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    Why 7 Deadly Diseases Strike Blacks Most

    Health care disparities heighten disease differences between African-Americans and white Americans.

    Black Americans and Lung Disease continued...

    Why?

    "There are a couple of reasons," Graham says. "One is that 71% of African-Americans versus 58% of white Americans live in communities that violate federal air pollution standards. When we look at African-Americans in terms of demographic distribution, they are more likely to be located near, if not next to, transportation corridors, and to places where the air is drawn."

    Another reason is that a higher percentage of black Americans than white Americans live close to toxic waste dumps -- and to the factories that produce this waste.

    Genetic differences may also play a role. For example, it is clear that cigarette smoking causes lung disease. Cigarette smoking is declining faster among blacks than among whites -- but blacks still die of lung diseases more frequently than white Americans. This could be due to health care disparities -- blacks may get diagnosed later, when diseases are harder to treat -- but it could also be due to genetic susceptibility.

    "The environment is involved, and there is potential genetic susceptibility -- but we also have to talk about the fact that African-Americans' social and economic status lags behind that of Caucasians," Graham says. "And low socioeconomic status is linked to more disease."

    It's not a simple question of access to health care itself, but access to specialists. Even within HMOs, Graham says, blacks get specialist referrals less often than whites.

    "I wonder if minority populations put as much pressure on their doctors to get specialty referrals," says Graham, who works to empower black community groups to know what they should expect from their health care. "And there may be more insidious, darker reasons why doctors are less likely to refer African-American patients. But as a specialist myself, I know that patients who get to see me have gone to their doctors and said, 'This isn't working.'"

    African-Americans and Heart Disease, Stroke

    Heart disease and stroke disproportionately affect African-Americans. Why?

    "What sets the stage for the more aggressive and higher incidence of heart disease in African-Americans is a very high incidence of high blood pressure," Yancy says. "This predisposes African-Americans to more heart disease, kidney disease, and stroke. And heart failure -- an African-American is much more likely to get there with an absence of previous heart disease. That is most important. This makes us focus on high blood pressure as it forces heart failure."

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