Smoking Cessation After Lung Cancer Diagnosis and the Risk of Second Primary Lung Cancer: The Multiethnic Cohort Study.

Background: Smoking cessation reduces lung cancer mortality. However, little is known about whether diagnosis of lung cancer impacts changes in smoking behaviors. Furthermore, the effects of smoking cessation on the risk of second primary lung cancer (SPLC) have not been established yet. This study aims to examine smoking behavior changes after initial primary lung cancer (IPLC) diagnosis and estimate the effect of smoking cessation on SPLC risk following IPLC diagnosis. Methods: The study cohort consisted of 986 participants in the Multiethnic Cohort Study who were free of lung cancer and active smokers at baseline (1993-1996), provided 10-year follow-up smoking data (2003-2008), and were diagnosed with IPLC in 1993-2017. The primary outcome was a change in smoking status from "current" at baseline to "former" at 10-year follow-up (ie, smoking cessation), analyzed using logistic regression. The second outcome was SPLC incidence after smoking cessation, estimated using cause-specific Cox regression. All statistical tests were 2-sided. Results: Among 986 current smokers at baseline, 51.1% reported smoking cessation at 10-year follow-up. The smoking cessation rate was statistically significantly higher (80.6%) for those diagnosed with IPLC between baseline and 10-year follow-up vs those without IPLC diagnosis (45.4%) during the 10-year period (adjusted odds ratio = 5.12, 95% confidence interval [CI] = 3.38 to 7.98; P < .001). Incidence of SPLC was statistically significantly lower among the 504 participants who reported smoking cessation at follow-up compared with those without smoking cessation (adjusted hazard ratio = 0.31, 95% CI = 0.14 to 0.67; P = .003). Conclusion: Lung cancer diagnosis has a statistically significant impact on smoking cessation. Quitting smoking after IPLC diagnosis may reduce the risk of developing a subsequent malignancy in the lungs.

Endotypes of Chronic Rhinosinusitis Across Ancestry and Geographic Regions.

PURPOSE OF REVIEW: Preliminary studies have suggested differences in endotypes of chronic rhinosinusitis (CRS) across ancestry/ethnic groups. Eosinophilic CRS (ECRS) is the predominant subtype for Western/European ancestry CRS patients and non-eosinophilic CRS (nECRS) for Asian patients. This review aims to re-analyze CRS endotypes across ancestry populations using one consistent criteria to existing data. RECENT FINDINGS: Although tissue eosinophilia is the most commonly used criterion for ECRS, various cut-off points are suggested. Surrogate markers have been extensively studied. Sixty-six cohorts with study criteria were included with a total of 8557 patients. Raw data from 11 studies 544 patients were re-analyzed using number of tissue eosinophils. At lower cut-off values of ≥ 5 and ≥ 10 cells/HPF, most patients of Asian and Western/European ancestry were classified as ECRS without difference. In contrast, at cut-off points of ≥ 70 and ≥ 120 cells/HPF, the majority of both groups became reclassified as nECRS. After applying one consistent criteria to existing data, differences across ancestry and geographic populations in endotypes of CRS were no longer evident.

Measurement and modeling of race and health in Brazil: continuing the discussion / Medição e modelagem de raça e saúde no Brasil: continuando a discussão / Medición y modelización de raza y salud en Brasil: continuando la discusión

Recent reviews have discussed the conceptualization of race in health studies in Brazil. This review further documents and discusses specific measurement and modeling issues with regard to race and how this can impact result interpretation. Three scientific databases were used to search the literature on race and three health outcomes. The search yielded 38 empirical studies on birth outcomes, self-rated health, and weight. Results suggest that, while there are racial patterns in the overall literature, conceptual and methodological challenges can be addressed to clarify the ways in which racial group membership is linked to health.

Recentes revisões têm discutido a conceitualização da raça em estudos sobre saúde no Brasil. Esta revisão descreve e discute temas específicos de medição e modelização de raça e como isso pode impactar a interpretação de resultados. Três bases de dados científicas foram usadas para buscar a literatura sobre raça e três resultados em saúde. A pesquisa encotnrou 38 estudos empíricos sobre os resultados do parto, auto-avaliação da saúde e peso. Os resultados sugerem que, embora existam padrões raciais na literatura em geral, os desafios conceituais e metodológicos podem ser abordados para esclarecer as formas em que a adesão ao grupo racial está ligada à saúde.

Recientes revisiones han discutido la conceptualización de la raza en estudios de la salud en el Brasil. Esta revisión documenta y discute temas específicos de medición y modelización con respecto a la raza y cómo esto puede impactar la interpretación de resultados. Tres bases de datos científicas fueron utilizadas para buscar la literatura sobre raza y tres resultados de salud. La búsqueda encontró 38 estudios empíricos sobre los resultados del nacimiento, la autoevaluación de la salud y el peso. Los resultados sugieren que, si bien hay patrones raciales en la literatura general, desafíos conceptuales y metodológicos pueden ser abordados para aclarar las formas en que la pertenencia a grupos raciales está vinculada a la salud.

Volatilidade classificatória e a (in)consistência da desigualdade racial / Volatilidad clasificatoria y la (in)consistencia de la desigualdad racial / Classificatory volatility and (in)consistency of racial inequality

O monitoramento de desigualdades raciais, seja num plano socioeconômico ou em termos de desfechos de saúde, pressupõe que a declaração da raça apresente estabilidade. Caso contrário, a dinâmica dessas desigualdades poderia resultar da reclassificação racial, e não de processos vinculados a iniquidades socioeconômicas e de saúde. Este estudo propõe uma tipologia da incerteza racial classificatória (contextual - temporal, geográfica, procedimental - e amostral) e discute, com base na literatura e dados secundários nacionalmente representativos, a magnitude da variabilidade racial segundo essas cinco dimensões. Os resultados demonstram que, pelo menos, duas dessas incertezas - geográfica e procedimental - são substanciais, mas têm pouca influência sobre o hiato racial de renda. Abordam-se os impactos desses resultados sobre a existência e a extensão das iniquidades raciais em saúde e conclui-se que a estrutura das desigualdades entre brancos e negros é consistente, ainda que a cor da pele seja volátil.

