Minorities hit hardest by arthritis

The burden of arthritis is greater for African Americans and Hispanics, despite lower prevalence among these groups according to a Centers for Disease Control and Prevention (CDC) report published in the May issue of Preventing Chronic Disease. According to the Arthritis Foundation, these findings suggest a critical need to expand the reach of effective strategies aimed at arthritis prevention and management, particularly among groups bearing a disproportionate burden.

The report finds that the prevalence of activity limitation, work limitation and severe joint pain are significantly higher among African Americans and Hispanics. These two groups are nearly twice as likely as whites to have severe joint pain and work limitations and 1.3 times as likely to have activity limitations.

“Arthritis is a debilitating disease that profoundly impacts the lives of millions of Americans on a daily basis,” said Dr. Patience White, vice president of public health for the Arthritis Foundation. “The effects of the 46 million Americans with arthritis on the economy are enormous; the direct and indirect medical costs of this disease are estimated to be $128 billion each year.” With the aging of the baby boomer population, the prevalence of arthritis is expected to rise significantly from 46 million Americans to 67 million Americans by 2030, adds White.

Fortunately, there are simple steps everyone can take to prevent and decrease the pain and disability of arthritis. Small amounts of weight loss and physical activity can make a big difference. For example, for every one pound of weight loss, there is a four-pound reduction in the load exerted on each knee. In addition, safe and effective self-management education programs are available. People living with arthritis can benefit from participating in one of the Arthritis Foundation’s exercise or self-management programs, such as the Arthritis Foundation Walk With Ease Program, Arthritis Foundation Aquatic Program, Arthritis Foundation Exercise Program, and Arthritis Foundation Self-Help Program.

February 26, 2010
BIRMINGHAM, Ala. – African-Americans age 65 and younger are more than twice as likely to have a stroke compared with Caucasians in any region, and people who have a stroke are more likely to die in the South than elsewhere, according to researchers at the University of Alabama at Birmingham (UAB) School of Public Health.

The findings are from UAB’s Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, one of the largest ongoing health studies that includes more than 30,200 U.S. participants.

This new report is among the first to show major regional and racial disparities in stroke rates. It also underscores the need for targeted stroke-prevention and care strategies in those at greatest risk, said Virginia Howard, Ph.D., a UAB associate professor of epidemiology and a REGARDS co-principal investigator.

The study was presented Feb. 26 at the International Stroke Conference in San Antonio.

“This is the first study to take national data and really lay it out on the table,” Howard said. “We found in the 45-54 age group that blacks have a 2.5-fold greater stroke rate compared to whites, which is startling.”

The study also shows a stroke rate greater than 12 percent higher in eight Southeast states known as the Stroke Belt – Alabama, Arkansas, Georgia, Louisiana, Mississippi, North and South Carolina and Tennessee – with the highest stroke rate in the coastal states of Georgia, North and South Carolina.

“These are stroke-incidence data. It doesn’t tell us how to fix the problem, but it gives us our clearest stroke picture to date in this country,” Howard said.

In the new study, REGARDS researchers reviewed data on more than 26,500 participants with no history of stroke. They kept in periodic telephone contact with the participants for nearly five years and documented 299 strokes to which they applied a rate formula. In the 45-54 age group, the stroke rate is 192 percent for African-Americans compared with 74 percent for whites.

“That disparity in the incidence rate evens out and changes as you monitor stroke in older Americans. In fact the racial differences reverse, so by the time they reach about age 80 and older, whites have a higher stroke rate compared with blacks,” Howard said. It is not clear why the differences change with age, but it may have to do with different types of strokes occurring in different age groups.

The bottom line is that certain subgroups are at greater risk and need to pay closer attention to their stroke-risk factors, said George Howard, Dr.PH., a UAB professor of biostatistics and a REGARDS co-principal investigator. Stroke-risk factors include family history, high blood pressure and high cholesterol, diabetes, obesity, tobacco use and other variables.

The new study was collaboration between UAB, the University of Cincinnati, the University of Vermont in Burlington, Wake Forest University in Winston-Salem, N.C. and the National Institute of Neurological Disorders and Stroke (NINDS). Funding for this study comes from NINDS.

About the UAB School of Public Health

The UAB School of Public Health is a community of scholars and professionals working and teaching in varied arenas of public health with the goal of fostering research and best practices crucial to the health of our nation and its peoples. The school offers more than 20 areas of study and manages dozens of research and community-service centers.

The study consisted of 3,552 observations representing 17,794 patients undergoing major hepatectomy. Unadjusted analyses revealed that African-American patients had a two-fold increased odds of surgical mortality relative to Caucasians. Even after adjustment for other risk factors, African Americans had a two-fold increased odds of surgical mortality relative to Caucasians.

Conclusions

In-hospital mortality after major hepatectomy varies substantially by race. African-American patients have two-fold higher population-level odds of surgical mortality than Caucasian patients do. Our analyses suggest that clinical factors, insurance status, and hospital factors do not account for these differences. Additional studies to clarify the nature of this disparity and identify targets for intervention are warranted.