BACKGROUND & AIMS: :More than one-third of the approximately two million people entering publicly funded substance abuse treatment in the United States do not complete treatment. Additionally, racial and ethnic minorities with addiction disorders, who constitute approximately 40 percent of the admissions in publicly funded substance abuse treatment programs, may be particularly at risk for poor outcomes. Using national data, we found that blacks and Hispanics were 3.5-8.1 percentage points less likely than whites to complete treatment for alcohol and drugs, and Native Americans were 4.7 percentage points less likely to complete alcohol treatment. Only Asian Americans fared better than whites for both types of treatment. Completion disparities for blacks and Hispanics were largely explained by differences in socioeconomic status and, in particular, greater unemployment and housing instability. However, the alcohol treatment disparity for Native Americans was not explained by socioeconomic or treatment variables, a finding that warrants further investigation. The Affordable Care Act could reduce financial barriers to treatment for minorities, but further steps, such as increased Medicaid funding for residential treatment and better cultural training for providers, would improve the likelihood of completing treatment and increase treatment providers' cultural competence.

背景与目标： ：在美国，约有200万人接受公共资助的药物滥用治疗，其中超过三分之一的人没有完成治疗。此外，患有成瘾性疾病的种族和少数民族大约占公共资助的药物滥用治疗计划中入院人数的40％，可能特别容易遭受不良后果的威胁。使用国家数据，我们发现黑人和西班牙裔美国人完成酒精和毒品治疗的可能性比白人低3.5-8.1个百分点，而美洲原住民完成酒精治疗的可能性降低了4.7个百分点。在这两种治疗方式中，只有亚裔美国人的表现要好于白人。黑人和西班牙裔人的完成差距主要是由于社会经济地位的差异，尤其是失业率上升和住房不稳定造成的。但是，没有通过社会经济或治疗变量来解释美国原住民在酒精治疗方面的差异，这一发现值得进一步研究。 《平价医疗法案》可以减少对少数群体进行治疗的经济障碍，但是进一步的措施，例如增加用于住院治疗的医疗补助资金以及对提供者的文化培训，将增加完成治疗的可能性，并提高治疗提供者的文化能力。

BACKGROUND & AIMS: BACKGROUND:Acculturation has been linked to an increased prevalence of alcohol-related problems. However, most of the research has been conducted with Hispanic populations in metropolitan areas of the United States, none of which is on the U.S.-Mexico border. This study examines the association between acculturation, heavy episodic drinking, and DSM-IV alcohol abuse and dependence among Hispanics in the Texas-Mexico border. METHODS:The study used data from a survey conducted (2002 to 2003) along the Texas-Mexico border and included 472 male and 484 female Hispanic adults from El Paso, the Rio Grande Valley, and colonias. Based on the Acculturation Rating Scale for Mexican Americans-II scale, respondents were coded into 4 acculturation categories: "very Mexican oriented,"Mexican bicultural,"Anglo bicultural," or "very Anglo/Anglicized.". RESULTS:Acculturation was related to lower rates of alcohol use disorders among men and a higher frequency of heavy episodic drinking among women. Multivariate analyses indicate that men who report heavy episodic drinking and those who are "very Mexican,"bicultural Mexican," or "bicultural Anglo" are more at higher risk for alcohol abuse and/or dependence compared with "very Anglo/Anglicized" men. For women, acculturation level did not predict alcohol disorders. Statistical analyses included testing for bivariate associations and multivariate logistic regression predicting heavy episodic drinking alcohol abuse or dependence. CONCLUSIONS:This study suggests that acculturation has different effects on drinking for men and women. This finding needs some attention as literature also indicates that women drink more and may develop more alcohol-related problems as they acculturate. This increase in women's drinking is probably because of U.S. society's more liberal norms governing female drinking. The "bimodal" distribution of risk, in which only men in "very Anglo" group are at a lower risk than the others, may be unique to the Border. The association between acculturation and alcohol use disorders does not appear to be linear and the effect of acculturation is not uniform on individuals' drinking behavior.

背景与目标： 背景：适应症与酒精相关问题的患病率上升有关。但是，大多数研究是针对美国大都市地区的拉美裔人群进行的，这些人群都不在美国-墨西哥边境。这项研究检查了在德克萨斯州-墨西哥边境的文化容忍度，大量饮酒和DSM-IV酒精滥用与西班牙裔之间的依赖性之间的联系。
方法：该研究使用的数据来自德克萨斯州-墨西哥边境（2002年至2003年），包括来自埃尔帕索，里奥格兰德河谷和科洛尼亚斯的472名西班牙裔成年人和484名女性西班牙裔成年人。根据“墨西哥裔美国人II的文化适应等级量表”，将受访者分为4个文化适应类别：“非常墨西哥化”，“墨西哥双重文化”，“盎格鲁双重文化”或“非常盎格鲁/盎格鲁化”。
结果：适应与男性饮酒障碍的发生率较低和女性频繁发作性饮酒的频率较高有关。多变量分析表明，与“非常盎格鲁/英国化”男性相比，报告大量饮酒和“非常墨西哥”，“双文化墨西哥”或“双文化盎格鲁”的男性更容易遭受酒精滥用和/或依赖。对于女性而言，文化适应程度并不能预测酒精中毒，统计分析包括双变量关联测试和多元逻辑回归分析，以预测严重的偶发性饮酒或依赖。
结论：这项研究表明，适应对男性和女性的饮酒有不同的影响。这一发现需要引起注意，因为文献还表明女性在饮酒时会饮酒更多，并可能发展出更多与酒精有关的问题。女性饮酒量的增加可能是由于美国社会对女性饮酒的规范更为宽松。边界是独一无二的“双峰”风险分布，其中只有“非常盎格鲁”群体中的男子处于比其他人更低的风险中。适应与酒精使用障碍之间的关联似乎不是线性的，并且适应对个体的饮酒行为的影响也不统一。