El monitoreo de desigualdades raciales, sea en un plano socioeconómico o en términos de desenlaces de salud, presupone que la declaración de raza presenta estabilidad. En caso contrario, la dinámica de estas desigualdades podría resultar de una reclasificación racial, y no de procesos vinculados a inequidades socioeconómicas y de la salud. Este estudio propone una tipología de la incertidumbre racial clasificatoria (contextual -temporal, geográfica, procedimental- y muestral) y discute, a partir de la literatura y de datos secundarios nacionalmente representativos, la magnitud de la variabilidad racial, según estas cinco dimensiones. Los resultados demuestran que, por lo menos, dos de esas incertezas -geográfica y procedimental- son sustanciales, pero tienen poca influencia sobre el hiato racial de renta. Se abordan los impactos de esos resultados sobre la existencia y la extensión de las inequidades raciales en salud y se concluye que la estructura de las desigualdades entre blancos y negros es consistente, aunque el color de la piel sea volátil.

Monitoring racial inequalities, whether socioeconomic or health-related, assumes stability in racial classification. Otherwise, the dynamics of these inequalities could result from racial reclassification rather than from processes related to socioeconomic and health inequalities per se. The study proposes a typology of uncertainty in racial classification (contextual - temporal, geographic, procedural - and sampling) and draws on the literature and nationally representative secondary data to discuss the magnitude of racial variability in Brazil according to these five dimensions. The results show that at least two of these uncertainties - geographic and procedural - are substantial, but have little influence on the racial gap in income. We address the impacts of these results on the existence and extent of racial inequalities in health and conclude that the structure of inequalities between whites and blacks is consistent, although skin color classification is volatile.

National Cancer Data Base analysis of radiation therapy consolidation modality for cervical cancer: the impact of new technological advancements.

PURPOSE: To utilize the National Cancer Data Base to evaluate trends in brachytherapy and alternative radiation therapy utilization in the treatment of cervical cancer, to identify associations with outcomes between the various radiation therapy modalities. METHODS AND MATERIALS: Patients with International Federation of Gynecology and Obstetrics stage IIB-IVA cervical cancer in the National Cancer Data Base who received treatment from January 2004 to December 2011 were analyzed. Overall survival was estimated by the Kaplan-Meier method. Univariate and multivariable analyses were performed to identify factors associated with type of boost radiation modality used and its impact on survival. RESULTS: A total of 7654 patients had information regarding boost modality. A predominant proportion of patients were Caucasian (76.2%), had stage IIIB (48.9%) disease with squamous (82.0%) histology, were treated at academic/research centers (47.7%) in the South (34.8%), and lived 0 to 5 miles (27.9%) from the treating facility. A majority received brachytherapy (90.3%). From 2004 to 2011, brachytherapy use decreased from 96.7% to 86.1%, whereas intensity modulated radiation therapy (IMRT) and stereotactic body radiation therapy (SBRT) use increased from 3.3% to 13.9% in the same period (P<.01). Factors associated with decreased brachytherapy utilization included older age, stage IVA disease, smaller tumor size, later year of diagnosis, lower-volume treatment centers, and facility type. After controlling for significant factors from survival analyses, IMRT or SBRT boost resulted in inferior overall survival (hazard ratio, 1.86; 95% confidence interval, 1.35-2.55; P<.01) as compared with brachytherapy. In fact, the survival detriment associated with IMRT or SBRT boost was stronger than that associated with excluding chemotherapy (hazard ratio, 1.61' 95% confidence interval, 1.27-2.04' P<.01). CONCLUSIONS: Consolidation brachytherapy is a critical treatment component for locally advanced cervical cancer; however, there has been declining utilization of brachytherapy. Increased use of IMRT and SBRT boost coupled with increased mortality risk should raise concerns about utilizing these approaches over brachytherapy.

Minorities are less likely to receive autologous blood transfusion for major elective orthopaedic surgery.

BACKGROUND: Surgeons commonly arrange for patients to perform autologous blood donation before elective orthopaedic surgery. Understanding sociodemographic patterns of use of autologous blood transfusion can help improve quality of care and cost containment. QUESTIONS/PURPOSES: We sought to determine whether there were (1) racial disparities, (2) insurance-based disparities, or (3) income-based disparities in autologous blood use. Additionally, we evaluated the combined effect of (4) race and insurance and (5) race and income on autologous blood use, and we compared ratios of autologous with allogeneic blood use. METHODS: Of the more than 3,500,000 patients undergoing major elective orthopaedic surgery identified in the Nationwide Inpatient Sample between 2008 and 2011, 2.4% received autologous blood transfusion and 12% received allogeneic blood transfusion. Multivariable logistic regression was performed to determine the influence of race, insurance status, and income on autologous blood use. RESULTS: Compared with white patients, Hispanic patients had lower odds of autologous blood use for elective hip (odds ratio [OR], 0.75; 95% CI, 0.69-0.82) and knee arthroplasties (OR, 0.71; 95% CI, 0.67-0.75). Black patients had lower odds of receiving autologous blood transfusion for hip arthroplasty (OR, 0.78; 95% CI, 0.74-0.83). Compared with the privately insured, uninsured and publicly insured patients were less likely to receive autologous blood for total joint arthroplasty and spinal fusion. Patients with low and medium income were less likely to have autologous blood transfusion for total joint arthroplasty and spinal fusion compared with high-level income earners. Even at comparable income and insurance levels with whites, Hispanic and black patients tended to be less likely to receive autologous blood transfusion. Ratios of autologous to allogeneic blood use were lower among minority patients. CONCLUSIONS: Historically disadvantaged populations receive fewer autologous blood transfusions for elective orthopaedic surgery. Whether the differential use is attributable to patient preference or unequal access to this practice should be investigated further. LEVEL OF EVIDENCE: Level II, prognostic study. See the Instructions for Authors for a complete description of levels of evidence.

