TAG: "Health disparities"

UC Davis names Future of Nursing Scholars recipient


New scholarship program will increase the number of doctorally prepared nurses.

Sarah Brown Blake, UC Davis

Betty Irene Moore School of Nursing graduate student Sarah Brown Blake is among the 16 nurses who are the first recipients of the Future of Nursing Scholars program awards. This new multifunder scholarship program, spearheaded by the Robert Wood Johnson Foundation (RWJF), is aimed at increasing the number of doctorally prepared nurses. Brown Blake’s scholarship is funded by RWJF and was awarded by UC Davis.

Brown Blake intends to focus her doctoral research on exploring environmental health disparities. She is particularly concerned about issues related to clean, accessible and affordable drinking water and the impact of water contamination on the health of rural and agricultural communities in California’s San Joaquin Valley. Brown Blake completed the interprofessional and innovative Master of Science — Leadership in Nursing Science and Health-Care Leadership Graduate Degree Program at the Betty Irene Moore School of Nursing at UC Davis in spring 2014. Prior to that, Brown Blake was a public health nurse with the Arlington County Health Department in Arlington, Virginia, where she specialized in maternal, child and adolescent health.

“I am tremendously grateful to receive this scholarship and other support from the RWJF. I have no doubt that this opportunity will significantly impact my career as a future researcher, educator and nurse leader,” Brown Blake said.

The Future of Nursing Scholars program provides grants to schools of nursing so that they can provide scholarships to doctoral students who commit to completing the program in three years. Brown Blake will receive an award of $75,000, as well as mentoring and leadership development over the course of the Doctor of Philosophy program.

“We are honored to be included as one of the first nursing schools to receive the Future of Nursing Scholars grants, especially as a new school that this year graduated our first Doctors of Philosophy,” said Heather M. Young, associate vice chancellor for nursing and dean of the Betty Irene Moore School of Nursing at UC Davis. “Being a part of the Future for Nursing: Campaign for Action has brought home to me the importance of increasing the number of doctorally prepared nurses in the nation. This effort goes a long way toward promoting that goal. It’s a wonderful way to create community among doctoral scholars who will be our future leaders.”

In addition to RWJF, Independence Blue Cross Foundation, United Health Foundation, Cedars-Sinai Medical Center, and the Rhode Island Foundation are supporting the Future of Nursing Scholars grants to schools of nursing this year.

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Three UC schools receive grants to prepare doctoral nurses

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Implantable heart devices provide similar survival benefits to diverse groups


Study is among the largest to compare survival benefits of these devices by race, ethnicity.

Gregg Fonarow, UCLA

Racial and ethnic minorities who receive implantable devices to treat heart failure derive the same substantial survival benefit from these therapies as white patients, new UCLA-led research shows.

While the American College of Cardiology and American Heart Association jointly recommend the use of implantable cardioverter defibrillators (ICDs) and cardiac resynchronization therapy (CRT) devices for all eligible patients, minorities have not been well represented in clinical trials of the devices, and previous studies had shown that African American and Hispanic patients are less likely to receive these recommended therapies.

The current study — among the largest to compare the survival benefits of these devices by race and ethnicity — involved more than 15,000 patients at 167 cardiology and multi-specialty practices across the U.S. The research was coordinated by 10 academic medical centers, including UCLA

The findings are published in the current issue of the Journal of the American College of Cardiology.

Drawing on data from the Registry to Improve the Use of Evidence-Based Heart Failure Therapies in the Outpatient Setting (IMPROVE HF), the researchers monitored 15,177 heart failure patients over two years to measure the benefits of implantable device therapy on survival in community practice settings.

They found that ICD device therapy reduced the likelihood of death during the two-year period by 36 percent, with no significant differences by race or ethnicity. They also found a 45 percent reduction in mortality with CRT therapy, again without any significant differences in device benefit by race or ethnicity.

“This is among the largest studies to address the question of race- and ethnicity-specific benefits with ICD or CRT therapies in real-world practice,” said senior author Dr. Gregg C. Fonarow, who holds the Eliot Corday Chair in Cardiovascular Medicine and Science and directs the Ahmanson–UCLA Cardiomyopathy Center at the David Geffen School of Medicine at UCLA. “Our results are a reminder to physicians and patients that this proven life-extending therapy should be offered to all eligible heart failure patients without regard for race or ethnicity.”

