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Huang Y, Shi W, He Q, Tan J, Tong J, Yu B. Racial and ethnic influences on carotid atherosclerosis: Epidemiology and risk factors. SAGE Open Med 2024; 12:20503121241261840. [PMID: 39045542 PMCID: PMC11265241 DOI: 10.1177/20503121241261840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 05/28/2024] [Indexed: 07/25/2024] Open
Abstract
Carotid atherosclerosis-related stenosis, marked by atherosclerotic plaque formation in the carotid artery, significantly increases ischemic stroke risk. Its prevalence varies across ethnic groups, reflecting racial disparities. Epidemiological studies have highlighted different susceptibilities to carotid stenosis among racial groups. Native Americans and Whites show greater vulnerability, indicating genetic and environmental influences. The impact of carotid stenosis is more severe in Hispanic and Black populations, with a higher incidence of related brain injuries, underscoring the need for targeted interventions. Comparative imaging studies between Chinese and White individuals reveal unique patterns of carotid stenosis, enhancing understanding of its pathophysiology and management across ethnicities. This review also categorizes risk factors, distinguishing those with racial disparity (such as genetic loci, sleep apnea, and emotional factors, socioeconomic status) from those without. In summary, racial disparities affect carotid stenosis, leading to varying susceptibilities and outcomes among ethnic groups. Recognizing these differences is essential for developing effective prevention, diagnosis, and management strategies. Addressing these disparities is critical to reducing ischemic stroke's burden across populations. Continued research and targeted interventions are crucial to improve outcomes for individuals at risk of carotid stenosis and its complications.
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Affiliation(s)
- Yijun Huang
- Department of General Surgery, Huashan Hospital Affiliated to Fudan University, Shanghai, China
| | - Weihao Shi
- Department of General Surgery, Huashan Hospital Affiliated to Fudan University, Shanghai, China
| | - Qing He
- Department of General Surgery, Huashan Hospital Affiliated to Fudan University, Shanghai, China
| | - Jinyun Tan
- Department of General Surgery, Huashan Hospital Affiliated to Fudan University, Shanghai, China
| | - Jindong Tong
- Department of Vascular Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China
- Shanghai Key Laboratory of Vascular Lesions Regulation and Remodeling, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China
| | - Bo Yu
- Department of General Surgery, Huashan Hospital Affiliated to Fudan University, Shanghai, China
- Department of Vascular Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China
- Shanghai Key Laboratory of Vascular Lesions Regulation and Remodeling, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China
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Swilley-Martinez ME, Coles SA, Miller VE, Alam IZ, Fitch KV, Cruz TH, Hohl B, Murray R, Ranapurwala SI. "We adjusted for race": now what? A systematic review of utilization and reporting of race in American Journal of Epidemiology and Epidemiology, 2020-2021. Epidemiol Rev 2023; 45:15-31. [PMID: 37789703 DOI: 10.1093/epirev/mxad010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/31/2023] [Accepted: 09/28/2023] [Indexed: 10/05/2023] Open
Abstract
Race is a social construct, commonly used in epidemiologic research to adjust for confounding. However, adjustment of race may mask racial disparities, thereby perpetuating structural racism. We conducted a systematic review of articles published in Epidemiology and American Journal of Epidemiology between 2020 and 2021 to (1) understand how race, ethnicity, and similar social constructs were operationalized, used, and reported; and (2) characterize good and poor practices of utilization and reporting of race data on the basis of the extent to which they reveal or mask systemic racism. Original research articles were considered for full review and data extraction if race data were used in the study analysis. We extracted how race was categorized, used-as a descriptor, confounder, or for effect measure modification (EMM)-and reported if the authors discussed racial disparities and systemic bias-related mechanisms responsible for perpetuating the disparities. Of the 561 articles, 299 had race data available and 192 (34.2%) used race data in analyses. Among the 160 US-based studies, 81 different racial categorizations were used. Race was most often used as a confounder (52%), followed by effect measure modifier (33%), and descriptive variable (12%). Fewer than 1 in 4 articles (22.9%) exhibited good practices (EMM along with discussing disparities and mechanisms), 63.5% of the articles exhibited poor practices (confounding only or not discussing mechanisms), and 13.5% were considered neither poor nor good practices. We discuss implications and provide 13 recommendations for operationalization, utilization, and reporting of race in epidemiologic and public health research.
