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Asthma

Asthma is a growing concern in this country, particularly in inner-city African-American and Latino populations. Asthma is a chronic lung disease characterized by episodes of airflow obstruction. Symptoms of an asthma attack include coughing, wheezing, shortness of breath, and chest tightness. Asthma occurs in people who are predisposed to develop asthma because of genetic and environmental factors that determine susceptibility. A variety of "triggers" may initiate or worsen an asthma attack, including viral respiratory infections, exercise, and exposure to allergens or to airway irritants such as tobacco smoke and certain environmental pollutants.

Once asthma sufferers learn what conditions prompt their attacks, they can take steps to control their environment and avoid these triggers. However, medical treatment with anti-inflammatory agents (especially inhaled steroids) and bronchodilators is usually necessary to prevent and control attacks. With optimal management, control of asthma is usually an attainable goal.

Asthma affects nearly 15 million Americans, more than 5 percent of the U.S. population. In 1991, asthma claimed approximately 5,000 lives. After a decade of steady decline in the 1970s, the prevalence of asthma, hospitalizations for asthma, and mortality due to asthma each increased during the 1980s.

In 1993, among children and young adults, African Americans were three to four times more likely than whites to be hospitalized for asthma, and were four to six times more likely to die from asthma. Poverty, substandard housing that results in increased exposure to certain indoor allergens, lack of education, inadequate access to health care, and the failure to take appropriate medications may all contribute to the risk of having a severe asthma attack or, more tragically, of dying from asthma.

The scope of the health care problem caused by asthma lies not only in the large number of Americans with the disease, but also in the limitations that asthma can impose on daily life. Asthma is the leading cause of school absenteeism due to chronic illness and is the second most important respiratory condition as a cause of home confinement for adults. Each year, asthma causes more than 18 million days of restricted activity, and millions of visits to physicians' offices and emergency rooms. A recent study found that children with asthma lose an extra 10 million school days each year; this problem is compounded by an estimated $1 billion in lost productivity for their working parents. In 1990, asthma-related health care cost our nation approximately $6.2 billion.

Diabetes

Today, diabetes mellitus is one of the most serious health challenges facing the more than 30 million African Americans. The following statistics illustrate the magnitude of this disease among African Americans.

In 1993, 1.3 million African Americans were known to have diabetes. This is almost three times the number of African Americans who were diagnosed with diabetes in 1963. The actual number of African Americans who have diabetes is probably more than twice the number diagnosed because previous research indicates that for every African American diagnosed with diabetes there is at least one undiagnosed case.
For every white American who gets diabetes, 1.6 African Americans get diabetes.
One in four black women, 55 years of age or older, has diabetes. (Among African Americans, women are more likely to
Twenty-five percent of blacks between the ages of 65 and 74 have diabetes.
African Americans with diabetes are more likely to develop diabetes complications and experience greater disability from the complications than white Americans with diabetes.

Cardiovascular

Cardiovascular disease, which blocks the blood vessels to cause heart attacks, kidney problems and strokes, kills more Americans than any other disease. African-Americans are at greater risk for CVD than any other population group, according to the American Heart Association. In 1993, black men were almost 1 1/2 times as likely as white men to die from CVD; black females were 69.1 percent more likely than white women to die from CVD.

In San Mateo County, 171.4 of 100,000 African-Americans die from heart disease compared to 107.8 per 100,000 population of whites. High blood pressure, which means blood doesn't flow easily through blood vessels, strains the heart and damages blood vessels. It is a risk factor for heart attack and the greatest single cause of stroke. It affects 28 percent of African-American adults and more than two-thirds of African Americans over age 60. It is the No.1 preventable cause of more than 65,000 deaths annually among African- Americans.

Tuberculosis

Blacks in the United States continue to have a disproportionate share of TB. The percentage of TB cases that occur in blacks or African Americans is higher than expected based on the percentage of blacks in the US population.

If looking at only people born in the US, the proportion of TB in African Americans is even greater.

Rates of TB in both blacks and whites have gone down over the past decade, but the disparity remains.

We must better target our efforts to prevent and control TB in this group.

Prostate Cancer: A Major Health Concern for African American Men

Prostate cancer is the most commonly diagnosed form of cancer for men in the United States. Prostate cancer hits African American men especially hard.

In a 2000 study published by the Journal of the National Cancer Institute, African American men were found to be at nearly twice the risk of prostate cancer compared with white men, even after adjustment for a number of known and suspected prostate cancer risk factors.¹, African American men have the highest rate of prostate cancer in the US. ² In addition, a 2000 Roper Starch survey showed that African American men are significantly more likely than white men to experience side effects from prostate cancer treatment, including incontinence. They are also more likely than white men to be dissatisfied with their doctor's support.

Researchers are trying to determine why the African American community suffers more prostate cancer. Some possibilities include:

Environmental and nutritional factors may play an important role. Blacks in Africa do not have the same high rate of prostate cancer and mortality as blacks in the United States. A genetic difference and lower levels of vitamin D may contribute to the higher rates of prostate cancer in African American men. ¹
Less access to health care, including lack of insurance, may mean that African American men don’t always get the preventive care they need.
Distrust or negative attitudes towards screening tests and health care may mean that prostate cancer is diagnosed when it is more advanced in African American men.