BACKGROUND & AIMS: Since less than one-third of patients in need of a BMT find related donors, most patients will rely on registries of volunteer donors. For patients from minority ethnic groups the chances of finding matched unrelated donors are lower, in part due to the smaller representation of minorities in the registries. Our purpose was to determine the representation of Hispanics in the National Marrow Donor Program (NMDP), the largest registry of volunteer marrow donors in the United States. We analyzed a database provided by the NMDP that contained information on minorities. The number of Hispanic volunteer donors has increased 110-fold in the last 6 years. The proportion of Hispanics in the registry has also increased from 1.1% to 6%. Nevertheless, the proportion of Hispanic patients that received unrelated marrow transplants facilitated by the NMDP has increased only from 2.8% to 3.9% since 1989. Only 19.7% of the formal searches initiated by Hispanic patients resulted in transplants compared to the 30.4% observed in the Caucasian population. Despite increments in the number and proportion of Hispanic volunteer donors, the proportion of Hispanics that receive BMT from unrelated donors remains low. We conclude that, in addition to increased recruitment efforts, other strategies will be necessary in order to find enough marrow donors to meet the needs of the Hispanic population.

背景与目标： 由于需要BMT的患者中不到三分之一找到相关的捐献者，因此大多数患者将依赖志愿捐献者的登记簿。对于少数族裔的患者，找到匹配的无关亲属的机会较低，这部分是由于登记处中少数族裔的代表较少。我们的目的是确定西班牙裔美国人在国家骨髓捐献者计划（NMDP）中的代表情况，该计划是美国最大的志愿者骨髓捐献者注册表。我们分析了NMDP提供的数据库，其中包含有关少数群体的信息。在过去的6年中，西班牙裔志愿捐助者的数量增加了110倍。西班牙裔美国人在注册表中的比例也从1.1％增加到6％。然而，自1989年以来，接受NMDP促进的无关骨髓移植的西班牙裔患者比例仅从2.8％增至3.9％。由西班牙裔患者发起的正式搜索中只有19.7％进行了移植，而在美国，这一比例为30.4％。高加索人口。尽管拉美裔志愿捐助者的数量和比例有所增加，但从无关亲属捐助者那里接受BMT的拉美裔比例仍然很低。我们得出的结论是，除了加大招募力度之外，还需要其他策略，以便找到足够的骨髓捐献者来满足西班牙裔人口的需求。

BACKGROUND & AIMS: :While leukemia rates are thought to be lower in South and Central America, no study has systematically investigated incidence rates of the leukemia subtypes among Hispanics in the U.S. This was a retrospective cohort study, using data from the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute, 1992 - 2001, to compare leukemia incidence rates as a function of race and ethnicity. It was found that in adults, Hispanics had lower incidence rates for each of the major types of leukemia as compared to non-Hispanic Whites: For AML, elderly Whites had an incidence rate ratio (IRR) of 1.61 in comparison to Hispanics (p < 0.001) and 1.27 in comparison to Blacks (p < 0.001); for CML, the IRR among the elderly was 1.42 that of Hispanics (p < 0.001) and 1.22 that of Blacks (p = 0.003); and for CLL, the IRR was 2.31 times that of Hispanics (p < 0.001) and 1.48 times that of Blacks (p < 0.001). In ALL, however, Hispanics aged 0 - 19 had a significantly higher incidence rate than Whites and Blacks, with an IRR of 1.32 compared to Whites (p < 0.001), and 2.62 compared to Blacks (p < 0.001). In AML, CML, and CLL, among people age 65 or older, white non-Hispanics have higher incidence rates than Blacks, and Blacks have higher incidence rates than Hispanics. Childhood ALL incidence rates are highest among Hispanics, and lowest among Blacks.

背景与目标： ：虽然在南美洲和中美洲，白血病的发生率较低，但尚无系统研究美国拉美裔人中白血病亚型的发生率的研究。这是一项回顾性队列研究，使用了来自监测，流行病学和最终结果的数据（美国国家癌症研究所（SEER）计划，1992年至2001年，用于比较白血病发病率与种族和种族的关系。发现在成年人中，西班牙裔美国人与非西班牙裔白人相比，每种主要白血病的发病率均较低：对于AML，老年白人与西班牙裔美国人相比的发病率比率（IRR）为1.61（p < 0.001）和1.27（相对于黑人）（p <0.001）；对于CML，老年人的内部收益率是西班牙裔的1.42（p <0.001）和黑人的1.22（p = 0.003）；对于CLL，IRR是西班牙裔的2.31倍（p <0.001）和黑人的1.48倍（p <0.001）。然而，在所有人群中，0-19岁的西班牙裔美国人的发病率明显高于白人和黑人，与白人相比，IRR为1.32（p <0.001），与黑人相比，IRR为2.62（p <0.001）。在AML，CML和CLL中，在65岁或65岁以上的人群中，非西班牙裔白人的发病率高于黑人，而黑人的患病率高于西班牙裔。儿童期ALL发病率在西班牙裔中最高，在黑人中最低。