Conflicting race/ethnicity reports: lessons for improvement in data quality.

OBJECTIVE: To learn the frequency of conflicting race/ethnicity reports, to examine patterns of conflicting reports, and to identify possible avenues for data quality improvement. METHODS: As part of the Data Improvement Project on Patient Ethnicity and Race (DIPPER), an analysis of conflicting race/ethnicity reports for cancer cases was conducted. Using matched hospital discharge data and central cancer registry data from 2009, the race/ethnicity of patients in the 2 datasets were compared. Those with conflicting reports ("mismatched") were examined more closely. From a sample of 2,356 patients, 187 had conflicting reports for their race (7.9%) and 357 had conflicting reports for their ethnicity (15% was thus developed). RESULTS: In the 2009 hospital discharge data, an unknown response occurred nearly twice as often for Hispanic ethnicity as for race. Almost 85% of the mismatched race cases were classified as non-white in the hospital discharge data and white in the central cancer registry data. The most common ethnicity mismatch was coded unknown by the hospital but non-Hispanic by the registry. CONCLUSIONS: Hospital cancer registrars occasionally lack easy access to race and, more often, ethnicity data. More attention should be given to discrepancies (including allowing staff to flag and verify existing data), and staff training should improve both perceived and real data accuracy. In the future, hospitals and registries would be better served by pairing race and ethnicity together in the electronic medical record. This would ensure quick, easy access for cancer registrars. Perhaps standard setters should add ethnicity to the gold standard criteria for registries.

Description of color/race in Brazilian biomedical research / Descrição de cor/raça em pesquisas biomédicas brasileiras

CONTEXT AND OBJECTIVE: Over recent years, the terms race and ethnicity have been used to ascertain inequities in public health. However, this use depends on the quality of the data available. This study aimed to investigate the description of color/race in Brazilian scientific journals within the field of biomedicine. DESIGN AND SETTING: Descriptive study with systematic search for scientific articles in the SciELO Brazil database. METHODS: A wide-ranging systematic search for original articles involving humans, published in 32 Brazilian biomedical scientific journals in the SciELO Brazil database between January and December 2008, was performed. Articles in which the race/ethnicity of the participants was identified were analyzed. RESULTS: In total, 1,180 articles were analyzed. The terms for describing race or ethnicity were often ambiguous and vague. Descriptions of race or ethnicity occurred in 159 articles (13.4%), but only in 42 (26.4%) was there a description of how individuals were identified. In these, race and ethnicity were used almost interchangeably and definition was according to skin color (71.4%), ancestry (19.0%) and self-definition (9.6%). Twenty-two races or ethnicities were cited, and the most common were white (37.3%), black (19.7%), mixed (12.9%), nonwhite (8.1%) and yellow (8.1%). CONCLUSION: The absence of descriptions of parameters for defining race, as well as the use of vague and ambiguous terms, may hamper and even prevent comparisons between human groups and the use of these data to ascertain inequities in healthcare.

CONTEXTO E OBJETIVO: Nos últimos anos os termos raça e etnia têm sido usados para verificar iniquidades em saúde pública. Entretanto, o uso dos termos depende da qualidade dos dados disponíveis. O presente estudo teve como objetivo verificar a descrição de cor/raça em revistas científicas brasileiras da área biomédica. TIPO DE ESTUDO E LOCAL: Estudo descritivo com busca sistemática de artigos científicos da base de dados SciELO Brasil. MÉTODOS: Foi realizada uma ampla busca sistemática de artigos originais envolvendo seres humanos, publicados em 32 revistas científicas biomédicas brasileiras da base de dados SciELO Brasil, publicados no período de janeiro a dezembro de 2008. Foram analisados artigos em que as raças/etnias dos participantes da pesquisa foram identificadas. RESULTADOS: Ao todo foram analisados 1.180 artigos. Os termos para descrever a raça ou etnia foram frequentemente ambíguos e vagos. A descrição da raça ou etnia ocorreu em 159 (13,4%) artigos, mas somente em 42 (26,4%) havia a descrição de como os indivíduos foram identificados. Nestes, raça e etnia foram usados praticamente como sinônimos e a definição ocorreu pela cor da pele (71,4%), ancestralidade (19,0%) e autodefinição (9,6%). Foram citadas 22 raças/etnias, sendo as mais comuns a branca (37,3%), a negra (19,7%), a parda (12,9%), a não-branca (8,1%) e a amarela (8,1%). CONCLUSÃO: A ausência de descrição de parâmetros para definir raça, bem como termos vagos e ambíguos, pode dificultar e mesmo inviabilizar a comparação de grupos humanos e a utilização desses dados para verificar iniquidades em saúde.

