for the Fc[Gamma]RIIA candidate polymorphism) at 1q23(lod = 3.37 in African-Americans) is syntenic with linkage in a murine model of lupus. Sib-pair and multipoint nonparametric analyses also support linkage (P < 0.05) at nine loci detected by using two-point lod score analysis (lod > 2.0). Our results are consistent with the presumed complexity of genetic susceptibility to SLE and illustrate racial origin is likely to influence the specific nature of these genetic effects.

Byline: Jonathan M. Sorof (1), Edith P. Hawkins (2), Eileen D. Brewer (1), Ivy I. Boydstun (1), Arundhati S. Kale (1), David R. Powell (1) Keywords: Key words: Focal segmental glomerulosclerosis; Proteinuria; Race Abstract: In patients with proteinuria, African-American (AA) ethnicity is reported to be a risk factor for focal segmental glomerulosclereosis (FSGS) and its progression to end-stage renal disease (ESRD). We reviewed our single-center experience to determine the probability of FSGS and its progression to ESRD based on ethnicity and age at presentation in children with proteinuria with or without nephrotic syndrome. Proteinuria without systemic disease or acute glomerulonephritis was the presenting feature in 17% (236/1,403) of children in the renal patient database of Texas Children&apos;s Hospital, Baylor College of Medicine. Histopathological diagnoses were established in 107 of 236 patients (45%). FSGS was identified in 65 patients, accounting for 28% of all patients with proteinuria and 61% of patients who underwent renal biopsy. FSGS was more prevalent in AA (45%) than in non-AA patients (22%) (P=0.001), and AA patients with FSGS were older at presentation (12.7+-4.4 years) than non-AA patients (5.6+-4.6 years) (P&lt 0.001). Among patients who underwent renal biopsy, increasing age at presentation increased the probability of having FSGS in AA but not non-AA patients (P=0.04). Five-year actuarial renal survival of FSGS was worse in AA (8%) than in non-AA patients (31%) (P=0.01). These data suggest an increased risk and worse outcome of FSGS in AA compared with non-AA children. Author Affiliation: (1) Department of Pediatrics-Renal Section, Texas Children&apos;s Hospital, Baylor College of Medicine, Houston, Texas, USA, US (2) Department of Pathology, Texas Children&apos;s Hospital, Baylor College of Medicine, Houston, Texas, USA, US Article note: Received February 4, 1998 received in revised form March 30, 1998 accepted April 20, 1998

Exercise may be effective in reducing blood pressure and enlargement of the heart in African-American men with severe hypertension. Of 46 African-American men with severe hypertension, 23 were assigned to receive drug therapy alone and 23 to receive drug therapy and follow an exercise program. The exercise program involved riding an exercise bicycle three times a week at 60% to 80% maximal heart rate for 20 to 60 minutes. After 16 weeks, the average systolic pressure decreased from 88 millimeters (mm) of Hg to 83 mm Hg in the exercise group, and increased from 88 mm Hg to 90 mm Hg in the non-exercise group. Enlargement of the left ventricle decreased more in the exercise group than in the non-exercise group after 16 weeks. During a second 16 week phase, medication was decreased successfully in 10 of 14 exercisers but in none of the non-exercisers.

Black people may have a significantly higher risk of cardiac arrest than whites. Survival rates may also be lower among black patients after cardiac arrest. Among 6,451 patients who had an out-of-hospital cardiac arrest in Chicago, IL between Jan 1, 1987 and Dec 31, 1988, 2,910 were black, 3,207 were white and 334 were members of other races. For every age group, black individuals had a significantly higher incidence of cardiac arrest than white individuals. Less than 1% of black patients survived after cardiac arrest, compared with 3% of white patients. Significantly fewer black patients had bystander-initiated cardiopulmonary resuscitation or were admitted to the hospital. The response time of emergency medical services was similar for black patients and white patients.

African American patients with hypertension may be more likely to develop impaired kidney function than are members of other ethnic groups despite special treatment for the condition. Among 5,524 men with mild to moderate high blood pressure, 2,758 received special treatment for high blood pressure and 2,766 received the usual care. Control of blood pressure was approximately the same in both treatment groups and among patients from different ethnic groups, but black patients were more likely to develop impaired kidney function than non-black patients. Patients with both increased systolic and diastolic blood pressure and older patients were also more likely to develop impaired kidney function. Decreased diastolic blood pressure was associated with a lower chance of kidney disorders among the non-black patients. Treatment to maintain a decreased diastolic blood pressure did not affect the risk of developing impaired kidney function among the black patients.

