Health Care disparities refer to gaps in the quality of health and the access to adequate health care across racial and ethnic groups. The Health Resources and Services Administration characterize health disparities as "population-specific differences in the presence of disease, health outcomes, or access to health care." In the United States, health disparities are well documented in minority populations such as African Americans, Native Americans, and Hispanics. When compared to whites, these minority groups generally have higher incidence of chronic diseases, higher mortality, and poorer health outcomes.  The health disparities between African Americans and other racial groups are striking and are apparent in life expectancy, infant mortality, and other measures of health status. For example, in 1999 the average American could expect to live 76.9 years, the average African American could only expect to live 71.4 years. Factors contributing to poor health outcomes among African Americans include discrimination, cultural barriers, and lack of access to health care.

Ten Leading Causes of death in the U.S. in 2005  for Blacks or African Americans: CDC, National Vital Statistics Report, Vol. 53, Nov.17, March, 2005

1.   Heart Disease: According to the Office of Minority Health, (Minority and low-income populations have a disproportionate burden of death and disability from CVD. Additionally, African Americans have the highest rate of high blood pressure of all groups and tend to develop it younger than others.  An often-cited statistic: cardiovascular disease (CVD) is the number 1 cause of death in the industrialized world, and by 2020 it will be the number 1 cause of death worldwide.

CVD, primarily coronary heart disease and stroke, is the leading cause of death for mature adult (MA) blacks and whites, accounting for over 15,000 or about 27% of MA deaths in 2001. In 2001, rates CVD deaths in MA were 18% higher for blacks than whites.  Black women tend to develop heart disease at an earlier age and have the highest mortality rate from heart disease of all women.

Risk factors for CVD include: 

Overweight and obesity: According to a 2000 study by the US Department of Health and Human Services Black adults are more likely than all other race/ethnicity groups to be overweight. Significant disparities exist among women; according to the study black women were 56% more likely to report being obese or overweight than white women

Physical inactivity Physical inactivity: according to a 2001 study conducted at Brigham and Women’s Hospital physical inactivity is more prevalent among African-Americans than whites.  Factors that are particularly important include physical activity and a healthy diet

Diabetes: Research conducted by the CDC and the American Diabetes Association found that Adults with diabetes are 2-4 times more likely to die of heart disease than those without diabetes.  African Americans were 3.2 times more likely to be discharged from a hospital with a diagnosis of diabetes than whites.

Cigarette smoking: Cigarette smoking rates are similar among white and black however whites are more likely to quit smoking than blacks.

High blood pressure: Those with high blood pressure may have 3-4 times the risk of CHD and 7 times the risk of stroke than those with normal blood pressure. The prevalence of high blood pressure among U.S. blacks is among the highest in the world. Blacks are more likely to develop high blood pressure at an earlier age and to have higher blood pressure than whites. Black women in the U.S. have the highest incidence of hypertension of any race-sex group. Blacks are less likely to have their hypertension controlled than whites, with black women being the least likely

High blood cholesterol: Blacks tend to have lower blood cholesterol levels than whites. Among African Americans in the U.S., 45% of men and 46% of women have high blood cholesterol.  A 10% decrease in total cholesterol levels may result in an estimated 30% reduction in the incidence of coronary heart disease.

Family History of CVD:  Cardiovascular disease is concentrated in families with a positive family history of CVD , (meaning your risk of CVD is increased if any of your immediate relatives, such as siblings, parents, or children, have or had heart disease, a heart attack, or stroke, especially before age 50) the outlook for someone who has a family history of CVD is not hopeless. Scientists have established that several risk factors—both modifiable (such as diet, physical activity level, and tobacco use) and non-modifiable (like age and genetics)—play a role in the development of CVD. Moreover, scientists aren’t even sure if the increased risk of developing CVD in someone with a family history of the disease is a result of a shared genetic predisposition or if it simply represents a greater exposure to the same harmful environmental influences.

2.   Cancer: is the second leading cause of deaths for African Americans. According to the Center for Disease Control article, Health Disparities experienced by Black or African Americans in the United States, both African American females and males suffer disproportionately from a variety of cancers as compared to their white counterparts. Some examples of this for African American females are:

1. Out of 100,000 African American females, 54 of them will suffer from colon/rectal cancer as compared to 43 white women.

2. Out of 100,000 African American females, 13 will suffered from pancreatic cancer as compared to 8 White women.

3. Additionally, even though deaths caused by breast cancer have decreased among white women, African American women continue to have higher rates of mortality from breast and cervical cancer.

For African American males:

• 251 per 100,000 African American males suffer from Prostate Cancer as compared to 167 per 100,000 white men.

• 108 per 100,000 African American men suffer from lung/bronchus cancer as compared to 72 white men.

• 68 per 100,000 African American men suffer from colon/rectal cancer as compared to 58 per 100,000 white men.

 Overall, African Americans have more malignant tumors and are less likely to survive cancer than the general population.

