Background

The prevalence of hypertension is known to differ by racial group in adults in the United States (US), but findings in children are scarce and inconsistent. The objective of this study was to assess the racial differences in pediatric hypertension and to explore whether these differences, if any, can be explained by low birth weight (LBW) and obesity.

Methods

Analyses were performed for participants aged 8-17 years (N = 9,250) included in the 1999-2010 National Health and Nutrition Examination Survey. Multivariate logistic regressions and weighted analysis were carried out considering the complex survey design.

Results

Compared to non-Hispanic White youth, the crude prevalence of hypertension was significantly higher in non-Hispanic Blacks (7.1% vs. 5.6%; P = 0.04), but not in Mexican Americans (5.4% vs. 5.6%; P = 0.77). Blacks also had higher rates of LBW (14.6% vs. 5.9%; P <0.001) and obesity (22.9% vs. 15.8%; P <0.001) than Whites. In stratified analysis by age-sex groups, the Black-White difference in hypertension prevalence was only significant in boys aged 13-17 (9.6% vs. 6.6%). After controlling for age, Black boys had a 51% higher odds of having hypertension (Odds ratio = 1.51; 95% confidence interval: 1.03, 3.43; P = 0.04) compared to White youth at ages 13-17. This racial difference persisted with additional adjustment for birth weight (odds ratio (OR) = 2.00; P = 0.02) and for current body mass index (OR = 1.50; P = 0.04). Mexican American youth had no difference in hypertension prevalence as compared to White youth after adjusting for age, sex, birth weight and obesity (Odds ratio = 0.82; P = 0.16) and in age-sex stratified subgroups.

Conclusions

Non-Hispanic Black adolescent boys have a significantly higher hypertension rate than their non-Hispanic White counterparts in the US. This racial difference cannot be explained by LBW and current obesity status within the Black population.

Purpose

The purpose of this study is to investigate the racial/ethnic disparities in health-related quality of life (HRQOL) among adults with self-reported diabetes and identify the different risk factors related to HRQOL for specific racial/ethnic groups in the United States.

Methods

National Health and Nutrition Examination Survey (NHANES) 2001-2010 participants (ages 20 years and older) who were self-identified as non-Hispanic white, non-Hispanic black, or Hispanic and with self-reported diabetes were included in the analysis (n = 2594). The Centers for Disease Control and Prevention's HRQOL-4 was used to assess factors associated with HRQOL through multivariate logistic regression models with survey weighting. Stepwise model selection was applied to select the most significant factors for HRQOL in each racial/ethnic group.

Results

Hispanic participants were less likely to report 14 or more mentally unhealthy days and activity-limited days compared to non-Hispanic white counterparts, adjusting for age, sex, education, marital status, family poverty-income ratio (PIR), body mass index, smoking status, insurance coverage, and diabetes duration. Current smoking status and obesity were significantly associated with worse HRQOL among whites and blacks. Marital status predicted better HRQOL only among Hispanics. Having insurance coverage predicted better HRQOL among both blacks and Hispanics. Increased family PIR had a favorable association with the 4 HRQOL domains consistently among all races/ethnicities.

Conclusion

Minimal racial/ethnic disparities in HRQOL were observed among US adults with self-reported diabetes. Support is offered for more individualized health care and communication with patients to target care and interventions that improve health and quality-of-life indicators.

This study aimed to examine whether sociodemographic factors and acculturation affect achievement of selected American Diabetes Association (ADA) nutrition therapy recommendations among Hispanics with diabetes. Cross-sectional data for Hispanics with diabetes in the National Health and Nutrition Examination Survey (NHANES) 2003-2010 were used. Achievements of the ADA recommendation for five nutrition components were examined (i.e., daily intake of saturated fat, cholesterol, sodium, and fiber, and daily servings of alcohol). Acculturation measurement derived from language use, country of birth, and length of residence in the U.S. Logistic regressions were performed. Only 49% of Hispanics with diabetes met three or more recommended criteria. Male gender and younger age (≤45) predicted poor recommendation adherence. More acculturated individuals had around 50% lower odds to achieve saturated fat [OR 0.5, CI 0.2-0.7], fiber [OR 0.5, CI 0.2-0.9], sodium [OR 0.5, CI 0.3-0.9] and cholesterol intake [OR 0.5, CI 0.3-0.8] recommendations than their less acculturated counterparts.

Research shows aconsistent racial disparity in obesity between white and black adults in the United States. Accounting for the disparity is a challenge given the variety of the contributing factors, the nature of the association, and the multilevel relationships among the factors. We used the multivariable mediation analysis (MMA) method to explore the racial disparity in obesity considering not only the individual behavior but also geospatially derived environmental risk factors. Results from generalized linear models (GLM) were compared with those from multiple additive regression trees (MART) which allow for hierarchical data structure, and fitting of nonlinear and complex interactive relationships. As results, both individual and geographically defined factors contributed to the racial disparity in obesity. MART performed better than GLM models in that MART explained a larger proportion of the racial disparity in obesity. However, there remained disparities that cannot be explained by factors collected in this study.