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Low-income diabetics up to 10 times likelier to lose a limb than wealthier patients


Most amputations preventable with earlier medical care, UCLA researchers say.

Carl Stevens, UCLA

It’s no secret that poverty is bad for your health. Now a new UCLA study demonstrates that California diabetics who live in low-income neighborhoods are up to 10 times more likely to lose a toe, foot or leg than patients residing in more affluent areas of the state. Earlier diagnosis and proper treatment could prevent many of these amputations, the researchers say.

The study authors hope their findings, published in the August issue of Health Affairs, will motivate public agencies and medical providers to reach out to patients at risk of late intervention and inspire policymakers to adopt legislation to reduce barriers to care.

“I’ve stood at the bedsides of diabetic patients and listened to the surgical residents say, ‘We have to cut your foot off to save your life,’” said lead author Dr. Carl Stevens, a clinical professor of medicine at the David Geffen School of Medicine at UCLA. “These patients are often the family breadwinners and parents of young children — people with many productive years ahead of them.

“When you have diabetes, where you live directly relates to whether you’ll lose a limb to the disease,” added Stevens, an emergency physician for 30 years at Harbor–UCLA Medical Center. ”Millions of Californians have undergone preventable amputations due to poorly managed diabetes. We hope our findings spur policymakers nationwide to improve access to treatment by expanding Medicaid and other programs targeting low-income residents, as we did in California in 2014.”

Dylan Roby, UCLA

The authors used data from the UCLA Center for Health Policy Research’s California Health Interview Survey, which estimated the prevalence of diabetes among low-income populations by ZIP code. They blended these statistics with household-income figures from the U.S. Census Bureau and hospital discharge data from the Office of Statewide Health Planning and Development that tracked diabetes-related amputations by ZIP code.

The result was a detailed set of maps showing diabetic amputation rates by neighborhood for patients 45 and older — the age range at greatest risk for amputation from disease complications.

“Neighborhoods with high amputation rates clustered geographically into hot spots with a greater concentration of households falling below the federal poverty level,” said co-author Dylan Roby, director of health economics at the UCLA Center for Health Policy Research and an assistant professor at the UCLA Fielding School of Public Health. “Amputation rates in California were 10 times higher in the poorest neighborhoods, like Compton and East Los Angeles, than in the richest neighborhoods, such as Malibu and Beverly Hills.”

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Mother’s place of birth is a risk factor for autism in U.S.-born children


Risk varies by race and ethnicity.

Beate Ritz, UCLA

Can the place where a woman is born and raised be a risk factor for autism in her child? According to new research out of UCLA, the answer is yes.

In the U.S., the prevalence of autism has been reported to be highest among non-Hispanic white children, but a new study from the UCLA Fielding School of Public Health offers evidence that other ethnic groups actually are at a higher risk for the disorder. Using data from racially diverse Los Angeles County, which is home to a large number of recent immigrants, the researchers found that the mother’s place of birth is a risk factor for autism among U.S. children.

Specifically, they found that when compared with children born to white American mothers, children of foreign-born women who are black, Central or South American, Filipino and Vietnamese had a higher risk of autism. The same held true for children of U.S.-born African American and Hispanic women. The risks were adjusted for maternal age, education levels, socioeconomic status, whether the families had health insurance and other factors known to influence the diagnosis rate.

The study appears in the current online edition of the journal Pediatrics.

Autism spectrum disorders are complex developmental disorders that affect how a person behaves, interacts with others, communicates and learns. Until now, though, scientists have had a difficult time determining possible prenatal risk factors other than the mother’s age and complications during pregnancy. However, recent European studies have reported an association between the nation where a woman is born and her children’s risk for autism.

“Epidemiology has a long tradition of using migration studies to understand how environmental and genetic factors contribute to disease risk in populations,” said Dr. Beate Ritz, the paper’s senior author, and a professor and chair of the Fielding school’s Department of Epidemiology. The fact that 22 percent of 6-year-olds born in the United States have immigrant parents opened a unique opportunity for us to consider the influence of nativity, race and ethnicity on the causes of autism spectrum disorder.”

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Fact sheets provide snapshot of adult Californians’ health by race, ethnicity


UCLA report digs deeper into differences among groups within Latino, Asian populations.

