Health Differences between Black and White Populations
Current Health Problems
Health Differences between Black and White Populations
Morbidity. Many Black people experience wide, deep health disparities— factors such as the lack of access to health services, low income, and a tendency to self-treat illness and to wait until symptoms are so severe that a doctor must be seen (Weissman, Betancourt, Green, et al. 2011). When statistical adjustments are made for age, Blacks exceed Whites in the average number of days spent in acute care settings, on bed rest, and in restricted activity. Adolescent pregnancy is a major concern with the population. The risk of infant mortality and low birth weight are also greater in the community, as is the rate of low-birth-weight babies. Table 11–2 compares selected health status indicators for Blacks and all races. It illustrates that the birth rate is higher, that the percentages of women not getting early prenatal care and third-trimester or
280 ■ Chapter 11
no prenatal care are higher, and that the percentage of teenage births to women under 18 is nearly double, as is the infant mortality rate.
Sickle-Cell Anemia. The sickling of red blood cells is a genetically inherited trait that is hypothesized to have originally been an African adaptation to fight malaria. This condition occurs in Africans/Blacks and causes the normal, disk-like red blood cell to assume a sickle shape. Sickling results in hemolysis and thrombosis of red blood cells because these deformed cells do not flow properly through the blood vessels. Sickle-cell disease comprises the following blood characteristics:
1. The presence of 2 hemoglobin-S genes (Hb SS) 2. The presence of the hemoglobin-S gene with another abnormal
hemoglobin gene (Hb SC, Hb SD, etc.) 3. The presence of the hemoglobin-S gene with a different abnormality
in hemoglobin synthesis
Some people (carriers) have the sickle-cell trait (Hb SS, Hb SC, or others) but do not experience symptoms of the disease.
Table 11–2 Comparison of Selected Health Status Indicators—All Races and Black or African American: 2007
Health Indicator All Races Black or African Americans
Crude birth rate per 1,000 population by race of mother
14.3 16.6
Percentage of live births to women receiving prenatal care first trimester
67.5 57.0
Percentage of live births to women receiving third-trimester prenatal care or no prenatal care
8.4 12.6
Percentage of live births to teenage childbearing women under 18
3.4 6.1
Percentage of low birth weight per live births <2,500 grams
8.22 13.55
Infant mortality per 1,000 live births (2006) 6.7 12.9 Cancer—all sites per 100,000 population 446.7 470.0 Lung cancer incidence per 100,000 population Men: 65.4 Men: 87.2
Women: 47.4 Women: 51.2 Breast cancer incidence per 100,000 122.5 120.5 Prostate cancer incidence per 100,000 158.3 152.0 Male death rates from suicide, all ages, age adjusted per 100,000 resident population
11.3 8.8
Male death rates from homicide, all ages, age adjusted per 100,000 resident population
6.1 37.1
Source: National Center for Health Statistics. Health, United States, 2010: With Special Feature on Death and Dying. Hyattsville, MD. 2011: Author, pp. 102, 106, 107, 110, 124, 137, 180–181, 184–185, and 204. Retrieved from http://www.cdc.gov/nchs/, June 9, 2011.
HEALTH and ILLNESS in the Black Population ■ 281
The clinical manifestations of sickle-cell disease include hemolysis, anemia, and states of sickle-cell crises, in which severe pain occurs in the areas of the body where the thrombosed red cells are located. The cells also tend to clump in abdominal organs, such as the liver and the spleen. At present, statistics indi- cate that only 50% of children with sickle-cell disease live to adulthood. Some children die before the age of 20, and some suffer chronic, irreversible compli- cations during their lifetime (A.D.A.M. Medical Encyclopedia, 2012).
Sickle-cell anemia can only occur when 2 people who carry sickle-cell trait have a child together. It is possible to detect the sickle-cell trait in healthy adults and to provide genetic counseling about their risk of bearing children with the dis- ease. However, for many people, this is not an option. The cost of genetic coun- seling, for example, may be prohibitive (A.D.A.M. Medical Encyclopedia, 2012).
Mortality. Blacks born in 2000 in the United States will live, on average, 5.7 fewer years than Whites. The life expectancy for a Black person born in 2007 was 73.6 years, whereas for a White person born in 2007 it was 78.4 years.
The leading 3 chronic diseases that are causes of death for African Americans are the same as those for Whites, but the rates are greater in other diseases. For example:
■ The number of people living with end-stage renal disease per million on December 31, 2007, was 1,698.2—of this total, the prevalence was 4,122.8, Black, and 1,294.6, White.
■ Coronary heart disease death rates are higher for Blacks—305.9/100,000 age adjusted, than for Whites—234.8/100,000 age adjusted.
■ Among women, non-Hispanic Black women had the highest obesity rates.
■ Black men experience a higher risk of cancer of the prostate than White men do.
■ Homicide is the most frequent cause of death for Black American men between the ages of 25 and 34. The rate in 2007 was 82.5 per 100,000 resident population, whereas for White males of the same age it was 9.9 per 100,000.
■ The rate of HIV/AIDS among Black American men is generally higher than that for White men and the mortality rate for Black men, all ages, age adjusted, is 24.5/100,000; for ages 45–64, the rate is 58.3/100,000 and this is the highest rate (NCHS, 2011).
Table 11–3 lists the 10 leading causes of death for Black Americans and com- pares them with the causes of death for the general population in 2007.