3. Stroke: is the third leading cause of death in American and it disproportionately affects African-American. African Americans have the highest stroke death rates in the world. African-Americans are 3-4 times more likely to suffer a stroke than white Americans in those aged 34-55 years, and 33% more likely to die from a stroke most of this difference is accounted for by disparities among women, with African American women 37% more likely to die from stroke than white women African Americans as a group are less likely to receive or ask for information on how to decrease, prevent, or manage stroke. One major factor is the rate of high blood pressure in African Americans is among the highest in the world and African Americans with high blood pressure have an 80% higher chance of dying from a stroke than in the general population. Blacks have a higher prevalence of other stroke risk factors, including diabetes, obesity, poor dietary habits, and physical inactivity. For every 6 white Americans who have diabetes, 10 African Americans have the disease.  Approximately 80% of cardiovascular disease is preventable.

4. Diabetes: is a group of diseases marked by high levels of blood glucose resulting from defects in the insulin production, insulin action or both. Diabetes can lead to serious complications and premature death. Diabetes is one of the leading causes of death in the United States and ranks fourth as one of the major causes of death in African-Americans.  The prevalence of diabetes among blacks in the U.S. has quadrupled during the past 30 years, with increasing incidence in black youths.  Approximately 2.7 million or 11.4% of all African Americans aged 20 years or older have diabetes, but one-third of them are unaware of their diagnosis

There are two types of diabetes.

Type 1 diabetes: (formerly called juvenile diabetes) is an autoimmune disorder results when the body’s immune system attacks and destroys its own insulin producing cells. (Type 1 diabetes is more prevalent in people of Caucasian descent)

Type 2 diabetes: (formerly called adult onset diabetes) occurs when the body does not make enough insulin or can not effectively use the insulin it produces. This form of diabetes is preventable and typically develops in adults over the age of 40. Type 2 diabetes accounts for 90-95% of all diagnoses cases of diabetes. Factors which increase the risk of Type 2 diabetes are:

• Having a family history of diabetes                                                    

• Being a member of an ethnic group such as African-American, Native American, Hispanic/Latino and some Asian/Pacific Islanders               

• Obesity                                                                                                   

• Gestational diabetes/ or having diabetes while pregnant and delivering a baby which weighs more than nine pounds (4,100 grams) at birth.

• impaired glucose tolerance,

• physical inactivity

5. Unintentional injuries: Great strides have been made in reducing injury-related deaths; injury remains the leading cause of death for persons 1 to 44 years of age in the United States. Injuries account for one third of all years of potential life lost (YPLL), an indicator used by the Centers for Disease Control and Prevention to measure premature mortality, before age 65 in the United States. Injuries account for more YPLL than heart disease, cancer and stroke combined, which are the next leading causes of YPLL nationally.

6.  Homicide: In 2001, homicide claimed the lives of 20,308 Americans. In the United States homicide is the second leading cause of death for persons 15 to 34 years of age. In African American age 15-34 this is the leading cause of death.  (CDC 2003). Among 10 to 24 year olds, homicide is the leading cause of death for African Americans, the second leading cause of death for Hispanics, and the third leading cause of death for American Indians, Alaska Natives, and Asian/Pacific Islanders (CDC 2006).
 

7. HIV/AIDS:  HIV infection is a viral infection caused by the human      immunodeficiency virus (HIV) that gradually destroys the immune system, resulting in infections that are hard for the body to fight. Alternative Names: Human immunodeficiency virus infection 

According to the Office of Minority Health, HIV infection is the fifth leading cause of death for people who are 25-44 years old in the United States, and it is estimated that 850,000 to 950,000 U.S. residents are living with HIV infection, one-quarter of which is unaware of their infection. HIV/AIDS has impacted African Americans particularly hard.  Since the beginning of the epidemic, African Americans have accounted for 379,278 (40%) of the estimated 944,306 AIDS cases diagnosed. From the beginning of the epidemic in 1981 through December 2004, an estimated 201,045 African Americans with AIDS died. In 2004, African Americans accounted for 20,965 (49%) of the 42,514 estimated AIDS cases diagnosed in the United States (including US dependencies, possessions, and associated nations). More HIV/AIDS diagnosis more African Americans were reported with AIDS than any other racial/ethnic group. (National Center for HIV, STD and TB Prevention). It is the leading cause of death for African American men ages 35-44.  The rate of AIDS diagnoses for African American adults and adolescents was 10 times the rate for whites and almost 3 times the rate for Hispanics. The rate of AIDS diagnoses for African American women was 23 times the rate for white women. The rate of AIDS diagnoses for African American men was 8 times the rate for white men.  The 178,233 African Americans living with AIDS in the United States accounted for 43% of all people in the United States living with AIDS. Of the 48 US children (younger than 13 years of age) who had a new AIDS diagnosis, 29 were African American. Of persons whose diagnosis of AIDS had been made since 1996, a smaller proportion of African Americans (64%) were alive after 9 years compared with American Indians and Alaska Natives (65%), Hispanics (72%), whites (74%), and Asians and Pacific Islanders (81%).

