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Statistics on Racial Disparity and Health

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In light of recent events, we are seeing greater emphasis towards unravelling the implications of racial disparities.

The 2016 Canadian Census indicates 22.3% of the Canadian population defines themselves as a visible minority, with an additional 4.9% as Aboriginal.1 According to the 2019 U.S. Census, ~40% of the American population belongs to a racial or ethnic minority. By 2050, the U.S. ethnic minority population is predicted to rise to 54% of the population.2

Due to extensive research on the health of minorities, scientists possess a litany of data to critically analyze the manifestation of chronic disease in these populations.

According to an article posted in by the Journal of American Dietetic Association, ‘diet-related disparities’ can be defined as:

 “Differences in dietary intake, dietary behaviors, and dietary patterns in different segments of the population, resulting in poorer dietary quality and inferior health outcomes for certain groups and an unequal burden in terms of disease incidence, morbidity, mortality, survival, and quality of life.” Thus, diet-related disparities reflect differences in diet and the incidence, prevalence, mortality, and the burden of disease between and within specific population subgroups. Typically, racial and ethnic minority groups –defined here as Black or African American, Hispanic, Asian, and American Indian/Alaska natives — experience diet-related disparities, and consequently tend to have poorer nutrient profiles and dietary behaviors and patterns relative to whites.2

The current scientific consensus on mortality rates and overall health appear to be far worse in minority groups.

In our nations’ renewed focus to close the gap between racial minorities and non-minorities, we are presented with a compelling need to re-examine our research. The purpose of this article is to provide insight into critical findings and observations on the topic of health in minority populations.

The following is a recapitulation of well-accepted nutrition-related disparities obtained via meta-analyses or systematic reviews.

1) A 2005-2008 review conducted by the Canadian Community Health Survey (C.C.H.S.) investigated the differences in chronic conditions and risk factors of the Aboriginal and non-Aboriginal populations in northern Canada. The Canadian Aboriginal people consist of three distinct groups: First Nations (F.N.), Inuit, and Metis. Epidemiological evidence from the past half-century suggests a rising prevalence in diabetes, obesity, and heart disease amongst the Canadian Aboriginal population. Using the C.C.H.S. review as the primary means of data, researchers were able to investigate the implications of diet, lifestyle, and socioeconomic factors across northern Aboriginal and non-Aboriginal inhabitants. The sample size from the 2005-2006 and 2007-2008 data cycles were 132 947 and 131 959, respectively. Respondents to this survey provided information regarding their age, sex, income, education status, health conditions, and risk/protective factors such as smoking, alcohol consumption, and physical exercise.

Here are the key findings from this study:

  • Educational attainment is lower in Aboriginal populations compared to non-Aboriginals
  • Annual income is lower for F.N. and Inuit compared to Metis and non-Aboriginal
  • Inuits have the lowest reported incidences of chronic conditions while having the second-highest level of binge drinking and the highest reports of smoking across all populations. Although binge drinking is high, the Inuit population indicates lower levels of regular alcohol consumption.
  • All Aboriginal populations report higher incidences of binge drinking and smoking compared to non-Aboriginals
  • Incidences of obesity are 21% for non-Aboriginal populations and 24-28% for F.N., Inuit, and Metis.
  • Northern FN populations have lower arthritis, asthma and heart disease than southern Aboriginal communities; however, they carry similar rates of overweight, obesity, regular drinking and binge drinking as southern Aboriginals.
  • Northern Metis populations have lowered incidences of arthritis, asthma, and heart disease compared to Metis in southern Canada; however, they have higher levels of obesity, regular drinking, and binge drinking than southern Aboriginals.

The results of this inquiry support the contention there is differences between various aboriginal groups, non-aboriginals, and Aboriginals region-to-region. This study clarifies that socioeconomic factors and lifestyles across the three distinct Aboriginal groups influence their risk factors uniquely.

Bruce S.G. et al. “Chronic disease and chronic disease risk factors among Frist Nations, Inuit, and Metis Populations of northern Canada.” Chronic Diseases and Injuries in Canada, Nov 2014, 344. 3

 

2) A 2012 article published by the American Society for Nutrition provides insight into nutrition-related disparities in maternal health and infancy in minority populations. This study, which serves as a summary report of five separate review articles, consolidates critical information to understand and support the empirically observed challenges in these populations.