BACKGROUND & AIMS: PURPOSE:We investigated comorbidities and endometrial cancer survival by ethnicity because Hispanic whites (HWs) have worse survival than non-Hispanic whites (NHWs). METHODS:An endometrial cancer cohort (1992-2004) established with the Surveillance, Epidemiology and End Results-Medicare-linked database (n = 3,286) was followed through 2007. Endometrial cancer-specific and other cause mortality were evaluated with multivariate hazard ratios (mHRs). RESULTS:HWs were more likely than NHWs to have regional/distant disease (31.7 vs. 24.8 %), diabetes (31.7 vs. 11.0 %), and hypertension (49.4 vs. 37.6 %). HWs had poorer endometrial cancer-specific survival than NHWs (age-adjusted HR = 1.28; 95% CI 1.01-1.61), but not after adjustment for tumor characteristics and treatment (mHR = 1.02; 95% CI 0.81-1.29). In contrast, even after adjustment for cancer-related factors, other cause mortality in HWs was elevated (mHR = 1.27; 95% CI 1.01-1.59), but not after further adjustment for comorbid conditions (mHR = 1.07; 95% CI 0.85-1.35). CONCLUSIONS:Comorbidities, particularly diabetes, were more common in HWs than in NHWs and impacted other cause mortality. Improving diabetes management may be an effective means of improving other cause mortality. This may be particularly true for HWs, given their particularly high prevalence of diabetes.

背景与目标： 目的：我们按种族调查了合并症和子宫内膜癌的存活率，因为西班牙裔白人（HWs）的生存率较非西班牙裔白人（NHWs）差。
方法：通过监测，流行病学和最终结果-医疗保险相关数据库（n = 3,286）建立的子宫内膜癌队列（1992-2004）一直持续到2007年。 mHRs）。
结果：HWs比NHWs更容易发生区域性/远距离疾病（31.7 vs. 24.8％），糖尿病（31.7 vs. 11.0％）和高血压（49.4 vs. 37.6％）。硬体患者的子宫内膜癌特异性生存率较NHW差（年龄调整后的HR = 1.28; 95％CI 1.01-1.61），但在调整肿瘤特征和治疗后未见异常（mHR = 1.02; 95％CI 0.81-1.29）。相比之下，即使在调整了癌症相关因素后，硬件中的其他原因死亡率也有所提高（mHR = 1.27; 95％CI 1.01-1.59），但在对合并症进行了进一步调整后并未升高（mHR = 1.07; 95％CI 0.85- 1.35）。
结论：合并症，尤其是糖尿病，在家庭医院中比在家庭医院中更为常见，并且会影响其他原因的死亡率。改善糖尿病管理可能是改善其他原因死亡率的有效手段。考虑到HW的糖尿病患病率特别高，这可能尤其如此。

BACKGROUND & AIMS: INTRODUCTION:We estimated the prevalence and correlates of mild cognitive impairment (MCI) among middle-aged and older diverse Hispanics/Latinos. METHODS:Middle-aged and older diverse Hispanics/Latinos enrolled (n = 6377; 50-86 years) in this multisite prospective cohort study were evaluated for MCI using the National Institute on Aging-Alzheimer's Association diagnostic criteria. RESULTS:The overall MCI prevalence was 9.8%, which varied between Hispanic/Latino groups. Older age, high cardiovascular disease (CVD) risk, and elevated depressive symptoms were significant correlates of MCI prevalence. Apolipoprotein E4 (APOE) and APOE2 were not significantly associated with MCI. DISCUSSION:MCI prevalence varied among Hispanic/Latino backgrounds, but not as widely as reported in the previous studies. CVD risk and depressive symptoms were associated with increased MCI, whereas APOE4 was not, suggesting alternative etiologies for MCI among diverse Hispanics/Latinos. Our findings suggest that mitigating CVD risk factors may offer important pathways to understanding and reducing MCI and possibly dementia among diverse Hispanics/Latinos.

背景与目标： 简介：我们估算了中老年不同西班牙裔/拉丁裔的轻度认知障碍（MCI）的患病率和相关性。
方法：使用美国国家老龄化-阿尔茨海默氏症协会的诊断标准，评估了该多站点前瞻性队列研究中（n = 6377; 50-86岁）的中老年和不同西班牙裔/拉丁裔（M = 6377; 50-86岁）。
结果：总体MCI患病率为9.8％，在西班牙裔/拉丁美洲裔人群之间有所不同。老年，高心血管疾病（CVD）风险和抑郁症状升高是MCI患病率的重要相关因素。载脂蛋白E4（APOE）和APOE2与MCI没有显着相关。
讨论：西班牙裔/拉丁美洲裔背景的MCI患病率各异，但没有以前的研究报道的那么广泛。 CVD风险和抑郁症状与MCI升高有关，而APOE4则不相关，这表明在多种西班牙裔/拉丁裔中MCI的替代病因。我们的研究结果表明，减轻CVD危险因素可能为理解和减少不同西班牙裔/拉丁裔之间的MCI以及痴呆症提供重要途径。

BACKGROUND & AIMS: PURPOSE:The purpose of this study is to examine whether the prevalence of hypertension differs by acculturation status among Hispanics in Dallas County, Texas. The authors test the hypothesis that compared with those of low acculturation, those of mid- and high-level acculturation will be at greater risk for having hypertension. METHODS:Conducted from July 2000 through October 2002, the Dallas Heart Study (DHS) is a general population cross-sectional study of cardiovascular risk factors among Dallas County residents. These analyses focus on the 1163 DHS participants who self-reported Hispanic ethnicity, completed a household interview, and had blood pressures measured. Acculturation was assessed with a validated 12-item scale that measured the following dimensions of cultural adaptation: language; media preference; social interaction; and ease of relationships with those of other ethnicities. RESULTS:The majority of participants were born in Mexico (57.5%) and ranged in age from 18 to 65 years (mean age 33 years). Women made up just under half of the sample (47.81%). The unadjusted prevalence of hypertension was 9.78%. When age-adjusted for the 2000 US Standard Population, the prevalence was 17.27%. The chi(2) analysis showed that those of low acculturation were significantly less likely to have hypertension (6.05%) than those of mid- and high-level acculturation (10.78% and 12.80%, respectively). After controlling for the effects of possible confounders (i.e., sociodemographic factors, health care access and utilization, health behaviors, and health status), logistic regression showed that when compared with Hispanics of low acculturation, those of middle and high acculturation were at greater risk of having hypertension (OR=3.04, 95% CI, 1.27, 7.29 and OR=2.62, 95% CI, 1.04, 6.59, respectively). CONCLUSION:These findings demonstrate that acculturation is significantly associated with hypertensive status.