8. Chronic lower respiratory disease (COPD): Chronic obstructive pulmonary disease (COPD) is a group of lung diseases that cause swelling of the airways.  Emphysema, Asthma and chronic bronchitis are the most common forms of COPD. Alternative Names COPD; Chronic obstructive airway

African Americans are less likely to have or die from COPD (Chronic Obstructive Pulmonary Disease), yet African Americans with COPD have more emergency room visits and similar disease severity as Whites who have smoked cigarettes over a longer period of time and are heavy smokers. African Americans have similar rates of cigarette smoking as Whites (22% vs. 24% respectively in 2002) and lower overall exposure to tobacco smoke, but are more likely to develop and die from lung cancer. Black men are at least 50 percent more likely to develop lung cancer and 36 percent more likely to die from the disease than White men.

In 2002, an estimated 3.4 million African Americans currently had asthma. African Americans have the highest asthma prevalence of any racial/ethic group. The current asthma prevalence rate among Blacks was 38 percent higher than that for Whites. African Americans account for 26 percent of the 4,200 deaths attributed to asthma in 2001. African Americans were three times more likely to die from asthma than Whites.      

9.  Nephritis, Nephrotic syndrome, and Nephrosis (Kidney Disease): Approximately 20 million Americans have kidney disease. The number of people diagnosed with kidney disease has doubled each decade for the last two decades. In 2000, about the same number of people died with kidney failure as with breast cancer and prostate cancer combined. African Americans are four times more likely to develop kidney failure than Caucasians. African Americans make up 12 percent of the population but account for 30 percent of people with kidney failure. Diabetes the fourth leading cause of death in African-Americans and high blood pressure a pre-curser to CVD the leading cause of death in African Americans accounts for about 70 percent of kidney failure in African Americans. A recent NKDEP survey of African Americans found that only 17 percent named kidney disease as a consequence of diabetes, and only eight percent named it as a consequence of high blood pressure. African American males ages 22 - 44 are 20 times more likely to develop kidney failure due to high blood pressure than Caucasian males in the same age group

10. Septicemia:  Septicemia is the clinical name for blood poisoning it is the presence of bacteria in the blood (bacteremia) and is often associated with severe disease.

Alternative Names Blood poisoning; Bacteremia with sepsis

Septicemia is a serious, rapidly progressive, life-threatening infection that can worsen very rapidly. Septicemia arises from infections throughout the body, including infections in the lungs, abdomen, and urinary tract. It may precede or coincide with infections of the bone (osteomyelitis), central nervous system (meningitis), or other tissues. Septicemia can rapidly lead to septic shock and death. Septicemia hospitalization rates are usually highest for African-Americans men and lowest for white women within each age group.

Sources:

1. CDC, National Vital Statistics Report, Vol. 53, Nov.17, March, 2005
2. American Cancer Society, Cancer Facts and Figures, 2003.
3. The NDIC a service of the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health “Diabetes in African Americans Fact Sheet”, National Diabetes Information Clearinghouse. http://diabetes.niddk.nih.gov/dm/pubs/africanamerican/index.htm
4. American Diabetes Association, www.diabetes.org
5. CDC National Center for Chronic Disease Prevention and Health Promotion: Diabetes Public Health Resources    Center for Injury Research and Policy, Columbus Children's Research Institute, 2005    
6. CDC National Center for Injury Prevention and Control, Division of Violence Prevention http://www.cdc.gov/ncipc/dvp/dvp.htm http://www.cdc.gov/ncipc/factsheets/yvfacts.htm
7. CDC Office of Minority And Women’s Health
8. National Center for Health Statistics: National Health Interview Survey, 2002. 
9. National Vital Statistics Report, Report on Final Mortality 2001. Chatila, WM, Wynkoop WA, Vance G, and Criner GJ. Smoking Patterns in African Americans and Whites with Advanced COPD. Chest. 2003 Jan; 125(1). 
10. National Vital Statistics Report, Report on Final Mortality 2001.
11. National Center for Health Statistics: National Health Interview Survey, 2002. 
12. Surveillance, Epidemiology, and End Results Program, 1975-2001, Division of Cancer Control and Population Sciences, National Cancer Institute.
13. U.S. Renal Data System. (2002). National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD.
14. National Kidney Disease Education Program. (2003). NKDEP Survey of African American Adults' Knowledge, Attitudes and Behaviors Related to Kidney Disease (Draft). National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD.
15.  www.blackdoctor.org “The Top Ten Diseases Specific To African Americans”  (Feb-2-2006)  by Glen Ellis
16.  CDC. Health disparities experienced by racial/ethnic minority populations.   MMWR 2004;53:755. CDC
17. http://www.medscape.com/viewarticle/497514?rss “From Morbidity & Mortality Weekly Report Health Disparities Experienced by Black or African Americans” - United States                                                    
    
    Posted 01/26/2005