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Affiliation(s)
- Monica E Swilley-Martinez
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599-7435, United States
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC 27599, United States
| | - Serita A Coles
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599-7440, United States
| | - Vanessa E Miller
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC 27599, United States
| | - Ishrat Z Alam
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599-7435, United States
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC 27599, United States
| | - Kate Vinita Fitch
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599-7435, United States
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC 27599, United States
| | - Theresa H Cruz
- Prevention Research Center, Department of Pediatrics, Health Sciences Center, University of New Mexico, Albuquerque, NM 87131, United States
| | - Bernadette Hohl
- Penn Injury Science Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104-6021, United States
| | - Regan Murray
- Center for Public Health and Technology, Department of Health, Human Performance and Recreation, University of Arkansas, Fayetteville, AR 72701, United States
| | - Shabbar I Ranapurwala
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599-7435, United States
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC 27599, United States
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Donnelly R, Cha H, Umberson D. Multiple Family Member Deaths and Cardiometabolic Health among Black and White Older Adults. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2022; 63:610-625. [PMID: 35932108 PMCID: PMC10204236 DOI: 10.1177/00221465221114485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Although the bereavement literature is voluminous, we know very little about how exposure to multiple family member deaths across the life course shapes health trajectories as people age and whether unequal exposure to bereavement contributes to racial inequities in cardiometabolic health. We use longitudinal data from the Health and Retirement Study (1992-2016) to consider how multiple family member deaths before midlife shape trajectories of cardiometabolic health after age 50 for Black and white adults (n = 22,974). Results show that multiple family member deaths prior to age 50 are associated with more cardiometabolic conditions at age 50 and a faster increase in conditions with advancing age. Moreover, Black adults are significantly disadvantaged by a greater risk of bereavement and more cardiometabolic conditions regardless of bereavement status. The life course trauma of exposure to multiple family member deaths uniquely contributes to the cardiometabolic risk of Black Americans.
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Harlow SD, Burnett-Bowie SAM, Greendale GA, Avis NE, Reeves AN, Richards TR, Lewis TT. Disparities in Reproductive Aging and Midlife Health between Black and White women: The Study of Women's Health Across the Nation (SWAN). Womens Midlife Health 2022; 8:3. [PMID: 35130984 PMCID: PMC8822825 DOI: 10.1186/s40695-022-00073-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 01/03/2022] [Indexed: 01/28/2023] Open
Abstract
This paper reviews differences in the experience of the menopause transition and midlife health outcomes between Black and White women who participated in the Study of Women's Health Across the Nation (SWAN), a 25-year, longitudinal, multi-racial/ethnic cohort study. We identify health disparities, i.e., instances in which Black women's outcomes are less favorable than those of White women, and consider whether structural racism may underlie these disparities. Although SWAN did not explicitly assess structural racism, Black women in SWAN grew up during the Jim Crow era in the United States, during which time racism was legally sanctioned. We consider how we might gain insight into structural racism by examining proxy exposures such as socioeconomic characteristics, reports of everyday discrimination, and a range of life stressors, which likely reflect the longstanding, pervasive and persistent inequities that have roots in systemic racism in the US. Thus, this paper reviews the presence, magnitude, and longitudinal patterns of racial disparities observed in SWAN in six areas of women's health - menopause symptoms, sleep, mental health, health related quality of life, cardio-metabolic health, and physical function -and elucidates the contextual factors that are likely influencing these disparities. We review the strengths and weaknesses of SWAN's design and approach to analysis of racial disparities and use this as a springboard to offer recommendations for future cohort studies.
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Affiliation(s)
- Siobán D Harlow
- Department of Epidemiology, University of Michigan, School of Public Health, United States, 1415 Washington Heights, Ann Arbor, MI, 48104-2029, USA.
| | - Sherri-Ann M Burnett-Bowie
- Endocrine Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Gail A Greendale
- Division of Geriatrics, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, USA
| | - Nancy E Avis
- Department of Social Sciences & Health Policy Wake Forest School of Medicine, Winston-Salem, USA
| | - Alexis N Reeves
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, USA
| | - Thomas R Richards
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, USA
| | - Tené T Lewis
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, USA
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Gaisenok O, Drapkina O. Gender differences in the detection of carotid atherosclerosis: DUPLEX registry cross-sectional study results. Monaldi Arch Chest Dis 2022; 92. [PMID: 35130677 DOI: 10.4081/monaldi.2022.2128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/22/2022] [Indexed: 11/23/2022] Open
Abstract
The aim of this study was to assess the features of detecting carotid atherosclerosis depending on gender, age, the presence of arterial hypertension, other major diseases and conditions according to The Duplex Registry Database. The registry sequentially included the results of duplex scanning of the carotid arteries (DSCA) of all patients who underwent it at the United Hospital with Outpatient Department in 2013 (n=2548). The incidence of carotid atherosclerosis (CAS) was higher in men than in women (58.6% (n=763) vs 45.5% (n=568), p<0.0000001). This was noted in all categories according to the gradation of stenosis, including in the category of the most severe lesion (>70%): 2.9% (n=32) vs 1.0% (n=13), p=0.003. The presence of CAD significantly increased the chances of detecting CAS in men (OR 4.47 vs 2.6, p<0.0000001). Signs more significant in their influence in women compared to men were the following: age (OR 5.3 [4.12; 6.71] p<0.0000001); arterial hypertension (OR 2.7 [2.12; 3.39] p<0.0000001) and cerebrovascular disease (OR 1.63 [1.13; 2.36] p=0.004). The OR of CAS detection for the "acute cerebrovascular accident" diagnosis in men and women differed 2 times (OR 1.2, p=0.4 vs 2.4, p=0.15). The "hypercholesterolemia" diagnosis when referred for DSCA did not show itself as a predictor of CAS detection in all study groups. Disorders of autonomic nervous system, hearing loss and screening examination showed a significant decrease in the probability of CAS detecting for the whole group (OR 0.14 [0.08;0.24] p<0.0000001; OR 0.16 [0.02;0.66] p=0.004 and OR 0.3 [0.25 0.37] p<0.0000001, respectively), so and separately for males and females. The present study revealed significant gender differences in the prevalence of carotid atherosclerosis and in the influence of various signs on an increase in the chances of its detection. The most significant signs were (OR men vs women): gender (1.3 vs 0.8), age (4.2 vs 5.3), arterial hypertension (1.8 vs 2.7), CAD (4.4 vs 2.6), cerebrovascular disease (1.26 vs 1.63).
