Minority Health and Health Equity Archive

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Racial Comparisons of Health Care and Glycemic Control for African American and White Diabetic Adults in an Urban Managed Care Organization
(2004) Gary, Tiffany L.; McGuire, Maura; McCauley, Jeanne; Brancati, Frederick L.
Abstract available at publisher's web site.
Neighborhood Characteristics and Availability of Healthy Foods in Baltimore
(2008) Franco, Manuel; Diez Roux, Ana V.; Glass, Thomas A.; Caballero, Benjamín; Brancati, Frederick L.
BACKGROUND: Differential access to healthy foods may contribute to racial and economic health disparities. The availability of healthy foods has rarely been directly measured in a systematic fashion. This study examines the associations among the availability of healthy foods and racial and income neighborhood composition. METHODS: A cross-sectional study was conducted in 2006 to determine differences in the availability of healthy foods across 159 contiguous neighborhoods (census tracts) in Baltimore City and Baltimore County and in the 226 food stores within them. A healthy food availability index (HFAI) was determined for each store, using a validated instrument ranging from 0 points to 27 points. Neighborhood healthy food availability was summarized by the mean HFAI for the stores within the neighborhood. Descriptive analyses and multilevel models were used to examine associations of store type and neighborhood characteristics with healthy food availability. RESULTS: Forty-three percent of predominantly black neighborhoods and 46% of lower-income neighborhoods were in the lowest tertile of healthy food availability versus 4% and 13%, respectively, in predominantly white and higher-income neighborhoods (p<0.001). Mean differences in HFAI comparing predominantly black neighborhoods to white ones, and lower-income neighborhoods to higher-income neighborhoods, were -7.6 and -8.1, respectively. Supermarkets in predominantly black and lower-income neighborhoods had lower HFAI scores than supermarkets in predominantly white and higher-income neighborhoods (mean differences -3.7 and -4.9, respectively). Regression analyses showed that both store type and neighborhood characteristics were independently associated with the HFAI score. CONCLUSIONS: Predominantly black and lower-income neighborhoods have a lower availability of healthy foods than white and higher-income neighborhoods due to the differential placement of types of stores as well as differential offerings of healthy foods within similar stores. These differences may contribute to racial and economic health disparities.
Incident Type 2 Diabetes Mellitus in African American and White Adults
(2000) Brancati, Frederick L.; Kao, W. H. Linda; Folsom, Aaron R.; Watson, Robert L.; Szklo, Moyses
Context Although the excess prevalence of type 2 diabetes mellitus in African Americans is well established, few studies have compared incident diabetes in African American and white persons. Objectives To compare risk of incident diabetes in African American vs white adults and to identify explanatory factors for racial disparities. Design Prospective cohort study using baseline data collected from 1986 to 1989 from the ongoing Atherosclerosis Risk in Communities (ARIC) Study, with 9 years of follow-up. Setting and Participants A total of 2646 African American and 9461 white adults aged 45 to 64 years without diabetes at baseline, sampled from 4 US communities. Main Outcome Measures Incident type 2 diabetes, ascertained by self-report of physician diagnosis, use of diabetes medications, or fasting glucose level of at least 7.0 mmol/L (126 mg/dL), compared among white and African American subjects and by presence of potentially modifiable risk factors. Results Diabetes incidence per 1000 person-years was about 2.4-fold greater in African American women (25.1 [95% confidence interval {CI}, 22.4-28.1] vs 10.4 [95% CI, 9.4-11.4]) and about 1.5-fold greater in men (23.4 [95% CI, 19.9-27.2] vs 15.9 [95% CI, 14.6-17.2]) than in their white counterparts (P<.001). Results from proportional hazards regression models indicated that racial differences in potentially modifiable risk factors, particularly adiposity, accounted for 47.8% of the excess risk in African American women but accounted for little excess risk in African American men. Compared with their white counterparts, African American men and women had higher blood pressures before diabetes onset (diastolic blood pressure difference=5.6 mm Hg in women and 8.4 mm Hg in men; P=.005). Conclusions Our data indicate that compared with their white counterparts, middle-aged African Americans are at greater risk of developing type 2 diabetes and have higher blood pressure prior to development of diabetes. In women, almost 50% of this excess risk might be related to potentially modifiable factors.
Race, Parity, and Gestational Diabetes as Risk Factors for Type 2 Diabetes Mellitus
(2000) Kahn, Henry S.; Williamson, David F.; Brancati, Frederick L.; Kao, W. H. Linda; Szklo, Moyses; Folsom, Aaron R.; Watson, Robert L.
Dr Brancati and colleagues1 found that even after adjustment for potentially modifiable factors, the relative risk (RR) for diabetes was higher for African American women vs white women than it was for African American men vs white men. We wish to suggest 2 possible explanations for this finding. First, among white women, high parity might2 or might not3 be a risk factor for type 2 diabetes. A study of older white women has shown that the association between parity and increased insulin resistance is discernible at ages 50 to 89 years,4 many years after childbearing. African American women may experience an even greater increase in insulin resistance than white women in association with multiparity as is suggested by evidence from a longitudinal study.5 African American women with multiple pregnancies had waist-to-hip ratio increases twice as great as African American women with no pregnancies, whereas white women

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