The UCLA Center for Health Policy Research has issued a series of easy-to-read fact sheets with health statistics on five major ethnic and racial groups in California — whites, Latinos, blacks, Asians and American Indians/Alaska Natives, as well as more detailed information on Latino and Asian subgroups.

A new visual report also provides infographics on key findings from the profiles, which used data from the 2011–12 California Health Interview Survey (CHIS) to explore a range of health topics, from insurance status to fruit-and-vegetable consumption to binge drinking.

The profiles provide a detailed and reliable source of information for policymakers, advocates, researchers, media and others interested in understanding the health of adult Californians, particularly those from previously understudied ethnic and racial minority groups.

Of specific interest are key health statistics for five groups within California’s Latino population (which accounts for 9.5 million of the state’s 27.8 million adults), including separate data for U.S.-born Mexicans and Mexicans born outside of the U.S., and health information on half a dozen Asian groups (3.9 million). Latino ethnic groups covered include Mexican, Salvadoran, Guatemalan, other Central American and South American. Asian groups include Chinese, Filipino, Japanese, Korean, Vietnamese and South Asian.

Among the findings for California’s estimated 27.8 million adults:

Number of uninsured
Approximately 6.2 million California adults (26.6 percent of the state’s adult population) had no health insurance for all or part of the past year.

Insured through work
Nearly six of 10 Asians in the state had employment-based health insurance, compared with five of 10 Californians overall. Among Asian ethnic groups, the figure ranged from a high of more than 7 of 10 for South Asians to fewer than 4 of 10 for Koreans. For Latinos overall, fewer than 4 of 10 had employment-based insurance was, while Guatemalans had the lowest rate — 2 of 10.

Mexican groups and poverty
More than 70 percent of adult Mexicans born outside the U.S. had household incomes under 200 percent of the federal poverty level (less than $46,100 for a family of four in 2012). For U.S.-born Mexicans, the proportion was much lower, at 44.3 percent.

Walking and health
About one-third of all Californians walked regularly on a weekly basis. Latinos had one of the highest rates, at nearly 35 percent, and Salvadorans were the most frequent walkers, with a 41 percent rate.

Californians and obesity
More than 6.8 million Californians — a full quarter of the adult population — were obese. Less than one in 10 Asians was obese, while nearly four in 10 blacks and American Indians/Alaska Natives were.

Read the full 2011–2012 Racial and Ethnicity Health Profiles.

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Redesigning the well-child checkup


UCLA study suggests new models for improving preventive care to low-income families.

Sandra Contreras, a parent coach, meets with Kioki Johnson and her family during a well-child checkup at Wee Care Associates. (Photo by Sandra Chacon)

Well-child visits are the foundation of pediatric primary care in the U.S. Accounting for more than one-third of all outpatient visits for infants and toddlers, the appointments are intended to give doctors the opportunity to identify health, social, developmental and behavioral issues that could have a long-term impact on children’s lives.

However, several studies have shown that the current system of well-child care leaves room for improvement. One major concern is that well-child care guidelines issued by the American Academy of Pediatrics call for physicians to provide more services than can realistically be completed within a 15-minute office visit. As a result, many children do not get all of the preventive care services that they need — and the problem is more acute for low-income families, thanks largely due to their greater psychosocial and developmental needs for and greater need for parenting education.

In a yearlong study led by Dr. Tumaini Coker, an assistant professor of pediatrics at Mattel Children’s Hospital UCLA, researchers developed a new design for preventive health care for children from birth through age 3 from low-income communities. The team partnered with two community pediatric practices and a multisite community health center in greater Los Angeles.

“The usual way of providing preventive care to young children is just not meeting the needs of the low-income families served by these clinics and practices,” said Coker, who also is a researcher with the hospital’s UCLA Children’s Discovery and Innovation Institute. “Our goal was to create an innovative and reproducible — but locally customizable — approach to deliver comprehensive preventive care that is more family-centered, effective and efficient.”

The researchers created two working groups of pediatric clinicians, staff, clinic leadership and parents to design the new models of care. One working group was at South Bay Family Health Care, and another working group combined the efforts of two pediatric practices, the Yovana Bruno Pediatric Clinic in Duarte and Wee Care Associates (led by Dr. Toni Johnson-Chavis), in Compton and Norwalk.