Evaluation of cephalic indices: a clue for racial and sex diversity / Evaluación del índice cefálico: una clave de la diversidad racial y de sexo

Cephalic index is an important parameter in evaluating racial and gender differences. A large body of evidence shows a clear racial variation in cephalic index. Therefore detailed knowledge of the population specific data on biometric features of the cranium is important in the study and comparison of the crania of populations from different racial backgrounds, assessing growth and development of an individual and in the diagnosis of any abnormalities of cranial size and shape. Despite its' significance, little is known concerning the cranial morphometry in Sri Lankans. Hence, the present study was undertaken to establish the cranial indices and head shapes in an adult Sri Lankan population. A total of 400 subjects with an age span of 20-23 years were included in the study. The cranial length, breadth and auricular head height of the subjects were recorded using a digital sliding caliper and Todd's head spanner. The horizontal, vertical and transverse cephalic indices were calculated using external dimensions of the skulls. There were significant gender differences in all principal cranial dimensions. The mean horizontal, vertical and transverse cephalic indices were 78.54, 78.68 and 100.52 respectively. The predominant cephalic phenotype of the study subjects were brachycephalic, hypsicephalic and acrocephalic. Among males dolicocephalics and among females brachycephalics dominated. The results of this study highlight the racial and gender differences in cranial morphometry and cephalic indices in an adult Sri Lankan population. The data will be of immense use in clinical, medico-legal, anthropological and archeological scenarios.

El índice cefálico es un parámetro importante para evaluar las diferencias raciales y sexuales. Una gran cantidad de evidencia muestra una clara variación racial en el índice cefálico. Por tanto, un conocimiento detallado de los datos específicos de una población sobre las características biométricas del cráneo, son importantes en el estudio y la comparación craneal de poblaciones de diferentes orígenes raciales, evaluación del crecimiento y desarrollo de un individuo, y el diagnóstico de cualquier anomalía del tamaño o forma del cráneo. A pesar de su importancia, poco se conoce sobre la morfometría craneal en Sri Lanka. El presente estudio se realizó para establecer los índices cefálicos y formas de la cabeza en una población adulta de Sri Lanka. Un total de 400 sujetos entre 20 y 23 años fueron incluidos en el estudio. La longitud de la cabeza, ancho y altura auricular fueron registradas con un caliper digital deslizante y un aparato de Todd. Los índices cefálicos horizontales, verticales y transversales fueron calculados utilizando las dimensiones externas de los cráneos. Hubo diferencias significativas de sexo en todas las dimensiones de la cabeza. La media horizontal, vertical y transversal de los índices cefálicos fueron 78,54; 78,68 y 100,52, respectivamente. Los fenotipos cefálicos predominantes fueron braquicéfalos, hipsicefálicos y acrocéfalos. Entre los hombres dominaron los dolicocefalos y entre mujeres los braquicéfalos. Los resultados de este estudio ponen de relieve la diversidad racial y las diferencias de sexo en la morfometría craneal e índice cefálico en una población adulta de Sri Lanka. La información será de utilidad inmensa en clínica, medicina legal, escenarios antropológicos y arqueológicos.

Definition and use of the variable "race" by medical students in Salvador, Brazil / Definição e utilização da variável "raça" por estudantes de medicina em Salvador, Bahia, Brazil

CONTEXT AND OBJECTIVE: The lack of a clear definition for human "race" and the importance of this topic in medical practice continue to create doubt among scholars. Here, we evaluate the use of the variable "race" by medical students in Salvador, Brazil. DESIGN AND SETTING: Cross-sectional study at a Brazilian federal public university. METHODS: 221 randomly selected subjects were included. A semi-structured questionnaire was used for data collection. The results were expressed as means and standard deviations of the mean, proportions and frequencies. The χ2 (chi-square) test was used for the statistical calculations. RESULTS: Approximately half of the students (45.4 percent) used the racial group variable in their studies on clinical practice. Of these, 86.8 percent considered it to be relevant information in the medical records and 92.7 percent, important for diagnostic reasoning; 95.9 percent believed that it influenced the cause, expression and prevalence of diseases; 94.9 percent affirmed that it contributed towards estimating the risk of diseases; 80.5 percent thought that the therapeutic response to medications might be influenced by racial characteristics; 41.9 percent considered that its inclusion in research was always recommendable; and 20.3 percent thought it was indispensable. The main phenotypic characteristics used for racial classification were: skin color (93.2 percent), hair type (45.7 percent), nose shape (33.9 percent) and lip thickness (30.3 percent). CONCLUSIONS: Despite the importance of different racial groups in medical practice, the majority of the professionals do not use or know how to classify them. It is necessary to add to and/or expand the discussion of racial and ethnic categories in medical practice and research.

CONTEXTO E OBJETIVO: A falta de uma definição clara da raça humana e a importância desse tema na prática médica continua a ser fonte de dúvidas para estudiosos. No presente artigo nós avaliamos o uso da variável raça por estudantes de medicina em Salvador, Brasil. TIPO DE ESTUDO E LOCAL: corte transversal, realizado numa universidade pública federal. MÉTODO: 221 estudantes, , foram incluídos. Um questionário semi-estruturado foi utilizado para a coleta dos dados. Os resultados são expressos como média e desvio-padrão da média, proporções e frequências. O teste do χ2 (qui-quadrado) foi utilizado para o cálculo estatístico. RESULTADOS: Aproximadamente metade dos estudantes (45,4 por cento) usava a variável grupo racial na sua prática clínica em estudos. Desses, 86,8 por cento a consideravam uma informação relevante no prontuário médico; 92,7 por cento no raciocínio diagnóstico; 95,9 por cento acreditavam que ela influenciava a causa, expressão e prevalência das doenças; 94,9 por cento afirmaram que ela contribuía para estimar o risco de doenças; 80,5 por cento informaram que a resposta terapêutica a medicamentos pode ser influenciada pelas características raciais; 41,9 por cento consideravam que sua inclusão nas pesquisas era sempre recomendável; e 20,3 por cento a avaliavam como indispensável. As principais características fenotípicas usadas para a classificação racial foram: cor da pele (93,2 por cento), tipo de cabelo (45,7 por cento), formato do nariz (33,9 por cento) e espessura dos lábios (30,3 por cento). CONCLUSÃO: Apesar de sua importância na prática médica, a maioria dos profissionais não usa e não sabe classificar os diversos grupos raciais. É necessário adicionar e/ou ampliar a discussão sobre as categorias raciais e étnicas no exercício da medicina e nas pesquisas médicas.

