Ian Mutchnick’s Questions for Board Review

Epid/Biostats, Questions 1-3, p 119 in First Aid

 

1.     Differences in the Incidence of Disease Among Various Ethnic Groups [Source:  http://www.netwellness.org/centers/ minorityhealth/default.cfm]

African Americans and Hispanics are the largest minority groups, followed by Asian Americans/Pacific Islanders, and Native Americans (including Alaskan Natives).

 

 

 

 

Minorities are more likely to suffer from chronic (long-term) and acute (short-term) diseases than whites.

The Department of Health and Human Services reports that the death rate among American minority populations is much greater than among whites—on the order of 60,000 "excess deaths" each year.

On average, whites live almost 7 years longer than blacks do, and nearly 8 years longer in terms of years of "healthy life," which combines longevity (how long you live) with quality of life.

Glaucoma develops earlier among African Americans and progresses more rapidly than it does among whites. It is the leading cause of blindness in black Americans.

 

Asthma death rates for African American men are three times greater than in white men.

 

About half of Hispanic women and African American women are overweight. Being overweight is a risk factor for many different diseases such as high blood pressure and diabetes

 

Lupus

·      Three times more common among African-Americans than it is among whites

·      Affects 1 in 250 African American women.

 

Smoking:

·      American Indian/Alaska Natives have the highest smoking prevalence among racial and ethnic groups; Asian/Pacific Islanders have the lowest.

·      In 1997, the national prevalence of current cigarette smoking among high school students was 32 percent higher than in 1991. Smoking increased 80 percent among black students, 34 percent among Hispanic students and 28 percent among white students

 

Of the AIDS cases diagnosed in 1997, 45 percent were among African Americans, compared to 33 percent among whites.

 

Primary Causes of Death Among US Minorities:

Cause

Facts

HTN – Heart Disease and Stroke

The following numbers indicate relative risk for African Americans as compared to Whites for each of the following conditions:

·       HTN:  2.0

·       Death due to stroke:  2.0

·       Death due to heart disease:  2.0

·       Risk of developing end stage renal disease due to HTN:  3.0

(African Americans may receive treatment less often and later in the disease)

 

With proper treatment, African Americans can achieve the same lowering in blood pressure and in cardiovascular disease as whites

Homicide and preventable accidents

For 1997, here are the relevant statistics:

·       6 out of 7 deaths by homicide and legal intervention were African Americans

·       24.7 per 100,000 African Americans died from injury by firearms

·       10.5 per 100,000 for whites

·       46.1 per 100,000 African American males died from injury by firearms 

·       18.1 per 100,000 for white males

·       119.9 per 100,000 African American males age 15-24 died from injury by firearms

·       24.8 per 100,000 whites

·       3.6 per 100,000 African Americans committed suicide

·       7.2 per 100,000 whites

Cancer

For every 100,000 individuals of belonging to the following ethnic groups, the number shown indicates how many were diagnosed with cancer from 1990-96:

·       African-Americans:  443

·       Whites:  403

·       Asian/Pacific Islanders:  279

·       Hispanic Americans:  275

·       American Indians:  153

 

The following numbers indicate the mortality rate per 100,000 individuals in each ethnic group:

·       African-Americans:  223 (50%)

·       Whites:  168 (42%)

·       Asian/Pacific Islanders:  103 (40%)

·       Hispanic Americans:  105 (38%)

·       American Indians:  104 (70%)

 

African-American men are at least 50 percent more likely to develop prostate cancer than men of any other racial or ethnic group in the US.

·       Interestingly, some of the world’s lowest rates of prostate cancer may be found among black men in certain regions of Africa, according to data from the book Cancer in Five Continents.

 

While white women are most likely to be diagnosed with breast cancer black women are more likely to die from the disease.

·       113 cases per 100,000 white women from 1990-96, versus 99 per 100,000 black women 

·       From 1990-96, 31 of every 100,000 black women died of breast cancer versus 26 per 100,000 white women.