背景与目标： 目的：本研究的目的是检查德克萨斯州达拉斯县的拉美裔人中高血压的患病率是否因适应程度而异。作者检验了这一假设，即与低适应症相比，中，高水平适应症的人患高血压的风险更大。
方法：2000年7月至2002年10月进行的达拉斯心脏研究（DHS）是对达拉斯县居民中心血管危险因素的一般人群横断面研究。这些分析的重点是1163名DHS参与者，他们自我报告了西班牙裔种族，完成了一次家庭访谈并测量了血压。用经过验证的12个项目的量表评估文化适应度，该量表测量了文化适应的以下方面：语言；媒体偏好；社交联系;与其他种族的关系也很容易。
结果：大多数参与者出生在墨西哥（57.5％），年龄在18至65岁（平均年龄33岁）之间。女性仅占样本的一半以下（47.81％）。未经调整的高血压患病率为9.78％。对2000年美国标准人口的年龄进行调整后，患病率为17.27％。 chi（2）分析显示，低容忍度的人患高血压的可能性（6.05％）比中高容忍度的人患高血压的可能性低得多（分别为10.78％和12.80％）。在控制了可能的混杂因素的影响（即，社会人口统计学因素，医疗保健获取和利用，健康行为和健康状况）之后，逻辑回归表明，与低适应症的西班牙裔美国人相比，中，高适应症的人处于更高的风险患有高血压（分别为OR = 3.04、95％CI，1.27、7.29和OR = 2.62、95％CI，1.04、6.59）。
结论：这些发现表明，适应症与高血压状态显着相关。

BACKGROUND & AIMS: BACKGROUND:Little is known regarding chronic kidney disease (CKD) in Hispanics. We compared baseline characteristics of Hispanic participants in the Chronic Renal Insufficiency Cohort (CRIC) and Hispanic-CRIC (H-CRIC) Studies with non-Hispanic CRIC participants. STUDY DESIGN:Cross-sectional analysis. SETTING & PARTICIPANTS:Participants were aged 21-74 years with CKD using age-based estimated glomerular filtration rate (eGFR) at enrollment into the CRIC/H-CRIC Studies. H-CRIC included Hispanics recruited at the University of Illinois in 2005-2008, whereas CRIC included Hispanics and non-Hispanics recruited at 7 clinical centers in 2003-2007. FACTOR:Race/ethnicity. OUTCOMES:Blood pressure, angiotensin-converting enzyme (ACE)-inhibitor/angiotensin receptor blocker (ARB) use, and CKD-associated complications. MEASUREMENTS:Demographic characteristics, laboratory data, blood pressure, and medications were assessed using standard techniques and protocols. RESULTS:Of H-CRIC/CRIC participants, 497 were Hispanic, 1,650 were non-Hispanic black, and 1,638 were non-Hispanic white. Low income and educational attainment were nearly twice as prevalent in Hispanics compared with non-Hispanics (P < 0.01). Hispanics had self-reported diabetes (67%) more frequently than non-Hispanic blacks (51%) and whites (40%; P < 0.01). Blood pressure >130/80 mm Hg was more common in Hispanics (62%) than blacks (57%) and whites (35%; P < 0.05), and abnormalities in hematologic, metabolic, and bone metabolism parameters were more prevalent in Hispanics (P < 0.05), even after stratifying by entry eGFR. Hispanics had the lowest use of ACE inhibitors/ARBs among the high-risk subgroups, including participants with diabetes, proteinuria, and blood pressure >130/80 mm Hg. Mean eGFR was lower in Hispanics (39.6 mL/min/1.73 m(2)) than in blacks (43.7 mL/min/1.73 m(2)) and whites (46.2 mL/min/1.73 m(2)), whereas median proteinuria was higher in Hispanics (protein excretion, 0.72 g/d) than in blacks (0.24 g/d) and whites (0.12 g/d; P < 0.01). LIMITATIONS:Generalizability; observed associations limited by residual bias and confounding. CONCLUSIONS:Hispanics with CKD in the CRIC/H-CRIC Studies are disproportionately burdened with lower socioeconomic status, more frequent diabetes mellitus, less ACE-inhibitor/ARB use, worse blood pressure control, and more severe CKD and associated complications than their non-Hispanic counterparts.

