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...
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
African-Americans and Heart Disease, Stroke
Heart disease and stroke disproportionately affect African-Americans.
"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."
Clinical trials show blacks and whites respond differently to treatments for
high blood pressure. Indeed, treatment guidelines suggest that doctors should
consider different drugs based on a patient's race.
But Yancey says that a closer look at the data shows that race tends to be a
marker for more complicated high blood pressure treatment.
"Data suggests that all therapies do equally well -- but patients at
higher risk need more intensive therapy," he says.
A similar situation exists for heart failure. A promising treatment for
heart failure didn't seem to be working -- until researchers noticed that it
worked much better for black patients than for white patients. A study of black
patients confirmed this finding -- and provided tantalizing evidence that the
drug will help patients of all races with certain disease characteristics.
"The way this discussion of race differences has been helpful for the
whole field of cardiology, is it is exposing new treatment options for all
people with heart failure, African-American and Caucasian," Yancy says.
Black Americans and Diabetes
Black Americans -- and Mexican-Americans -- have twice the risk of diabetes
as white Americans. In addition, blacks with diabetes have more serious
complications -- such as loss of vision, loss of limbs, and kidney failure --
than whites, notes Maudene Nelson, RD, certified diabetes educator at Naomi
Barry Diabetes Center at Columbia University.
"The theory is that maybe it is access to health care, or maybe a
cultural fatalism -- thinking, 'It is God's will,' or, 'My family had it so I
have it' -- not a sense of something I can have an impact on so it won't hurt
me," Nelson tells WebMD. "But more and more there is thinking it is
something that makes blacks genetically more susceptible. It is hard to tell
how much of it is what."