 

African-American men and women have the highest incidence rates of cancers of the colon and rectum, and lung and bronchus.

 

Death rates from breast cancer increased among American Indian/Alaska Native women more than 4 percent per year during 1990-96, a time when rates for other groups were stable or decreasing.

 

Only 54 percent of African-American women live five years or longer after being diagnosed with endometrial cancer, compared to 86 percent of white women. Lack of access to health care and less intense treatment only partially explain this disparity, according to Duke University researchers reporting at ACS's 42nd Annual Science Writers Seminar in late March. The research team found the tumor suppressor gene called PTEN was four times more likely to be damaged in the endometrial tumors of African-American study subjects than white subjects.

Infant deaths and perinatal abnormalities

Infant mortality per 1000 births, 1998:

·       13.8black

·       9.3 native american

·       6.0 white

·       5.8 hispanic american

·       5.5 asian/pacific islander

 

% of infants born with low and very low birthwieghts (1998):

·       13.0 african american

·       7.4 asian / pacific islander

·       6.8 native american

·       6.5 white

·       6.4 hispanic american

 

% of infants born preterm, 1998:

·       17.5 black

·       12.2 native American

·       11.4 hispanic

·       10.5 white

·       10.4 asian / PI

 

% women receiving adequate prenatal care, 1998:

·       57.3 native American

·       65.8 hispanic

·       67.0 black

·       74.0 asian/PI

·       76.0 white

 

Infant deaths due to birth defects, per 100,000 live births, 1998:

·       180.2 black

·       171.3 native american

·       154.2 white

·       152.3 asian/PI

·       149.9 hispanic

 

Liver disease

African-Americans and Hispanics have the highest rates of chronic hepatitis C, and a higher mortality from liver disease in general, than whites.  Given HCV infection:

·      86% of African Americans will become chronic

·      74% of Hispanics will become chronic

Diabetes

Prevalence of diabetes in the US (% of population), 1996:

·       Pima Indians:  50

·       Filipino:  22

·       Hawaiian:  18

·       Japanese:  16

·       Latinos:  14.3

·       Blacks:  12

·       Native American: 9

·       Whites:  5.9

 

[Source:  Diabetes 1996:  vital Statistics.  Alexandria, VA:  American Diabetes Association; 1996, 14] è http://www.blackandbrownsugar.com/powerpoint/sld003.htm

 

Factors Which May Contribute to Poorer Health Outcomes Among Minorities

 

2.      Leading Causes and Types of Cancers in Men Versus Women


The American Cancer Society tracks cancer occurrence, including the number of deaths, cases, and how long people survive after diagnosis. This year about 552,200 Americans are expected to die of cancer, more than 1,500 people a day. Cancer is the second leading cause of death in the US, exceeded only by heart disease. In the US, 1 of 4 deaths is from cancer. Nearly five million lives have been lost to cancer since 1990. In 2000, about 1,220,100 new cancer cases are expected to be diagnosed.  Since 1990, approximately 13 million new cases have been diagnosed. These estimates exclude noninvasive cancers (except noninvasive urinary bladder cancer) and do not include basal cell and squamous cell skin cancers. In fact, skin cancers are more common than cancers of any other organ, and over 1.3 million cases of basal cell and squamous cell skin cancer are expected to be diagnosed this year. ACS also tracks data regarding behaviors that influence the risk of developing cancer (such as tobacco use and certain dietary behaviors) and the use of screening tests (such as mammography, Pap tests, and sigmoidoscopy).[Source:  http://www3.cancer.org/cancerinfo/sitecenter.asp?ctid=8&scdoc=40000&scs=0&scp=0&scss=0]

 

Age-Adjusted Cancer Death Rates,* Females by Site, US, 1930-1996
Age-Adjusted Cancer Death Rates,* Females by Site, US, 1930-1996

*Per 100,000, age-adjusted to the 1970 US standard population. †Uterus cancer death rates are for uterine cervix and uterine corpus combined. Note: Due to changes in ICD coding, numerator information has changed over time. Rates for cancers of the uterus, ovary, lung & bronchus, and colon & rectum are affected by these coding changes.

