Ethnic Dis
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Comparative Study
Racial, ethnic and socioeconomic disparities in the clustering of cardiovascular disease risk factors.
To evaluate racial and ethnic differences in the clustering of cardiovascular disease (CVD) risk factors in the United States and to determine whether these differences vary by socioeconomic status (SES). ⋯ Increased CVD risk factor clustering exists among Americans with low SES, particularly among non-Hispanic Blacks. Among persons with high SES, Mexican Americans and non-Hispanic Blacks have a higher risk of CVD than non-Hispanic Whites. These disparities may be reduced through policy changes that promote heart-healthy environments throughout society.
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To interpret, within a sociological context, evidence of physician bias in the management and outcomes of coronary heart disease (CHD) treatment for African Americans vs Whites. ⋯ Socioeconomics, individual racism, and institutional racism represent 3 predominant pathways to differential treatment for CHD that are mediated by the patient-provider relationship. Racial biases are shown to be a part of the social structure of medical practices at both the macro and micro levels. Individual healthcare providers can potentially reduce disparities in Black-White CHD treatment and outcomes by examining the patient-provider relationship for bias. Future studies will require addressing more direct ways of measuring, monitoring, and reducing subtle bias in the healthcare system.
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Diabetic nephropathy is the number one cause of endstage renal disease in the United States. Blood pressure is most important in delaying the progression of renal disease in persons with diabetes and, agents that block the renin angiotensin system (RAS) should be the primary agents used to achieve blood pressure reduction. There is debate regarding which method of RAS blockade should be used as primary therapy in persons with diabetes. ⋯ Some studies and meta-analyses show ACE inhibitors as being superior with regard to cardioprotection. In our nephrology clinic, we find that patients who presented on an ACE inhibitor had significantly lower CVD than those on ARBs (49.2% vs 70.1% prevalence of CVD, ACE inhibitor vs ARB respectively, P=.042). We conclude that ACE inhibitors should be strongly considered as the primary method of RAS inhibition in persons with diabetes.
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To determine the effects of baseline cognitive function on incidence of disability in activities of daily living (ADL) in initially non-disabled Mexican-American elderly over a 7-year period. ⋯ Low MMSE score was associated with increased risk for incident ADL disability over a 7-year period in older Mexican Americans. Given the social, economic, and health impact of cognitive impairment, these findings suggest a need to develop effective intervention programs that delay or prevent the onset of cognitive and ADL disability in the elderly.