Influência da cor de pele auto-referida na prevalência da síndrome metabólica numa população urbana do Brasil / Influence of the self-reported skin color on the prevalence of metabolic syndrome in an urban Brazilian population / Influencia del color de la piel autodeclarado en la prevalencia del síndrome metabólico en una población urbana de Brasil

Fundamento: A síndrome metabólica tem uma elevada prevalência em diferentes partes do mundo, com variações entre diferentes grupos étnicos. Objetivo: Este estudo pretende explorar a influência da cor de pele auto-referida sobre a prevalência da SM. Métodos: Estudo transversal, realizado em subgrupo populacional em Salvador, Brasil. Utilizou-se auto-definição de cor de pele (branca, parda e negra) e o critério de SM do ATP-III. Foi usado o quiquadrado para tendência a fim de analisar gradiente das prevalências entre os grupos e a regressão logística para análises de associações. Resultados: A prevalência geral da SM, ajustada por variáveis potencialmente confundidoras, não diferiu entre brancos (23,3 por cento), pardos (23,3 por cento) e negros (23,4 por cento,). A análise por sexo mostrou entre os homens redução da prevalência da SM dos brancos, 26,2 por cento IC95 por cento(20,7-31,7), em comparação aos negros, 17,5 por cento IC95 por cento (12,3-22,8), e uma prevalência intermediária entre os pardos, 21,9 por cento IC95 por cento (18,6 - 25,1), p tend= 0,002. Entre as mulheres, a tendência foi inversa, maior nas negras, 27,0 por cento IC95 por cento (22,2-31,8), e menor nas brancas, 20,5 por cento IC95 por cento(15,6-25,4), p tend= 0,02. Na análise multivariada da associação entre cor de pele e SM (branco=grupo de referência), a cor negra entre os homens foi fator de proteção, razão de prevalência (RP)= 0,60 (0,36 - 0,97), enquanto que nas mulheres tendeu a ser fator de risco, RP= 1,33 (0,94 - 1,78). Conclusão: A prevalência da SM variou em função da cor de pele de modo inverso entre homens e mulheres. Ser negro foi fator de proteção entre homens e de risco nas mulheres.

Background: The metabolic syndrome (MS) has a high prevalence in different parts of the world, with variations between different ethnic groups. Objective: This study aims at exploring the influence of the self-reported skin color on the prevalence of MS. Methods: Cross-sectional study, carried out in a population subgroup (n=1,439 adults) in Salvador, Brazil. The self-reported skin color (white, mulatto or black) was used as well as the MS criterion of ATP-III. The Chi-square test for tendency was used to analyze the prevalence gradient between the groups and logistic regression, for association analysis. Results: The general prevalence of MS, adjusted for potentially confounder variables, did not differ among whites (23.3 percent), mulattos (23.3 percent) and blacks (23.4 percent). The analysis by sex showed, among men, a reduction in the MS prevalence of whites (26.2 percent, 95 percentCI: 20.7-31.7), in comparison to blacks (17.5 percent, 95 percentCI: 12.3-22.8) and an intermediate prevalence among mulattos, 21.9 percent, 95 percentCI: 18.6-25.1, p tend. = 0.002. Among the women, the tendency was the opposite, being higher among the blacks, 27.0 percent, 95 percentCI: 22.2-31.8, and lower among the whites, 20.5 percent, 95 percentCI: 15.6-25.4, p tend. = 0.02. The multivariate analysis of the association between skin color and MS (white = group of reference) showed that the black color of the skin was a protective factor among black men, with a prevalence ratio (PR) = 0.60 (0.36-0.97), whereas it tended to be a risk factor among black women, with a PR = 1.33 (0.94-1.78). Conclusion: The prevalence of MA presented an inverse variation according to the color of skin between men and women. To be black was a protective factor among men and a risk factor among women.

Fundamento: El síndrome metabólico tiene una elevada prevalencia en diferentes partes del mundo, con variaciones entre diferentes grupos étnicos. Objetivo: Este estudio pretende explorar la influencia del color de la piel autodeclarado sobre la prevalencia del SM. Métodos: ESTUDio transversal, realizado en subgrupo poblacional en Salvador, Brasil. Se utilizó la autodefinición de color de la piel (blanca, parda y negra) y el criterio de SM del ATP-III. Se usó el test chi-cuadrado para tendencia a fin de analizar gradiente de las prevalencias entre los grupos y la regresión logística para análisis de asociaciones. Resultados: La prevalencia general del SM, ajustado por variables potencialmente confusas, no difirió entre blancos (23,3 por ciento), pardos (23,3 por ciento) y negros (23,4 por ciento,). El análisis por sexo mostró entre los hombres reducción de la prevalencia del SM de los blancos, el 26,2 por ciento IC95 por ciento(20,7-31,7), en comparación con los negros, 17,5 por ciento IC95 por ciento (12,3-22,8), y una prevalencia intermedia entre los pardos, 21,9 por ciento IC95 por ciento (18,6 - 25,1), p tend= 0,002. Entre las mujeres, la tendencia fue inversa, mayor en las negras, 27,0 por ciento IC95 por ciento (22,2-31,8), y menor en las blancas, 20,5 por ciento IC95 por ciento(15,6-25,4), p tend= 0,02. En el análisis multivariado de la asociación entre color de la piel y SM (blanco=grupo de referencia), el color negro entre los hombres fue factor de protección, razón de prevalencia (RP)= 0,60 (0,36-0,97), mientras que en las mujeres tendió a ser factor de riesgo, RP= 1,33 (0,94-1,78). Conclusión: LA Prevalencia del SM varió en función del color de la piel de modo inverso entre hombres y mujeres. Ser negro fue factor de protección entre hombres y de riesgo en las mujeres.