Source: US Mortality Public Use Data Tapes 1960-1996, US Mortality Volumes 1930-1959, National Center for Health Statistics, Centers for Disease Control and Prevention, 1999.

 

 

 

Age-Adjusted Cancer Death Rates,* Males by Site, US, 1930-1996
Age-Adjusted Cancer Death Rates,* Males by Site, US, 1930-1996

*Per 100,000, age-adjusted to the 1970 US standard population. Note: Due to changes in ICD coding, numerator information has changed over time. Rates for cancers of the liver, lung & bronchus, and colon & rectum are affected by these coding changes.

Source: US Mortality Public Use Data Tapes 1960-1996, US Mortality Volumes 1930-1959, National Center for Health Statistics, Centers for Disease Control and Prevention, 1999.

 

 

3.     Prevalence of Common Psychiatric Disorders

 

 

Best Estimate ** (%)

Any Anxiety Disorder

16.4

Simple Phobia

8.3

Social Phobia

2.0

Agoraphobia

4.9

GAD

3.4

Panic Disorder

1.6

OCD

2.4

PTSD

3.6

 

 

Any Mood Disorder

7.1

MD Episode

6.5

Unipolar MD

5.3

Dysthymia

1.6

Biopolar I

1.1

Biopolar II

0.6

 

 

Schizophrenia

1.3

Nonaffective Psychosis

0.2

Somatization

0.2

ASP

2.1

Anorexia Nervosa

0.1

Severe Cognitive Impairment

1.2

 

 

Any Disorder

21.0

 

Question #4:  Way too big, but here is something that might help.  Skim for major epidemiology.

 

Among both men and women of all racial and ethnic groups, cardiovascular diseases (CVD),

primarily coronary heart disease and stroke, are our nation’s leading killer. Approximately

960,000 Americans die each year of CVD accounting for more than 40% of all deaths. Every day,

more than 2,600 Americans die of CVD, an average of one death ever 33 seconds. These diseases

are the leading causes of death and disability among Americans aged 35–64 each year. In addition,

the rate of premature deaths due to CVD are greater among racial and ethnic minorities. The

annual national economic impact of CVD nationwide as measured in health care expenditures,

medications, and lost productivity due to disability and death is estimated at $274 billion.

Coronary Heart Disease

Deaths rates of coronary heart disease vary widely in different racial and ethnic groups; the

highest death rates are among African Americans, followed by whites, American Indian/Alaska

Natives, Hispanics, and Asian/Pacific Islanders.1 Coronary heart disease accounts for 32.4% of

deaths among African American men and 41.6% of deaths among African American women.1

In 1995, death rates due to coronary heart disease were 330.9 per 100,000 population for African

American men (49% higher than for white men) and 213.2 per 100,000 for African American

women (67% higher than for white women). Among American Indian/Alaska Natives, coronary

heart disease accounted for 26.0% of deaths among men and 28.4% of deaths among women. It

accounted for more than one-third of deaths among Asian/Pacific Islanders. Approximately one

of four deaths among Hispanic men (25.4%) and one of three deaths among Hispanic women

(34.0%) were due to coronary heart disease.1

In addition to the high mortality rates, coronary heart disease is a highly prevalent condition;

6.9% of African Americans and 5.6% of Mexican Americans have coronary heart disease. It is

estimated that 2.6% of African American men; 5.2% of African American women; 3.4% of

Mexican American men and 4.6% of Mexican American women have angina.2 Nationally

representative estimates for the prevalence of coronary heart disease and angina are currently not

available for American Indian/Alaska Natives and Asian/Pacific Islanders.