Here are the key findings from this article:

  • Minority women are more likely to be overweight at conception.
  • Excess preconception weight leads to altered glucose/lipid metabolism, suboptimal breastfeeding outcomes, and postpartum weight retention.
  • Minority women are more likely to have more offspring leading to increased exposures to conception-related obesity cycles.
  • One of the reviews suggests all minorities see higher risk of experiencing inadequate maternal weight gain, while black women were more likely to retain weight postpartum. (Inadequate weight gain correlates with small-for-gestational-age infants who are at higher risk for developing later life obesity)
  • A separate review indicated an inverse correlation between exercise and gestational diabetes in Latino women.
  • Children who are an ethnic or racial minority are more likely to be obese by age 2.
  • Minority children are more likely to experience lower likelihood to breastfeed exclusively, premature introduction of complementary foods, maternal restrictive feeding style, sugar-sweetened beverages, and fast food. Also, these children are more likely to encounter maternal depression, fail to meet sleep recommendations, and have T.V. in the bedroom after two years.

Perez-Escamilla, R. and Bermudez, O.  “Early Life Nutrition Disparities: Where the Problem Begins.” American Society for Nutrition, Adv Nutr, 2012, 3, 71-72.

 

3) The rising prevalence of obesity in the United States is an evolving public health crisis. In 2015-2017, 71.6% of adults in the U.S. were considered overweight or obese.5 These figures are not exclusive to the U.S.; however, as our global obesity figures have tripled between 1975-2016.6

An article posted in 2007 by Epidemiologic Reviews used nationally representative data in the U.S. to statistically assess the prevalence of obesity and overweight across its population.

Here are the key findings from this article related explicitly to nutrition disparities in minority groups:

  • According to data obtained from the National Health and Nutrition Examination Surveys, Behavioral Risk Factor Surveillance System, and Add Health Study there are substantial racial/ethnic differences in overweight and obesity especially for women
  • Non-Hispanic Blacks had the highest prevalence of obesity/overweight
  • Data from 1999-2002 reveal non-Hispanic black females have a 20% higher incidence of obesity and overweight compared to white females
  • 80% of Non-Hispanic black women over 40 were overweight, and more than 50% are obese
  • The prevalence of extreme obesity in African-American women was double that of white and Mexican-American women
  • Young Asian adult women had the lowest incidences of obesity; however, the differences between Asian groups was considerable. Native Hawaiians and Samoans had the highest reported prevalence of obesity and overweight.
  • S. born Asians are 4x more likely to be obese
  • Differences in B.M.I cannot fully explain racial and ethnic differences. Other factors such as body image, lifestyle, and social and physical environments also serve as contributing factors
  • There is likely to be a bidirectional relationship between socioeconomic status and obesity due to its implications on education, occupation, and marriage.
  • Higher education levels correlate with lower incidences of obesity and overweight except for Black women
  • Black women surpassed all other racial and gender categories for central obesity in 1999-2000. Previous to that, Mexican-American women ranked first.
  • Prevalence of obesity and overweight in adolescent boys aged 6-11 is highest for Mexican Americans, while for females greatest in non-Hispanic Blacks.
  • One-third of obese preschool children and one-half of obese school-age children become obese as adults.

Wang, Y. and Beydoun, M.A. “The Obesity Epidemic in the United States – Gender, Age, Socioeconomic, Racial/Ethnic, and Geographic Characteristics: A Systematic Review and Meta-Regression Analysis.” Epidemiologic Reviews, 17 May 2007, 29, 6-28.7

 

4) The leading cause of death in the United States is cardiovascular disease. Cardiovascular disease is used synonymously with heart disease to denote the narrowing of the arteries leading to stroke, heart attack, or angina. Hypertension is often observed before the manifestation of cardiovascular disease.

The age-adjusted prevalence of high blood pressure is 39% in blacks and 29% in whites (29%).8

Researchers believe the heightened prevalence of hypertension in blacks is partially responsible for higher mortality rates due to cardiovascular or cerebrovascular causes. To determine the extent of additional risk in black populations, a 2008 study published in Annals of Family Medicine, used compiled data from the National Health and Nutrition Examination Survey (N.H.A.N.E.S.) to understand better how variances in systolic blood pressure (S.B.P.) affect mortality.

In this study, scientists used an age- and sex-specific exponential function to determine the variance in systolic blood pressure across the population. The results, cross-referenced against all blacks, blacks with hypertension, and whites, assess relative risk for mortality.