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Affiliation(s)
| | - Oksana Drapkina
- National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Health of Russia, Moscow.
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Wilson DT, O'Connor MF. From Grief to Grievance: Combined Axes of Personal and Collective Grief Among Black Americans. Front Psychiatry 2022; 13:850994. [PMID: 35573332 PMCID: PMC9095947 DOI: 10.3389/fpsyt.2022.850994] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 04/06/2022] [Indexed: 11/13/2022] Open
Abstract
In the current article, we argue that the current conceptualization of grief as "the acute pain that accompanies the loss of a loved one" is too narrow in scope. Specifically, our current conceptualization of grief fails to account for the various ways in which grief is manifested amongst Black Americans. Throughout the article, we explore how the history of the racialization of Black people in America has resulted in a unique experience of loss, grief, and bereavement which previous research has largely failed to elucidate. Additionally, we explore how grief catalyzes political and social action. The article also proposes a novel theoretical conceptualization of personal and collective grief to deepen our conceptualization of grief amongst Black Americans. Finally, we posit that we must also consider how to further research on this collective grief to increase our understanding of it and to account for similar phenomena that may exist in communities who've had similar experiences (e.g., Indigenous peoples in the Americas and Dalits in India).
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Affiliation(s)
- Da'Mere T Wilson
- Department of Psychology, University of Arizona, Tucson, AZ, United States
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Brown SL, Mellencamp KA, Lin IF. Sole Family Survivors: Older Adults Lacking Family of Origin Kin. J Gerontol B Psychol Sci Soc Sci 2021; 77:930-935. [PMID: 34969095 PMCID: PMC9071394 DOI: 10.1093/geronb/gbab239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES We introduced a unique form of kinlessness: sole family survivorship, which describes the lack of family of origin (i.e., biological parents and siblings) kin. This form of kinlessness may be particularly consequential for older adults who experience other forms of kinlessness (e.g., no spouse/partner or no children) as they are especially likely to have relied on their family of origin for support. METHODS Data from the 1998-2014 Health and Retirement Study (N = 148,346 person-waves) were used to estimate the prevalence of sole family survivorship among adults aged 55 and older and men and women aged 55-74 and 75+. Variation in prevalence levels of sole family survivorship across sociodemographic characteristics, health indicators, and family factors were also estimated. Finally, we tracked cohort trends in sole family survivorship. RESULTS More than 1 in 10 adults aged 55+ were sole family survivors and this figure rose to more than 1 in 4 among those aged 75+. Adults with no spouse/partner and no children were especially likely to be sole family survivors, meaning they face a double burden of kinlessness. DISCUSSION Sole family survivorship represents the culmination of loss of multiple, lifelong kin ties. It is more common among those lacking other close kin, signaling the presence of a uniquely vulnerable group of older adults who experience multiple forms of kinlessness. Future research should address how older adults and society at large adapt to kinlessness to ensure successful aging.
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Affiliation(s)
- Susan L Brown
- Department of Sociology and Center for Family and Demographic Research, Bowling Green State University, Bowling Green, Ohio, USA,Address correspondence to: Susan L. Brown, PhD, Department of Sociology and Center for Family and Demographic Research, Bowling Green State University, Bowling Green, OH 43403, USA. E-mail:
| | - Kagan A Mellencamp
- Department of Sociology and Center for Family and Demographic Research, Bowling Green State University, Bowling Green, Ohio, USA
| | - I-Fen Lin
- Department of Sociology and Center for Family and Demographic Research, Bowling Green State University, Bowling Green, Ohio, USA
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