背景与目标： 背景：对于西班牙裔的慢性肾脏疾病（CKD）知之甚少。我们将慢性肾功能不全队列（CRIC）和西班牙裔CRIC（H-CRIC）研究中的西班牙裔参与者的基线特征与非西班牙裔CRIC参与者进行了比较。
研究设计：横断面分析。
地点和参与者：参加CRIC / H-CRIC研究时，使用基于年龄的估计肾小球滤过率（eGFR）对CKD年龄在21-74岁的参与者。 H-CRIC包括2005-2008年在伊利诺伊大学招募的西班牙裔，而CRIC包括2003-2007年在7个临床中心招募的西班牙裔和非西班牙裔。
因素：种族/民族。
结果：血压，血管紧张素转换酶（ACE）抑制剂/血管紧张素受体阻滞剂（ARB）的使用以及与CKD相关的并发症。
测量：使用标准技术和方案评估人口统计学特征，实验室数据，血压和用药。
结果：在H-CRIC / CRIC参与者中，有497名是西班牙裔，有1,650名是非西班牙裔黑人，有1,638名是非西班牙裔白人。与非西班牙裔美国人相比，低收入和受教育程度是西班牙裔美国人的近两倍（P <0.01）。西班牙裔人的自我报告型糖尿病（67％）的发生率高于非西班牙裔黑人（51％）和白人（40％； P <0.01）。血压> 130/80 mm Hg在西班牙裔中更为常见（62％），比黑人（57％）和白人（35％； P <0.05）高，并且血液学，代谢和骨代谢参数异常在西班牙裔中更为普遍（P <0.05），甚至在通过条目eGFR进行分层后也是如此。在高危亚组中，包括糖尿病，蛋白尿和血压> 130/80 mm Hg的参与者中，西班牙裔患者使用ACE抑制剂/ ARB的比例最低。西班牙裔（39.6 mL / min / 1.73 m（2））的平均eGFR低于黑人（43.7 mL / min / 1.73 m（2））和白人（46.2 mL / min / 1.73 m（2）），而中位数西班牙裔的蛋白尿（蛋白排泄，0.72 g / d）高于黑人（0.24 g / d）和白人（0.12 g / d； P <0.01）。
局限性：通用性；观察到的关联受残余偏差和混淆的限制。
结论：CRIC / H-CRIC研究中患有CKD的西班牙人与非糖尿病患者相比，其社会经济地位较低，糖尿病更为频繁，使用ACE抑制剂/ ARB较少，血压控制更差，CKD和相关并发症更为严重，从而承担了不成比例的负担。西班牙裔同行。

BACKGROUND & AIMS: :The importance of differences in clinical characteristics between ethnic groups on operative mortality of coronary artery bypass grafting (CABG) has not been clarified. Data reporting to the California CABG outcomes reporting program is mandated under state law in California. Data from 121 hospitals in 2003 were analyzed, including clinical characteristics and predicted and observed operative mortalities in patients who underwent isolated CABG. In total 21,272 isolated CABGs were reported in 2003. Compared with Caucasians (n = 15,069), Hispanics (n = 2,561), Asians (n = 1,772), and African-Americans (n = 785) were younger, more likely to be women, and had more hypertension, diabetes, renal failure, and severe liver disease (all p values <0.05). Hispanics had more heart failure and Asians had a lower body mass index compared with Caucasians, whereas African-Americans had a higher body mass index and more peripheral artery disease and heart failure (all p values <0.05). Based on a multivariate model, the predicted operative mortality for Hispanics (3.2%), Asians (3.3%), and African-Americans (3.6%) was higher (all p values <0.001) than that of Caucasians (2.8%). However, observed operative mortality was similar across ethnic groups, although there was a trend toward higher mortality in Asians compared with Caucasians (3.5% vs 2.8%, p = 0.077). In conclusion, significant differences in risk profile for CABG exist across ethnicities. Although the predicted operative mortality for Hispanics, Asians, and African-Americans was significantly higher than that for Caucasians, there was no significant difference in the observed operative mortality.

背景与目标： ：种族之间临床特征差异对冠状动脉搭桥术（CABG）手术死亡率的重要性尚未阐明。加利福尼亚州CABG结果报告程序的数据报告是加利福尼亚州法律规定的。分析了来自2003年的121家医院的数据，包括接受分离CABG的患者的临床特征以及预测和观察到的手术死亡率。 2003年总共报告了21272个孤立的CABG。与白种人（n = 15069），西班牙裔（n = 2561），亚洲人（n = 1772）和非裔美国人（n = 785）相比，年龄较小，更有可能是女性，并且患有更多的高血压，糖尿病，肾衰竭和严重肝病（所有p值<0.05）。与高加索人相比，拉美裔人有更多的心力衰竭，亚洲人的体重指数较低，而非裔美国人则有更高的体重指数，更多的外周动脉疾病和心力衰竭（所有p值<0.05）。基于多变量模型，西班牙裔（3.2％），亚洲裔（3.3％）和非裔美国人（3.6％）的预计手术死亡率高于白种人（2.8％）（p均＜0.001）。然而，尽管亚裔人的死亡率比白人高（3.5％vs. 2.8％，p = 0.077），但是种族间观察到的手术死亡率相似。总之，跨种族存在CABG风险特征的显着差异。尽管西班牙裔，亚裔和非裔美国人的预计手术死亡率显着高于白种人，但观察到的手术死亡率没有显着差异。

BACKGROUND & AIMS: OBJECTIVE:The aim of this study was to evaluate referral and treatment delays by ethnicity/race in patients with rheumatoid arthritis (RA) treated at an academic rheumatology center. METHODS:We reviewed the medical records of all RA patients evaluated at an outpatient clinic between 2011 and 2016 to identify newly diagnosed and naive-to-treatment patients. We determined the durations between symptom onset and first rheumatology visit and time to initiate treatment. Data extraction included referral source, demographics, treatment, and laboratory tests. Routine use of a multidimensional health assessment questionnaire allowed us to calculate baseline RAPID3 (routine assessment of patient index data 3) scores. Comparisons between self-reported ethnicity/race groups were performed. We used logistic regression models to analyze associations between baseline variables and early referral. RESULTS:Data from 152 disease-modifying antirheumatic drug-naive RA patients were included in the study; 35% were white, 37% black, 20% Hispanic, and 8% other. The range in median time to first rheumatology visit was 6 to 8 months for all patient groups, except Hispanic. This group had a median time of 22.7 months (p = 0.01). The referral pattern was considerably variable between-groups; 40% of Hispanic patients were self-referred (p = 0.01). There were no statistically significant between-group differences for time to treatment initiation according to ethnicity/race. RAPID3 scores (p = 0.04) and erythrocyte sedimentation rates (p = 0.01) were significantly higher in the black and Hispanic groups. A high C-reactive protein value at baseline was associated with earlier referral. CONCLUSIONS:There is significant delay in initial presentation to a rheumatologist that was associated with a higher disease severity at presentation, especially for Hispanic patients.