Here are the key findings from this article:

  • Hypertensive black men over 75 years old have a mean systolic blood pressure of 22mm Hg higher than hypertensive black men in the youngest age cohort (25-34 ys old).
  • Hypertensive black women of the same age differential saw a variance of 26mm Hg.
  • The mean systolic blood pressure among black men with hypertension is 6mm higher than all black men and 6.5 mm higher than hypertensive non-Hispanic whites.
  • Hypertensive women saw differences of 6.5 mm Hg compared to all black women and 8.2 mmHg compared to hypertensive non-Hispanic whites.
  • When mortality in blacks with hypertension who die due to stroke and heart disease is compared against blacks without hypertension who die to the same causes, we observe a statistically significant increase in death rate
  • Measures to establish racial parity in black males can predictably reduce annual mortality by heart disease and stroke by 17% and 16% respectively. In females, scientists predict a reduction of 9% and 14%.
  • Racial disparity in systolic blood pressure accounts for an excess of 8,000 deaths attributed to heart disease and stroke
  • The complete etiology of racial disparity in systolic blood pressure is still unknown although there are numerous explanations: access to care, response to medication, severity of hypertension, and adherence to clinical care etc.

Fiscella, K. and Holt, K. “Racial Disparity in Hypertension Control: Tallying the Death Toll.” Annuals of Family Medicine, Nov/Dec 2008, 6(6), 497-502.9

 

5) According to the C.D.C., the second leading cause of death in the United States is cancer. Malignant and fatal tumors are common to regions such as breast, lung, colon, ovaries, prostate, lymphatic system, and bone.

A study released in 2009 sought to examine racial disparities in cancer survival by using a database provided by the Southwest Oncology Group. Data taken from 19 457 patients assess whether race was associated with increased mortality in cancer patients. Covariates for cohort groups include prognostic factors such as education, income, and socioeconomic factors.

Here are the key findings from this study:

  • African Americans were associated with increased mortality from early-stage premenopausal breast cancer, early-stage postmenopausal breast cancer, advanced-stage ovarian cancer, and advanced-stage prostate cancer.
  • The associated disparities remained consistent when data adjusts for education, income, and socioeconomic factors. Increased mortality is likely to be attributed to some degree to genetic and biological differences.
  • African Americans did not see statistically increased mortality from lung, colon, lymphoma, leukemia, and myeloma à these are considered all non-sex specific cancers.
  • Study limitations include early screening detection in breast cancer of non-African American leading to possible lead time bias, as well as noncancer health and comorbid disease disparities for the other cancer types

Albain, K.S. “Racial Disparities in Cancer Survival Among Randomized Clinical Trials Patients of the Southwest Oncology Group” J.N.C.I., 15 July 2009, 101(14), 984-992.10

 

6) African Americans display as much as a 70% greater incidence of diabetes compared to non-Hispanic whites.11 Known risk factors for diabetes, such a socioeconomic status, diet, health behavior, and obesity, fail to explain the increased prevalence of diabetic etiology in African Americans.12,13 Studies that elucidate differences in potassium handling support increased diabetic incidence in African Americans.14-16   Current literature suggests serum potassium is a novel risk factor in the development of hypertension and abnormal glucose metabolism.17,18

A 2011 study released by the American Journal of Clinical Nutrition investigates the relationship between serum potassium and incident diabetes between African Americans and whites. Subjects used in this study came from data obtained from the Atherosclerosis Risk in Communities Study (A.R.I.C.). The final sample study consisted of 2716 African Americans and 9483 whites free of diabetes at their baseline visit. Subjects were monitored for nine years before data reports were published and used in this study.

Here are the key findings from this study:

  • Of the nine-year study, 491/2716 African Americans developed diabetes, and 984/9483 white developed diabetes. Study results denoted a 2x higher crude incidence rate for African Americans.
  • Both groups showed an inverse relationship between serum potassium and incident diabetes; however, the results were insignificant between the two groups.
  • When researchers added covariates such as sex, B.M.I., physical activity, parent history of diabetes, hypertension, systolic blood pressure, family income, education, use of diuretics, use of A.C.E. inhibitors, serum magnesium, calcium, and creatinine, the relative hazard of diabetes in African Americans dropped by 75%.
  • Covariates which displayed the most statistical influence on potassium-race interactions were B.M.I. and serum potassium
  • Researchers confirmed low-normal serum potassium bears significant associations to the risk of incident diabetes and relative risks in African Americans than whites.

Chatterjee, R et al. “Serum potassium and the racial disparity in diabetes risk: the Atherosclerosis Risk in Communities (A.R.I.C.) Study” American Journal of Clinical Nutrition, 2011, 93, 1087-91.

 

Summary:

All of these studies share four commonalities:

    • Minority groups tend to have worse outcomes in all chronic conditions or lifestyle behaviors compared to whites.
    • All studies reinforce the impact of socioeconomic status, environment, access to care, educational status, health literacy, and lifestyle as both substantial and contributing factors to the trends observed.
    • When corrected for covariates, the differences observed between race is less significant. Thus, nutrition and health related disparity is unlikely to be genetically derived.
    • Each meta-analysis or systematic review has scientific limitations which prevent absolute accuracy against all populations.