Stroke

Stroke is the third leading cause of death and the leading cause of severe disability in the United

States.1 In 1998, the direct and indirect costs associated with stroke were estimated at $43.3

billion.2 There are substantial differences in stroke mortality rates across the different racial and

ethnic groups. Stroke mortality rates are highest among African Americans followed by

Asian/Pacific Islanders, whites, American Indian/Alaska Natives and Hispanics.1 Mortality rates

among African American men are 97% higher than among white men and rates among African

American women are 71% higher than among white women. In younger age groups (<65 years),

the disparities between African Americans and whites are even more pronounced.3 Prevalence

estimates indicate that 1.8% of African American men, 2.5% of African American women, 1.1%

of Mexican American men and 0.8% of Mexican American women have suffered a stroke.2

Nationally representative estimates for prevalent stroke are not available for American

Indian/Alaska Natives and Asian/Pacific Islanders.

Heart Failure

The number of persons living with heart failure is increasing and heart failure is currently the

leading cause for hospitalization among Medicare beneficiaries. The economic costs associated

with heart failure are also substantial, $20.2 billion in 1998.2 Death rates from heart failure in

1995 were 8.8 per 100,000 population among African American men (31% higher than for white

men) and 7.1 per 100,000 population among African American women (32% higher than for

white women). An estimated 3.2% of African American men and 2.8% of African American

women have heart failure.2 The estimated rate of new or recurrent heart failure events for

African American men aged 65–74 years is 21.1 per 1000 population; for ages 75–84 it is 52.0

per 1000 and for 85 and older it is 66.7 per 1000. For African American women the rates are

18.9, 33.5 and 48.4 respectively. Mortality data and prevalence estimates for other racial/ethnic

groups for heart failure are currently not available.

 

Question #5:

morbidity

A diseased condition or state, the incidence of a disease or of all diseases in a population.

 

mortality

The death rate. The ratio of the total number of deaths to the total population.

 

Case fatality rate

Usually expressed as the percentage of persons diagnosed as having a specified disease who die as a result of that disease within a given period.

 

Question #6:

Cigarette Smoking

 

Cigarette smoking is the most important preventable cause of premature death in the United States. It accounts for about 430,700 of the more than 2 million annual deaths. In 1992, an estimated 48 million (26.5% [95% CI=plus or minus 0.5%]) adults in the United States were current smokers, Smoking prevalence was highest among persons aged 25-44 years (30.8% [95% CI=plus or minus 0.8%]). Smoking

prevalence was highest among American Indians/Alaskan Natives (39.4% [95% CI=plus or minus6.0%]) and lowest among Asians/Pacific Islanders (15.2% [95% CI= plus or minus 3.6%]), declined with increasing levels of education, and was highest among persons who lived below the poverty level* (34.9% [95% CI=plus or minus 1.5%]). Approximately 25 million men (28.6% [95% CI=plus or minus 0.8%]) and 23 million women (24.6% [95% CI=plus or minus 0.7%]) were current smokers (Table 2). For most demographic groups, smoking prevalence was high among men than women.

 

But quitting is a lot easier said than done. Each year, about 17 million Americans try to stop smoking, according to the American Cancer Society. Only 1.3 million succeed.

 

Question #8:

Interpreting the Pedigree diagram

 

A male is represented by a square or the symbol , a female

by a circle or the symbol . Mating is shown by a horizontal line (marriage line)

connecting a male symbol and a female symbol; offspring symbols are connected in a

row (sibship line) beneath the mated pair. The offspring symbols appear from left to

right in the order of birth and are connected to the marriage line by a vertical line.

Possession of the character under study is shown by a solid or blackened symbol, and

absence is shown by an open or clear symbol. Multiple births are designated by joining

the individual symbols to the same point on the sibship line. Siblings not shown as

individual symbols are indicated by a number within a large symbol for each sex.