To design the new models of care, researchers gathered input from two sources. First, they solicited ideas from pediatricians, parents and health plan representatives about topics such as having non-physicians provide routine preventive care and using “alternative visit formats” — meeting with health care providers in alternative locations, meeting in groups as opposed to one-on-one, or getting providers’ advice electronically instead of in person, for example. Secondly, the teams surveyed existing literature on alternative providers, locations and formats for well-child care.

Using that input, the clinic working groups developed four possible new models of care that it submitted for review by a panel of experts on preventive care practice redesign. Based on the panel’s rankings, the working groups selected two models to implement and test — one for the private practices and the other for the community clinic.  The private practices adopted a one-on-one visit format while the community clinic used a group-visit format, but the two models shared several characteristics:

  • A trained health educator, or “parent coach,” at each facility who relieves the physician of some of the more routine services and provides preventive health education and guidance, parenting education, and comprehensive but efficient preventive health services related to development, behavior and family psychosocial concerns.
  • A considerably longer preventive care visit.
  • A website that enables parents to customize their child’s specific needs prior to their visit.
  • Scheduled text messages or phone calls enabling the health care team to communicate with parents.

These findings were reported online today (June 16) in the journal Pediatrics.

The next stage of research is already under way: The team is testing the model selected by the two private practices in those clinical settings, with families randomly chosen to receive the care using either the new delivery model and or the old one. Researchers will compare outcomes for the two groups of children by the end of 2014. The community clinic is currently implementing its selected model, and testing will begin there in July.

“For clinics and practices that provide child preventive health care to families living in low-income communities, the process we used to develop the new models — or the new models themselves — could help them bring innovation to their own practices,” Coker said.

The study was funded by grants from the National Institutes of Health’s National Institute of Child Health and Development and the Health Resources and Service Administration.

The study’s other authors were Dr. Paul Chung and Dr. Paul Shekelle of UCLA, Candice Moreno of the University of Illinois College of Medicine and Dr. Mark Schuster of Harvard Medical School. The authors have no financial ties relevant to this article to disclose.

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Mexican genetics study reveals huge variation in ancestry


UCSF/Stanford team uncovers basis for health differences among Latinos.

In the most comprehensive genetic study of the Mexican population to date, researchers from UC San Francisco and Stanford University, along with Mexico’s National Institute of Genomic Medicine (INMEGEN), have identified tremendous genetic diversity, reflecting thousands of years of separation among local populations and shedding light on a range of confounding aspects of Latino health.

The study, which documented nearly 1 million genetic variants among more than 1,000 individuals, unveiled genetic differences as extensive as the variations between some Europeans and Asians, indicating populations that have been isolated for hundreds to thousands of years.

These differences offer an explanation for the wide variety of health factors among Latinos of Mexican descent, including differing rates of breast cancer and asthma, as well as therapeutic response. Results of the study, on which UCSF and Stanford shared both first and senior authors, appear in the June 13 online edition of the journal Science.

“Over thousands of years, there’s been a tremendous language and cultural diversity across Mexico, with large empires like the Aztec and Maya, as well as small, isolated populations,” said Christopher Gignoux, Ph.D., who was first author on the study with Andres Moreno-Estrada, M.D., Ph.D., first as a graduate student at UCSF and now as a postdoctoral fellow at Stanford. “Not only were we able to measure this diversity across the country, but we identified tremendous genetic diversity, with real disease implications based on where, precisely, your ancestors are from in Mexico.”

For decades, physicians have based a range of diagnoses on patients’ stated or perceived ethnic heritage, including baseline measurements for lung capacity, which are used to assess whether a patients’ lungs are damaged by disease or environmental factors. In that context, categories such as Latino or African-American, both of which reflect people of diverse combinations of genetic ancestry, can be dangerously misleading and cause both misdiagnoses and incorrect treatment.

While there have been numerous disease/gene studies since the Human Genome Project, they have primarily focused on European and European-American populations, the researchers said. As a result, there is very little knowledge of the genetic basis for health differences among diverse populations.

“In lung disease such as asthma or emphysema, we know that it matters what ancestry you have at specific locations on your genes,” said Esteban González Burchard, M.D., M.P.H., professor of bioengineering and therapeutic sciences, and of medicine, in the UCSF schools of pharmacy and medicine. Burchard is co-senior author of the paper with Carlos Bustamante, Ph.D., a professor of genetics at Stanford. “In this study, we realized that for disease classification it also matters what type of Native American ancestry you have. In terms of genetics, it’s the difference between a neighborhood and a precise street address.”