Classificação de raça, cor e etnia: conceitos, terminologia e métodosutilizados nas ciências da saúde no Brasil, no período de 2000 à 2009 / Classification of race, color, and ethnicity: concepts, terminology and methods used in the health sciences in Brazil, from 2000 to 2009

Esta dissertação tem como objetivo principal analisar a utilização e a fundamentação teórico-metodológica da classificação de raça, cor e etnia na literatura das ciências da saúde, produzida no período de 2000 a 2009 , no Brasil. A metodologia utilizada é arevisão bibliográfica sistemática através das bases de dados do MEDLINE, LILACS e SCIELO. Preliminarmente comparou-se a terminologia de identificação étnico-racial utilizada nas publicações brasileiras e norte-americanas. No período em questão houve expressivo aumento de estudos em saúde com foco em cor / raça, embora ainda seja restrito o seu espectro nas ciências da saúde. O debate público sobre identidade racial também aumentou neste período, influenciado pelas políticas públicas e ações da sociedade civil voltadas para negros e indígenas. No estudo mapeou-se aspectos históricos, sociais , ideológicos e metodológicos que permeiam a abordagem da classificação étnico-racial ; concepções e valores vinculados a identidade, desigualdade, racismo, discriminação, mistura racial e equidade, entre outros, estão entre meados na literatura analisada. Ressalta-se a ausência e inconsistência conceitual no uso dos termos raça, cor e etnia e o emprego de terminologia diversificada e não padronizada na identificação dos indivíduos. Conclui-se que nas ciências da saúde ainda é insuficiente a abordagem metodológica na classificação de raça, cor e etnia, além de ser necessária a ampliação da investigação dos seus aspectos teóricos, conceituais etécnicos, sendo estes indissociáveis da discussão sobre desigualdades raciais e racismo.

This dissertation aims to analyze mainly the usage and the theoretical-methodological basis for the race, color and ethnicity classification in the Brazilian health sciences literature from 2000 through 2009. A systematic bibliographic review is the chosenmethodology by searching MEDLINE, LILACS and SCIELO databases, comparing preliminarily the ethnic/racial identification terminology used in North American andBrazilian publications. There was an expressive increase of Health studies focusing on color/race in this period, although their range is still restricted to what concerns Health Sciences. Public debate on racial identity has also intensified in this period, influencedby public policies and civil society actions targeted for Blacks and Indians. This study has mapped historical, societal, ideological and methodological aspects that permeate ethnic/racial classification approach; concepts and values connected to identity, inequality, racism, discrimination, racial mixture and equity, among others, are mingledin the literature analyzed. It is underlined the conceptual absence and inconsistency in the usage of the terms race, color and ethnicity and the use of diversified and nonstandardizedterminology in the identification of individuals. The conclusion is that themethodological approach in Health Sciences for the classification of race, color and ethnicity is still insufficient, in addition to the necessity of the expansion of investigations of their theoretical, conceptual and technical aspects, which must be associated to the discussion on racial inequalities and racism.

Does the way I see you affect the way I see myself? Associations between interviewers' and interviewees' "color/race" in southern Brazil / Como te percebo afeta o modo como me vejo? Relações da "cor/raça" de entrevistadores e de entrevistados no Sul do Brasil

This study assessed the associations between female interviewers' self-classified "color/race" and participants' self- and interviewer-classified "color/race". A cross-sectional study was carried out among adult individuals living in Pelotas, southern Brazil. Associations were examined by means of contingency tables and multinomial regression models, adjusting for interviewees' socioeconomic and demographic factors. Individuals aged > 40 years were 2.1 times more likely to classify themselves as brown (versus white) when interviewed by black (as compared to white) interviewers. Participants in the same age group were 2.5 times less likely to classify themselves as black (versus white), when interviewed by black interviewers. These differences were even greater among men 40 years or older. Compared to white interviewers, black female interviewers were 2.5 times less likely to classify men aged > 40 years as black. These results highlight the complexity of racial classification, indicating the influence of the interviewer's physical characteristics on the interviewee's "color/race".

Avaliou-se a relação entre "cor/raça" de entrevistadoras, auto e heteroclassificação de "cor/raça" dos entrevistados. Foi realizado um estudo com indivíduos adultos de Pelotas, Rio Grande do Sul, Brasil. As associações foram verificadas com tabelas de contingência e modelos multinomiais, ajustando-se para variáveis sócio-econômicas e demográficas dos entrevistados. Indivíduos com > 40 anos tiveram uma chance 2,1 vezes maior de se classificarem como pardos do que como brancos, quando abordados por entrevistadoras pretas, em relação às brancas. Entrevistados dessa mesma faixa etária apresentaram 2,5 vezes menos chances de se classificarem como pretos do que como brancos, ao serem abordados por entrevistadoras pretas. Essas diferenças foram mais expressivas entre homens de > 40 anos. Entrevistadoras pretas tiveram chance 2,5 vezes menor de classificar homens de > 40 anos como pretos do que como brancos, em comparação com as brancas. Os resultados indicam o caráter complexo da classificação racial, sugerindo a influência de características pessoais das entrevistadoras sobre a "cor/raça" dos entrevistados.