In light of the aforementioned findings, biological and genetic correlation should not be considered a sole contributor pertaining to chronic disease and lifestyle risk factors. When working to improve health in minority groups, health organizations should avoid using biology and genetics to define outcomes. Instead, emphasis is best applied in areas such as access to quality care, socioeconomic factors, education, income, and, health literacy.

References:

1. “2016 Census topic: Population and dwelling counts.” Statistics Canada, 8 February, 2017, https://www12.statcan.gc.ca/census-recensement/2016/rt-td/population-eng.cfm

2. Satia, J.A. “Diet-Related Disparities: Understanding the Problem and Accelerating Solutions,” Journal of American Dietetic Association, 2009 Apr, 109(4), 610-615.

3. Bruce S.G. et al. “Chronic disease and chronic disease risk factors among Frist Nations, Inuit, and Metis Populations of northern Canada.” Chronic Diseases and Injuries in Canada, Nov 2014, 34(4).

4. Perez-Escamilla, R. and Bermudez, O. “Early Life Nutrition Disparities: Where the Problem Begins.” American Society for Nutrition, Adv Nutr, 2012, 3, 71-72.

5. “Table 21. Selected health conditions and risk factors, by age: United States, selected years 1988-1994 through 2015-2016. Center for Disease Control and Prevention. Trend Tables, 2018, 1-2. https://www.cdc.gov/nchs/data/hus/2018/021.pdf

6. “Obesity and Overweight.” World Health Organization, 1 April 2020, https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight#:~:text=Worldwide%20obesity%20has%20nearly%20tripled,%2C%20and%2013%25%20were%20obese.

7. Wang, Y. and Beydoun, M.A. “The Obesity Epidemic in the United States – Gender, Age, Socioeconomic, Racial/Ethnic, and Geographic Characteristics: A Systematic Review and Meta-Regression Analysis.” Epidemiologic Reviews, 17 May 2007, 29, 6-28.

8. Ong KL, et al. “Prevalence, awareness, treatment, and control of hypertension among United States adults 1999-2004.” Hypertension. 2007;49(1):69-75.

9. Fiscella, K. and Holt, K. “Racial Disparity in Hypertension Control: Tallying the Death Toll.” Annuals of Family Medicine, Nov/Dec 2008, 6(6), 497-502. (9)

10. Albain, K.S. “Racial Disparities in Cancer Survival Among Randomized Clinical Trials Patients of the Southwest Oncology Group” J.N.C.I., 15 July 2009, 101(14), 984-992.

11. Cowie CC, Rust KF, Ford ES, et al. Full accounting of diabetes and pre-diabetes in the U.S. population in 1988-1994 and 2005-2006. Diabetes Care, 2009;32:287–94.

12. Signorello LB, Schlundt DG, Cohen SS, et al. Comparing diabetes prevalence between African Americans and whites of similar socioeconomic status. Am J Public Health, 2007;97:2260–7.

13. Suchindran S, Vana AM, Shaffer RA, Alcaraz JE, McCarthy JJ. Racial differences in the interaction between family history and risk factors associated with diabetes in the National Health and Nutritional Examination Survey, 1999-2004. Genet Med 2009;11:542–7.

14. Minor DS, Wofford MR, Jones DW. Racial and ethnic differences in hypertension. Curr Atheroscler Rep 2008;10:121–7.

15. Turban S, Miller ER, Ange B, Appel LJ. Racial differences in urinary potassium excretion. J Am Soc Nephrol 2008;19:1396–402.

16. Whelton PK, He J, Cutler JA, et al. Effects of oral potassium on blood pressure. Meta-analysis of randomized controlled clinical trials. J.A.M.A., 1997;277:1624–32.

17. He FJ, MacGregor, GA. Beneficial effects of potassium on human health. Physiol Plant 2008;133:725–35.

18. Institute of Medicine of the Natural Academics. Panel on Dietary Reference Intakes for Electrolytes and Water. Potassium. In: Dietary Reference Intakes for water, potassium, sodium, chloride, and sulfate. Washington, DC: National Academis Press, 2005: 186-268.

Naomi Sachs, B.Sc., A.C.H.N., PFT

www.naomisachs.com 

Fully-certified since 2015, Naomi has been successfully coaching clients throughout North America and facilitating their self-growth in the nutrition and fitness realm. If you are feeling overwhelmed by the myriad of health strategies available, her services aim to introduce clarity and self-motivation.