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Study aims to boost health of immigrant Latino farmworkers


UC Davis, UC Berkeley participate in $3M study.

A new, collaborative study aimed at designing and evaluating worksite-based health programs to lower the risk of obesity and diabetes among immigrant Latino farmworkers has been launched under the leadership of UC Davis.

The new five-year study, to be carried out through a partnership between UC Davis; Reiter Affiliated Companies, a large California berry grower; and the Health Initiative of the Americas at UC Berkeley; was recently funded with more than $3 million in grant funds from the National Institute of Diabetes, Digestive and Kidney Diseases.

“Latino farmworkers harvest much of our fruit and vegetables, yet they face obesity and diabetes rates much higher than the general population,” said lead investigator Marc Schenker, director of the UC Migration and Health Research Center and the Western Center for Agricultural Health and Safety, and a distinguished professor in UC Davis’ Department of Public Health Sciences.

He noted that the prevalence of obesity and diabetes has rapidly increased during the past decade in the United States. Among Latinos, the prevalence of overweight and obesity is now an alarming 78 percent, markedly higher than in the general population. Furthermore, the prevalence of diabetes among Latinos in the U.S. is almost twice that of non-Latino whites.

“To address that problem, we have created and are evaluating an obesity and diabetes prevention program that can be delivered to workers in the field,” Schenker said.

The study will include food and nutrition educational programs at the participants’ on-farm worksites, as well as exercise activities such as Zumba classes. All programs are led by community health workers or “promotoras.”

The study focuses on ranches in Salinas and Watsonville, but the ultimate goal is to disseminate the intervention program to farms throughout the state and country.

The program is designed to improve health outcomes among the farmworkers participating in the study and to evaluate those outcomes, as well as the economic impact for the employer.

“We hope that the economic benefits — which we anticipate will be demonstrated and quantified through this study — will help convince other companies in the agricultural industry to adopt similar programs,” Schenker said.

He added that Reiter Affiliated Cos. is a model industry partner for this study because it is already invested in the health of its workers.

Co-investigators on the study include Daniel Sumner, a professor of agricultural and resource economics at UC Davis and director of the UC Agricultural Issues Center; Nancy Keim, an adjunct professor in the UC Davis Department of Nutrition; Heejung Bang, a professor of biostatistics at UC Davis; and Xochitl Castaneda, director of the Health Initiative of the Americas at UC Berkeley.

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Tailored intervention has low impact on colorectal cancer screening


Program increased patients’ familiarity with options but only modest increase in testing.

Anthony Jerant, UC Davis

Colorectal cancer screening saves lives, but too few people get tested. In an effort to increase these numbers,researchers from UC Davis and elsewhere investigated whether an individualized interactive multimedia computer program (IMCP) would spur patients to get screened. Tailored to each patient’s knowledge, language (English or Spanish), and perceptions, this sophisticated intervention increased patients’ familiarity with their options and motivation for screening. However, the program generated only a modest increase in actual screening, one no greater than the increase resulting from a simple non-tailored “electronic leaflet.” The paper was published in the Annals of Family Medicine.

“We felt this novel approach might increase screening rates,” said lead author Anthony Jerant, professor in the Department of Family and Community Medicine at UC Davis. “While it did have a significant impact on attitudes, those did not translate into a significant increase in testing.”

Compared to other preventive diagnostics, such as mammograms and prostate cancer screening (PSA) tests, colorectal screening rates are low. They are especially low among Latinos, who often face economic, language and other barriers. Previous research has shown that tailoring an educational program to each patient’s needs can make the information more relevant, spurring the patient to take action. For example, personalized techniques have helped people address depression. The researchers hoped the enhanced approach would motivate equal numbers of Latino and non-Latino participants to get screened, and help close the gap in screening rates among different ethnic groups.

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Blum Center conference examines health inequities, solutions in Latin America


Despite improvements, childhood malnutrition, anemia, vaccine delivery problems persist.

Dr. Michael Rodriguez directs the UCLA Blum Center on Poverty and Health in Latin America.

Health has improved for Latin Americans in recent decades but Ferdinando Regalia, chief of the Inter-American Development Bank’s Social Protection and Health Division, reminded attendees at the second annual UCLA Blum Center Conference why there’s still more work to be done.