背景与目标： 目的：本研究的目的是评估在学术风湿病学中心接受治疗的类风湿关节炎（RA）患者的按种族/种族划分的转诊和治疗延迟。
方法：我们回顾了2011年至2016年在门诊评估的所有RA患者的病历，以识别新诊断和初次治疗的患者。我们确定了症状发作与第一次风湿病就诊之间的持续时间以及开始治疗的时间。数据提取包括引荐来源，人口统计学，治疗和实验室检查。常规使用多维健康评估问卷可以使我们计算基线RAPID3（对患者指数数据3的常规评估）得分。比较自我报告的种族/种族群体。我们使用逻辑回归模型来分析基线变量和早期转诊之间的关联。
结果：该研究包括来自152例抗风湿性药物的初治性RA患者的数据； 35％是白人，37％黑色，20％西班牙裔和8％其他。除西班牙裔外，所有患者组首次风湿病就诊的中位时间范围为6到8个月。该组的中位时间为22.7个月（p = 0.01）。小组之间的推荐模式差异很大。 40％的西班牙裔患者是自我推荐的（p = 0.01）。根据种族/种族，治疗开始时间的组间差异无统计学意义。在黑人和西班牙裔人群中，RAPID3评分（p = 0.04）和红细胞沉降率（p = 0.01）显着更高。基线时高C反应蛋白值与较早转诊有关。
结论：风湿病学医师在初次就诊时出现了明显的延误，这与就诊时疾病的严重程度更高有关，特别是对于西班牙裔患者。

BACKGROUND & AIMS: BACKGROUND:Genome-wide association studies have identified loci associated with coronary heart disease in whites of European ancestry. This study evaluated whether genetic markers previously identified in whites are associated with nonfatal acute myocardial infarction (MI) in Hispanics. METHODS AND RESULTS:Cases (n=1989) with a first nonfatal acute MI and population-based controls (n=2096) living in Costa Rica were studied. Fourteen single-nucleotide polymorphisms were genotyped. Seven single-nucleotide polymorphisms at 3 independent loci showed significant associations with MI. The odds ratios for the loci with the strongest associations were 1.16 (95 confidence interval [CI], 1.05 to 1.27) for rs4977574 (CDKN2A/2B), 1.15 (95 CI, 1.03 to 1.29) for rs646776 (CELSR2-PSRC1-SORT1), and 1.22 (95 CI, 1.08 to 1.38) for rs501120 (CXCL12); the corresponding PARs were 6.8, 10.5, and 15.2; respectively. We developed a genetic risk score by summing the number of the top 3 associated risk alleles. The OR for MI per genetic risk score unit was 1.18 (95 CI, 1.11 to 1.25; P=4.83 × 10(-8)). Discrimination of MI was significantly improved (P=0.02) when the genetic risk score was added to a model including clinical predictors. However, the increase in the area under the receiver-operating characteristic curve after the genetic risk score was added was moderate, from 0.67 (95 CI, 0.65 to 0.69) to 0.68 (95 CI, 0.66 to 0.70). CONCLUSIONS:These results indicate both the consistency and disparity of genetic effects on risk of MI between Hispanic and white populations. The improvement in the identified genetic markers on discrimination of MI in Hispanics was modest.

背景与目标： 背景：全基因组关联研究已确定与欧洲裔白人冠心病相关的基因座。这项研究评估了先前在白人中鉴定出的遗传标记是否与西班牙裔的非致命性急性心肌梗塞（MI）相关。
方法和结果：研究了第一例非致命急性心肌梗死的病例（n = 1989）和居住在哥斯达黎加的以人群为基础的对照（n = 2096）。对十四个单核苷酸多态性进行了基因分型。在3个独立位点的7个单核苷酸多态性显示与MI显着相关。 rs4977574（CDKN2A / 2B）关联最强的基因座的优势比为1.16（95置信区间[CI]，1.05至1.27），rs646776（CELSR2-PSRC1-SORT1）为1.15（95 CI，1.03至1.29）。 ，对于rs501120（CXCL12）为1.22（95 CI，1.08至1.38）；相应的PAR为6.8、10.5和15.2；分别。我们通过汇总前3个相关风险等位基因的数量，得出了遗传风险评分。每个遗传风险评分单位的MI的OR为1.18（95 CI，1.11至1.25； P = 4.83×10（-8））。当将遗传风险评分添加到包括临床预测因素的模型中时，MI的辨别力得到了显着改善（P = 0.02）。但是，添加遗传风险评分后，受体操作特征曲线下面积的增加是中等的，从0.67（95 CI，0.65至0.69）增加到0.68（95 CI，0.66至0.70）。
结论：这些结果表明西班牙裔和白人之间遗传因素对MI风险的影响的一致性和差异性。已确定的西班牙裔MI识别遗传标志物的改善是适度的。

BACKGROUND & AIMS: PURPOSE:The leading causes of mortality among Hispanics living in the United States are smoking related. This study sought to systematically review smoking cessation interventions targeting healthy Hispanic adults living in the United States, to conduct a "mini" meta-analysis of randomized controlled trials, and to offer recommendations for future research. DATA SOURCES:Studies were identified through computerized bibliographic databases (PsychINFO, PsycARTICLES, PsycFirst, MEDLINE, Science Direct, and Dissertation Abstracts Online), article reference lists, conference abstracts, and unpublished data through October 2008. STUDY INCLUSION AND EXCLUSION CRITERIA:Evaluation of a smoking cessation intervention among healthy U.S. Hispanic adults. Studies included in the meta-analysis were also required to be randomized controlled trials. DATA EXTRACTION:Twelve studies were eligible for the systematic review and five studies for the meta-analysis. Two independent raters coded each study. DATA SYNTHESIS:Interventions consisted of self-help, nicotine replacement therapy, and community-based interventions, as well as individual, group, and telephone counseling. There was evidence for the efficacy of smoking cessation interventions at the end of treatment (odds ratio, 1.54; 95% confidence interval, 1.09-2.16), which was attenuated in the longer term. CONCLUSIONS:Tobacco use among U.S. Hispanics is a growing public health concern. Smoking cessation interventions demonstrate promise among Hispanic adults living in the United States. More randomized trials evaluating tobacco interventions in this special population are warranted, with examination of the effect of cultural specificity and acculturation.

