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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...

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."

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."

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