DC-SIGN (CD209) gene promoter polymorphisms in a Brazilian population and their association with human T-cell lymphotropic virus type 1 infection.

This study evaluated four polymorphisms located in the DC-SIGN (CD209) gene promoter region (positions -336, -332 -201 and -139) in DNA samples from four Brazilian ethnic groups (Caucasians, Afro-Brazilian, Asians and Amerindians) to establish the population distribution of these single-nucleotide polymorphisms (SNPs) and correlated DC-SIGN polymorphisms and infection in samples from human T-cell lymphotropic virus type 1 (HTLV-1)-infected individuals. To identify CD209 SNPs, 452 bp of the CD209 promoter region were sequenced and the genotype and allelic frequencies were evaluated. This is the first study to show genetic polymorphism in the CD209 gene in distinct Brazilian ethnic groups with the distribution of allelic and genotypic frequency. The results showed that -336A and -139A SNPs were quite common in Asians and that the -201T allele was not observed in Caucasians, Asians or Amerindians. No significant differences were observed between individuals with HTLV-1 disease and asymptomatic patients. However, the -336A variant was more frequent in HTLV-1-infected patients [HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP), 80 %; healthy asymptomatic HTLV-1 carriers, 90 %] than in the control group (70 %) [P=0.0197, odds ratio (OR)=2.511, 95 % confidence interval (CI)=1.218-5.179). In addition, the -139A allele was found to be associated with protection against HTLV-1 infection (P=0.0037, OR=0.3758, 95 % CI=0.1954-0.7229) when the HTLV-1-infected patients as a whole were compared with the healthy-control group. These observations suggest that the -139A allele may be associated with HTLV-1 infection, although no significant association was observed among asymptomatic and HAM/TSP patients. In conclusion, the variation observed in SNPs -336 and -139 indicates that this lectin may be of crucial importance in the susceptibility/transmission of HTLV-1 infections.

Methods for improving cancer surveillance data in American Indian and Alaska Native populations.

BACKGROUND: The misclassification of race decreases the accuracy of cancer incidence data for American Indians and Alaska Natives (AI/ANs) in some central cancer registries. This article describes the data sources and methods that were used to address this misclassification and to produce the cancer statistics used by most of the articles in this supplement. METHODS: Records from United States cancer registries were linked with Indian Health Service (IHS) records to identify AI/AN cases that were misclassified as non-AI/AN. Data were available from 47 registries that linked their data with IHS, met quality criteria, and agreed to participate. Analyses focused on cases among AI/AN residents in IHS Contract Health Service Delivery Area (CHSDA) counties in 33 states. Cancer incidence and stage data were compiled for non-Hispanic whites (NHWs) and AI/ANs across 6 IHS regions of the United States for 1999 through 2004. RESULTS: Misclassification of AI/AN race as nonnative in central cancer registries ranged from 85 individuals in Alaska (3.4%) to 5297 individuals in the Southern Plains (44.5%). Cancer incidence rates among AI/ANs for all cancers combined were lower than for NHWs, but incidence rates varied by geographic region for AI/ANs. Restricting the rate calculations to CHSDA counties generally resulted in higher rates than those obtained for all counties combined. CONCLUSIONS: The classification of race for AI/AN cases in cancer registries can be improved by linking records to the IHS and stratifying by CHSDA counties. Cancer in the AI/AN population is clarified further by describing incidence rates by geographic region. Improved cancer surveillance data for AI/AN communities should aid in the planning, implementation, and evaluation of more effective cancer control and should reduce health disparities in this population.

Cancer in American Indian and Alaska Native young adults (ages 20-44 years): US, 1999-2004.

BACKGROUND: An examination of cancer incidence patterns in American Indians and Alaska Native (AI/AN) young adults may provide insight into their present and future cancer burden. METHODS: To reduce racial misclassification, incidence data were linked with the Indian Health Service (IHS) patient services database. Age-adjusted cancer incidence rates per 100,000 (AAR) and corresponding rate ratios (RR) for young adults (ages 20-44 years) were compared across IHS regions and for selected cancers within Contract Health Service Delivery Area counties by race (AI/AN vs non-Hispanic whites [NHW]) and sex. RESULTS: The all-sites cancer incidence rate was lower for AI/ANs (AAR of 83.8) than for NHWs (AAR of 111.2) (RR of 0.75) but varied by IHS regions. Among the leading cancers in AI/AN females the risk was elevated for stomach (RR of 3.22), colorectal (RR of 1.30), uterine (RR of 1.61), and kidney (RR of 1.39) cancers and was lower for breast (RR of 0.70) and thyroid (RR of 0.71) cancers. Among AI/AN young adult males the risk was elevated for stomach (RR of 2.62), liver (RR of 1.89), and kidney (RR of 1.59) cancers and lower for testicular germ cell cancer (RR of 0.64) and lymphoma (RR of 0.60). The risk for these and other cancers varied across IHS regions. CONCLUSIONS: Many of the cancer patterns that characterize the AI/AN population overall are apparent among young adults. Compared with NHW young adults, the overall cancer burden among AI/AN young adults was lower but varied for selected cancers and across IHS regions. Cancer control and research strategies are needed to address the unique genetic, social, cultural, and lifestyle aspects of AI/AN young adults.

Quality of race, Hispanic ethnicity, and immigrant status in population-based cancer registry data: implications for health disparity studies.