Black people may be more likely to develop end-stage renal (kidney) disease (ESRD) as a complication of non-insulin dependent diabetes mellitus (NIDDM) than whites. Among 442 patients treated for ESRD caused by diabetes between 1980 and 1985, 284 (64%) had NIDDM and 158 (36%) had insulin-dependent diabetes mellitus (IDDM). The number of blacks treated for diabetic ESRD per year was approximately three times as high as the number of whites. Approximately twice as many blacks developed ESRD associated with IDDM per year as whites. The number of blacks who developed ESRD associated with NIDDM per year was more than four times the number of whites. These differences may be caused by factors other than the higher incidence of diabetes and hypertension among blacks than among whites or differences in socioeconomic status. Black patients with diabetes may be genetically predisposed towards developing complications affecting their kidneys.

Black women who have coronary artery disease (CAD) may have a worse prognosis than black men who have CAD, compared to black men and women who do not have CAD. A study of 1,719 black patients enrolled in the Cook County (IL) Heart Disease Registry found that death rates from heart disease were similar in men and women. Patients were enrolled in the registry if they were referred for coronary angiography, hospitalized for a heart attack or referred for coronary artery bypass grafting. Those referred for coronary angiography were further subdivided by those who had a normal angiogram, that is, no CAD, and those who had CAD. Although death rates in men and women were similar, when men and women with CAD were compared to men and women without CAD, the women had a much worse prognosis. Women with CAD who suffered a heart attack were 10 times more likely to die than women without CAD. Men with CAD who suffered a heart attack were only four times more likely to die than those without CAD., Objective.--To evaluate the influence of gender on the prognosis of coronary heart disease among black patients. Design.--Cohort study based on a consecutive sample from a hospital registry, with a mean follow-up of 4 years. Setting.--An inner-city public hospital in Chicago, III. Patients.--The study included 1719 consecutive black patients (780 men and 939 women) who had any one of the following events: cardiac catheterization for presumed coronary heart disease, hospitalization for acute myocardial infarction, or coronary artery bypass grafting. Results.--Hospital and operative mortality rates following acute myocardial infarction and coronary artery bypass grafting were similar between the two sexes. The relative risks for cardiac death in women vs men were 0.88 (95% confidence interval [CI], 0.60 to 1.28), 0.79 (95% CI, 0.53 to 1.17), and 0.79 (95% CI, 0.34 to 1.85) for coronary artery disease, acute myocardial infarction, and coronary artery bypass grafting, respectively, after adjusting for age, history of diabetes, hypertension, angina pectoris and myocardial infarction, number of diseased vessels, and ejection fraction. Compared with patients of the same sex with normal angiograms, relative risk estimates were 5.0, 10.1, and 6.3 for women and were 1.8, 4.0, and 2.0 for men in the same three groups of patients, respectively. Conclusions.--Survival with coronary artery disease in black women is similar to that observed in black men, but relative to members of the same sex without the disease, the prognosis for women is considerably worse than for men.

Hypertension and end-stage renal disease (ESRD) are two of the major illness that afflict Afro-Americans. Prevention efforts to curb the incidence of these diseases among blacks must beproperly carried-out. In cases wherein prevention no longer apply, rehabilitation must be facilitated especially among ESRD patients. Organ transplantation can only be successful for as long as the entire black community is willing to donate organs. Campaigns which take into account the cultural experience of blacks can successfully solicit kidneys.

The prevalence of tuberculosis among blacks is about twice that of whites; however, this knowledge alone cannot be used to distinguish environmental from genetic factors, nor does it permit distinguishing susceptibility to infection from development of active disease once infected. In controlled environments, however, such distinctions can be made. In 227 nursing homes and two prisons, in which whites and blacks were completely integrated, records of tuberculin testing were examined to determine how many originally tuberculin-negative individuals converted to a tuberculin-positive, events which indicate infection with Mycobacterium tuberculosis. In the nursing homes, which represented 25,398 initially negative individuals, the conversion rate for blacks was 19 times that of whites. Similar results were obtained from the examination of prison records. Although blacks have a higher prevalence of tuberculosis, it was found that there was no racial difference in the percentage of blacks or whites who go on to develop clinical tuberculosis once they have been infected. Blacks are apparently more susceptible to tuberculosis than whites, and the factors that govern the progression from infection to disease are independent of those governing initial infection. (Consumer Summary produced by Reliance Medical Information, Inc.)

Aspirin may be better than ticlopidine for preventing a second stroke in African-American stroke patients, according to a study published in 2003. African-Americans have a higher risk of stroke than whites, perhaps because they are more likely to have high blood pressure or diabetes. This study made a special attempt to enroll African-American stroke patients and may be the largest study of these patients to date.

Many African-American gay men believe they have a low risk for contracting HIV infection and many are unaware they have the infection. In a survey of 920 black gay men in six cities who agreed to be tested for HIV, 16% tested positive and most were aware they were infected. Many engaged in risky sexual behaviors because they thought they had a low risk of infection.