Posted by James
As indicated in Table 4, lower perceived health status, belief that genetic testing will lead to racial discrimination, belief that all pregnant women should have genetic tests, and belief that God’s Word is the most important source for moral decisions were significantly associated with race when controlling for other factors.
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Posted by James
Demographics
Fifty percent of the respondents were African-American and 50% Caucasian. Distributions for sex, marital status, level of education, household income, self-rated health, likelihood of having a physical examination within the last year, religion and religious influence differed significantly between races (Table 1). Interestingly, a higher percentage of African Americans thought God’s Word was the most important source for moral decisions than did Caucasians (79% vs. 56%, PO.001).
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Posted by James
Sample and Recruitment
In 2004, we surveyed by telephone patients from four inner-city health centers. These centers were included because they were known to serve large numbers of persons of color and of disadvantaged persons and were willing to implement quality improvement initiatives. Most of these patients were part of a panel of 325 persons that was initially selected from a random sample (of billing records) of patients who were >50 years old and had been seen at one of the health centers in the last year and who continued to participate in our studies. A personalized introductory letter and a letter from the health centers endorsing the project and encouraging participation were sent to each of the sampled patients. A $10 honorarium was offered for completing the survey. Of the panel, 248 participated, 14 refused and 15 were ineligible—for a response rate of 80% [248/(325-15)]. This panel was augmented by a convenience sample that, following HIPAA guidelines, was recruited by the sites using an introductory letter and recruitment sheet that was distributed by office staff during visits. Among these 104 new recruits, 83 interviews were completed, 0 refused and one was ineligible—for a response rate of 81% (83/103). As such, the total sample for this study was 331 patients.
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Posted by James
INTRODUCTION
Racial disparities have been observed in a variety of diseases, including cancer incidence and death rates, obesity prevalence and diabetes mellitus. Unfortunately, racial disparity also occurs in use of medical services, including screening for certain cancers and immunizations. The obvious question is why these disparities occur. Unequal access to care is clearly one reason; differing cultural beliefs, values and trust in the medical system are other reasons.
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Posted by James
This study did not detect a statistically significant increased risk of elevated depressive symptoms among African-American adults with SCD compared to African-American adults without SCD. The prevalence of elevated depressive symptoms in those with high clinical SCD severity and the overall prevalence for SCD subjects were 40.3% and 38.6%, respectively, similar to the values found in other studies of 44.0%, 56.5% and 43.4%. Analysis of the bivariate and multivariable results support the suggestion of two earlier studies that depression may be a result of the demographics of SCD and not necessarily a direct result of the disease severity. The confidence interval for the odds ratio examining the association between elevated depressive symptoms and high clinical SCD severity goes from a value that almost excludes one (1.78, CI: 0.94, 3.38) in bivariate analysis to a range not statistically or clinically relevant (1.37, CI: 0.62, 3.02) in multivariable analysis after adjusting for employment and marital status. The change was almost entirely due to employment status with marital status being a weak confounder. This finding suggests that socioeconomic position plays an important role in explaining any association between SCD and depression.
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Posted by James
Chi-squared tests of the distributions of demographic risk factors among SCD subjects from Baltimore, MD and Washington, DC revealed no statistically significant or clinically important differences between the two groups. Thus, data for SCD patients from the two sites were pooled. This same two-step analytical process was also conducted for the non-SCD group. Of the 102 SCD subjects recruited, 79.4% had sickle cell anemia, 15.6% had sickle hemoglobin-C disease and 5.0% had sickle B-thalassemia. With regards to clinical severity, 71.6% had high, 14.7% had medium and 13.7% had low clinical SCD severity. There were statistically significant differences in educational level, income and employment status for subjects with SCD compared to those without SCD (p<0.05). Table 1 shows the distribution of covariates stratified by clinical severity of SCD. African Americans with SCD were more likely to have lower levels of education, more likely to have incomes of <$ 15,000, and more likely to be unemployed or on disability compared to African Americans without SCD. No statistically significant differences were observed in age, gender or marital status between subjects with SCD and non-SCD subjects. Three subjects were missing data for depressive symptoms or clinical severity and were excluded from further analysis. Income data were missing for 40 subjects, and as a result, employment status was therefore used as a measure of socioeconomic position.
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Posted by James
Subject Recruitment
This was a cross-sectional analysis of subjects initially recruited for a study examining the association between SCD and dental caries. Recruited were African-American adults with SCD individually matched to non-SCD, African-American adults on age (±5 years), gender and recruitment location. African-American adults aged >18 years who were diagnosed with SCD were recruited from patients who were admitted to Howard University Hospital for sickle cell crisis in Washington, DC or from patients who attended the outpatient hematology clinic at Howard University Hospital. Adult African-American SCD patients were also recruited from the outpatient hematology clinic at Johns Hopkins Hospital in Baltimore, MD. These locations were chosen based on the relatively large numbers of SCD patients that attend the outpatient hematology clinics at these hospitals.
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