Population-based cancer registry data from the Surveillance, Epidemiology, and End Results (SEER) Program at the National Cancer Institute are based on medical records and administrative information. Although SEER data have been used extensively in health disparities research, the quality of information concerning race, Hispanic ethnicity, and immigrant status has not been systematically evaluated. The quality of this information was determined by comparing SEER data with self-reported data among 13,538 cancer patients diagnosed between 1973-2001 in the SEER--National Longitudinal Mortality Study linked database. The overall agreement was excellent on race (kappa = 0.90, 95% CI = 0.88-0.91), moderate to substantial on Hispanic ethnicity (kappa = 0.61, 95% CI = 0.58-0.64), and low on immigrant status (kappa = 0.21. 95% CI = 0.10, 0.23). The effect of these disagreements was that SEER data tended to under-classify patient numbers when compared to self-identifications, except for the non-Hispanic group which was slightly over-classified. These disagreements translated into varying racial-, ethnic-, and immigrant status-specific cancer statistics, depending on whether self-reported or SEER data were used. In particular, the 5-year Kaplan-Meier survival and the median survival time from all causes for American Indians/Alaska Natives were substantially higher when based on self-classification (59% and 140 months, respectively) than when based on SEER classification (44% and 53 months, respectively), although the number of patients is small. These results can serve as a useful guide to researchers contemplating the use of population-based registry data to ascertain disparities in cancer burden. In particular, the study results caution against evaluating health disparities by using birthplace as a measure of immigrant status and race information for American Indians/Alaska Natives.

Misclassification of race/ethnicity in a population-based cancer registry (United States).

Cancer registry data on race/ethnicity are vital for understanding cancer patterns in population subgroups, as they inform public health policies for allocating resources and form the bases of etiologic hypotheses. However, accuracy of cancer registry data on race/ethnicity has not been systematically evaluated. By comparing race/ethnicity in the Greater Bay Area Cancer Registry to self-reported race/ethnicity for patients from 14 racial/ethnic groups, we determined the accuracy of this variable and the patient and hospital characteristics associated with disagreement. The extent of misclassification (measured by sensitivity and predictive value positive (PV+)) varied across racial/ethnic groups (total n=11,676). Sensitivities and PV+'s were high (exceeding 90%) for non-Hispanic Whites and Blacks, moderate for Hispanics and some Asian subgroups (70-90%), and very low for American Indians (<20%). Overall, registry and interview race/ethnicity disagreed for 11% of the sample. In a multivariate model, disagreement was associated with non-White race/ethnicity, younger age, being married, being foreign-born but preferring to speak English, and diagnosis in a large hospital. Improving data quality for race/ethnicity will be most effectively attempted at the reporting source. We advocate a concerted effort to systematize collection of these patient data across all facilities, which may be more feasible given electronic medical admissions forms.

Discrepancies between published data on racial classification and self-reported race: evidence from the 2002 North Carolina live birth records.

OBJECTIVES: We compared data on race as reported by the mother on North Carolina birth certificates with data on race in officially reported statistics. We also determined to what extent differences in the classification of race affect measures of racial disparity in maternal and child health indicators. METHODS: We examined how data on race are collected, coded, and tabulated in North Carolina via live birth certificates, death certificates, the Behavioral Risk Factor Surveillance System (BRFSS) telephone survey, and the Central Cancer Registry case records. We showed how the data on race collected through North Carolina birth and death certificates are translated into 10 fixed racial categories designated by the National Center for Health Statistics (NCHS) for use in official vital statistics. We compared race as reported by the mother on birth certificates to racial tabulations used in the official published birth statistics. We also examined to what extent differences in the determination of race affect measures of racial disparity in maternal and child health indicators. RESULTS: Out of nearly 118,000 live births in North Carolina in 2002, mothers reported more than 600 different versions of race on birth certificates. These entries were collapsed into the 10 standard racial categories outlined in federal coding rules. Approximately two-thirds of mothers of Hispanic ethnicity report their race with a label that can be categorized as "Other" race, but nearly all of these births are re-coded to "white" for the official birth statistics. Measures of racial disparity vary depending on whether self-reported or officially coded race is used. CONCLUSIONS: This study shows that, given the opportunity to report their own race, North Carolinians describe their race using a wide variety of terms and concepts. In contrast, health statistics are usually reported using a few standardized racial categories defined by federal policy. The NCHS rules for coding race should be reexamined. As the ethnic and racial diversity of the United States continues to increase, these rules will become increasingly antiquated.

Racial, cultural, and ethnic factors influencing end-of-life care.

Past efforts in the palliative and end-of-life care field have been laudably directed at increasing the cultural competence of providers and institutions and improving outreach to multicultural communities. Today, however, we face new challenges with regard to racial, cultural, and ethnic factors at the end of life. We now have documented evidence of disparities in almost every area of health care. In addition, breakthroughs in genomics research, including "race-based therapeutics," have redefined the meaning of our human differences. These trends, unfolding in an increasingly polarized post-9/11 world, greatly challenge our understanding of concepts of race, culture, and ethnicity. By definition, when considering these concepts, our focus shifts from the individual to that of group membership. In turn, this suggests using a population-based or epidemiological approach, which at once reveals inequalities and inequities in mortality patterns across diverse groups. Understanding and serving the needs of specific populations requires us to apply a framework of equity and to consider strategies to eliminate disparities. These include identifying sources of bias and discrimination in health care; enhancing the collection of racial, ethnic, and other demographic data; and increasing the representation of a range of diverse population groups in well designed qualitative and quantitative research. Using an epidemiological framework does not suggest, however, that we lose sight of dying individuals and their families. At the end of life, an individualized approach to care with a focus on quality is paramount for any patient, regardless of racial, ethnic, or cultural background.