背景与目标： 目的：居住在美国的西班牙裔美国人的主要死亡原因与吸烟有关。这项研究试图系统地回顾针对居住在美国的健康西班牙裔成年人的戒烟干预措施，对随机对照试验进行“小型”荟萃分析，并为以后的研究提供建议。
数据来源：研究通过计算机参考书目数据库（PsychINFO，PsycARTICLES，PsycFirst，MEDLINE，Science Direct和Dissertation Online）进行识别，并列出了文献参考清单，会议摘要和截至2008年10月的未公开数据。
研究纳入和排除标准：美国健康的西班牙裔成年人中戒烟干预措施的评估。荟萃分析中包括的研究也需要进行随机对照试验。
数据提取：十二项研究符合系统评价要求，五项研究适合荟萃分析。每个研究由两个独立的评估者编码。
数据综合：干预措施包括自助，尼古丁替代疗法和基于社区的干预措施，以及个人，团体和电话咨询。有证据表明治疗结束时戒烟干预的有效性（优势比为1.54； 95％的置信区间为1.09-2.16），但从长远来看会减弱。
结论：美国西班牙裔人群中的烟草使用引起了越来越多的公共卫生关注。戒烟干预措施证明了居住在美国的西班牙裔成年人的希望。有必要进行更多随机试验来评估这一特殊人群中的烟草干预措施，并检验文化特异性和适应性的影响。

BACKGROUND & AIMS: BACKGROUND:Hispanics, particularly men of Mexican origin, are more likely to engage in heavy drinking and experience alcohol-related problems, but less likely to obtain treatment for alcohol problems than non-Hispanic men. Our previous research indicates that heavy-drinking Hispanics who received a brief motivational intervention (BMI) were significantly more likely than Hispanics receiving standard care to reduce subsequent alcohol use. Among Hispanics who drink heavily the BMI effectively reduced alcohol use but did not impact alcohol-related problems or treatment utilization. We hypothesized that an adapted BMI that integrates cultural values and addresses acculturative stress among Hispanics would be more effective. METHODS/DESIGN:We describe here the protocol for the design and implementation of a randomized (approximately 300 patients per condition) controlled trial evaluating the comparative effectiveness of a culturally adapted (CA) BMI in contrast to a non-adapted BMI (NA-BMI) in a community hospital setting among men of Mexican origin. Study participants will include men who were hospitalized due to an alcohol related injury or screened positive for heavy drinking. By accounting for risk and protective factors of heavy drinking among Hispanics, we hypothesize that CA-BMI will significantly decrease alcohol use and alcohol problems, and increase help-seeking and treatment utilization. DISCUSSION:This is likely the first study to directly address alcohol related health disparities among non-treatment seeking men of Mexican origin by comparing the benefits of a CA-BMI to a NA-BMI. This study stands to not only inform interventions used in medical settings to reduce alcohol-related health disparities, but may also help reduce the public health burden of heavy alcohol use in the United States. TRIAL REGISTRATION:Trial registration clinicaltrials.gov identifier NCT02429401; Registration date: April 28, 2015.

背景与目标： 背景：西班牙裔美国人，特别是墨西哥血统的男性，与非西班牙裔男性相比，更可能大量饮酒并遇到与酒精有关的问题，但获得酒精问题的治疗的可能性较小。我们先前的研究表明，接受短暂动机干预（BMI）的重度饮酒的西班牙裔比接受标准护理的西班牙裔美国人减少随后饮酒的可能性要高得多。在大量喝酒的西班牙裔美国人中，BMI有效地减少了酒精的使用，但并未影响与酒精有关的问题或治疗方法的使用。我们假设，一个经过整合的BMI能够整合文化价值观并解决西班牙裔美国人的适应压力，会更加有效。
方法/设计：我们在此描述用于设计和实施一项随机（每病约300例患者）对照试验的协议，该协议评估了文化适应性（CA）BMI与非适应性BMI（NA-BMI）的相对有效性）在墨西哥裔男性中的社区医院中。研究参与者将包括因酒精相关伤害而住院或经筛查为重度饮酒呈阳性的男性。通过考虑西班牙裔人群中大量饮酒的风险和保护因素，我们假设CA-BMI将显着减少饮酒和饮酒问题，并增加寻求帮助和治疗的利用率。
讨论：这可能是第一项通过比较CA-BMI和NA-BMI的益处来直接解决非墨西哥裔寻求治疗的男性酒精相关健康差异的研究。这项研究不仅可以为医疗环境中的干预措施提供信息，以减少与酒精有关的健康差异，而且还可以帮助减轻美国大量饮酒的公共健康负担。
试验注册：试验注册临床试验.gov标识符NCT02429401；报名日期：2015年4月28日。