He spoke about an indigenous 16-year-old woman in rural Panama who just last year gave birth to a stillborn child, an outcome that could have been prevented if she had received treatment at a health clinic.

Regalia said it was “one of the thousands of deaths that happen every day in silence without witnesses, but with the same pain and affliction as (if we’re talking) about our daughters, wives and friends.”

“Let’s not forget about their babies,” he told the audience gathered to hear opening remarks at the conference organized by the UCLA Blum Center for Health and Poverty in Latin America.

The conference drew approximately 150 attendees, including health ministry and other government and community officials from 10 Latin American nations, on Tuesday and Wednesday to hear about health issues in the region as well as solutions.

Cindy Fan, UCLA vice provost for international studies, also spoke during the conference’s opening remarks, noting that the university has at least 150 faculty members in 28 academic fields that work on Latin American research. Units such as the Latin American Institute and the Blum Center are also focused on the region.

“The (Blum) Center seeks to anticipate policy changes and devise strategies to improve health and reduce poverty and address and combat inequities among disadvantaged populations and these are really important missions that a campus like UCLA is embracing,” she added.

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UC Davis personalizing outreach to address Asian cancer health disparities


National Minority Cancer Awareness Week is April 13-19.

In an effort to reduce cancer health disparities among Asian-Americans, UC Davis Comprehensive Cancer Center now offers individual, in-language education and culturally sensitive materials for every Asian-American cancer patient.

Debuting during the National Minority Cancer Awareness Week April 13-19, the new brochures and five-minute videos are designed to inform Asian-Americans about the importance of engaging in cancer research. The educational efforts also are part of the Asian-American Cancer Education Study (AACES), a UC Davis program aimed at increasing awareness of clinical trials and the importance of donation of biospecimens such as blood, saliva or tissue.

Asian-Americans’ involvement in clinical trials and biospecimen donation is crucial because Asian-Americans are consistently underrepresented in cancer research. Studies show that language barriers, mistrust of the medical system and cultural differences often create misunderstandings about the nature and purpose of clinical trials and biospecimen donation, discouraging participation.

“Asian-Americans are the only racial group for whom cancer is the leading cause of death, so we are highly motivated to increase their involvement,” said professor Moon Chen, the cancer center’s associate director for cancer control.

UC Davis researchers have found that less than five percent of all clinical trials participants in the U.S. include minorities, less than two percent of clinical cancer research studies focus on non-white ethnic or racial groups, and biospecimen collection among diverse populations lags far behind that of non-Hispanic whites.

The Asian American Network for Cancer Awareness and Training (AANCART), headquartered at the UC Davis Comprehensive Cancer Center, developed the brochures and DVDs based on extensive research using ethnically specific community outreach programs in Honolulu, Los Angeles, Sacramento and San Francisco. Through community focus groups and surveys conducted in Vietnamese, Chinese, Korean, Tagalog and Hmong, AANCART sought to understand existing cultural barriers and misconceptions about participation in cancer research. They found many causes of confusion, from pervasive cultural beliefs to language problems such as inaccurate translation of certain terms and phrases.

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Higher social class linked to fewer bone fractures among non-white women


UCLA findings help shed light on importance of social class in fracture risk of midlife women.

If you are a middle-aged African-American or Asian woman, your social class may play a significant role in how likely you are to suffer bone fracutres, a UCLA-led study suggests.

The study, published in the current issue of Osteoporosis International, is unique in that it followed Asian, African-American and white women for a period of nine years during midlife; most previous studies on socioeconomic status and osteoporosis risk had focused solely on older white women and often had not collected information on fractures over time.

The new findings help shed light on the importance of social class — and particularly education levels — in the fracture risk of midlife women from different racial and ethnic groups, the researchers said.

Osteoporosis is a public health concern for a wide variety of individuals. About half of post-menopausal women and 20 percent of older men will suffer an osteoporosis-linked fracture, said the study’s lead author, Dr. Carolyn Crandall, a professor of medicine in the division of general internal medicine and health services research at the David Geffen School of Medicine at UCLA.

“The traditional paradigm of assessing fracture risk does not include consideration of socioeconomic factors, such as education and income,” she said. “Examining the associations of socioeconomic status with fracture risk could help the targeting of individuals at risk of future fracture and inform the development of preventive strategies.”

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