BACKGROUND & AIMS: OBJECTIVES:This study examined factors related to oral health and dental service use among Mexican-Americans, Cuban-Americans, and Puerto Ricans from the Hispanic Health and Nutrition Examination Survey, 1982-84 (HHANES). METHODS:Categorical measures of oral health were created: (1) perceived oral health status, (2) evaluated oral health status, (3) decayed permanent teeth, (4) teeth missing due to caries, (5) total permanent teeth present, and (6) periodontal classification. The effects of acculturation, education, dental insurance, and perceived condition of teeth and gums on dental service use in the past two and five years were examined using logistic regression. All analyses were performed separately for each of the three samples using SAS-callable SUDDAN. RESULTS:Dental insurance and education were the most important factors in determining use of dental cleanings and use of dental care. For Mexican-Americans, Cuban-Americans, and Puerto Ricans, acculturation was a factor in determining use of dental care in the past five years. CONCLUSIONS:While dental insurance and education appear to be the most important factors for determining both use of dental cleaning services and use of dental care in all three samples, acculturation also had some impact for determining use of dental care.

背景与目标： 目的：本研究从1982-84年西班牙裔健康与营养调查（HHANES）中，研究了墨西哥裔美国人，古巴裔美国人和波多黎各人与口腔健康和牙科服务使用相关的因素。
方法：建立了口腔健康的分类指标：（1）感知的口腔健康状况；（2）评估的口腔健康状况；（3）龋坏的恒牙；（4）由于龋齿缺失的牙齿；（5）存在的恒牙总数； （6）牙周分类。使用逻辑回归分析了过去两年和五年中的适应性，教育，牙科保险以及牙齿和牙龈的感知状况对牙科服务使用的影响。使用SAS调用的SUDDAN对三个样品中的每个样品分别进行了所有分析。
结果：牙科保险和教育是决定使用牙齿清洁剂和使用牙齿护理的最重要因素。对于墨西哥裔美国人，古巴裔美国人和波多黎各人，过去五年来，文化适应是决定使用牙科护理的一个因素。
结论：虽然在所有三个样本中，牙科保险和教育似乎是确定使用牙科清洁服务和使用牙科护理的最重要因素，但文化适应对确定使用牙科护理也有一定影响。

BACKGROUND & AIMS: OBJECTIVES:Deaths from motor vehicle crashes (MVCs) have decreased significantly over the past three decades. Unfortunately, few data have been collected regarding death rates for MVCs in minority populations. The purpose of this study was to compare the death rate of whites versus Hispanics for MVCs in a rural environment. METHODS:This study examined one rural county in North Carolina from January 1, 1999, to December 31, 1999. A retrospective cohort study was performed using the North Carolina State Highway Patrol computerized database of MVCs. Data regarding the total number of MVCs, fatalities, alcohol-related deaths, seatbelt usage, and cause of the collision were analyzed for both whites and Hispanics. Census information regarding population in this region also was obtained from the U.S. Bureau of Census. Data were analyzed using a chi-square test, with an alpha value of 0.05 used to establish statistical significance. RESULTS:During the study period, whites were involved in 2,689 MVCs, compared with 158 MVCs for Hispanics. Whites were involved in ten fatal MVCs, compared with seven fatal MVCs involving Hispanics. The percent of fatal MVCs for whites was 0.3%, or 10 deaths per 2,689 MVCs. In contrast, the percent of fatal MVCs for Hispanics was 4.4%, or 7 deaths per 158 MVCs; odds ratio (OR) = 12.4, 95% CI = 4.7 to 33.1. The 2000 Census Report for Pitt County noted a white population of 81,613 and a Hispanic population of 4,216. Based on these population data, the death rate for MVCs per 100,000 population was 12.3 for whites versus 166.0 for Hispanics, OR = 13.6, 95% CI = 5.2 to 35.6. Although the cause for this disparity was not determined, previous studies suggest that alcohol and decreased seatbelt usage are contributing factors. CONCLUSIONS:In this study, the death rates among Hispanics for rural MVCs were significantly higher than for whites. The causes of this disparity are not clear but are important to define. Only by understanding this disparity can we begin to develop appropriate interventions that may prevent these deaths.

背景与目标： 目标：在过去的三十年中，机动车事故造成的死亡人数显着减少。不幸的是，很少收集到有关少数族裔MVC死亡率的数据。本研究的目的是比较农村环境中MVC的白人与西班牙裔美国人的死亡率。
方法：本研究调查了1999年1月1日至1999年12月31日北卡罗来纳州的一个乡村县。使用北卡罗来纳州州高速公路巡逻的MVC计算机数据库进行了一项回顾性队列研究。分析了白人和西班牙裔的有关MVC总数，死亡人数，与酒精有关的死亡，安全带的使用以及撞车原因的数据。有关该区域人口的人口普查信息也可从美国人口普查局获得。使用卡方检验分析数据，α值为0.05，以建立统计显着性。
结果：在研究期间，白人参与了2689个MVC，而西班牙裔为158个。白人卷入了十次致命的MVC，而西班牙裔卷入了七次致命的MVC。白人的致命MVC百分比为0.3％，即每2689个MVC中有10例死亡。相比之下，西班牙裔致命MVC的百分比为4.4％，即每158个MVC中有7例死亡。比值比（OR）= 12.4，95％CI = 4.7至33.1。皮特县2000年人口普查报告指出，白人人口为81,613，西班牙裔人口为4,216。根据这些人口数据，白人每100,000人口MVC的死亡率为12.3，而西班牙裔为166.0，OR = 13.6，95％CI = 5.2至35.6。尽管尚未确定造成这种差异的原因，但先前的研究表明，酒精和安全带使用量的减少是造成这种情况的因素。
结论：在这项研究中，西班牙农村居民的MVC死亡率显着高于白人。造成这种差异的原因尚不清楚，但定义起来很重要。只有了解了这种差异，我们才能开始制定适当的干预措施，以预防这些死亡。