Health - Diseases And Minority Populations

Cancer

Cancer is the uncontrolled multiplication and spread of abnormal cells and can lead to death if unchecked. Cancer incidence varies according to racial and ethnic background. Such risk factors as occupation, use of tobacco and alcohol, sexual and reproductive behaviors, and nutritional and dietary habits influence the development of cancer. Cancer screening, treatment, and mortality rates also vary by race and ethnicity.

African-Americans have both the highest cancer incidence and the highest cancer mortality rates of all racial and ethnic groups, while the cancer incidence and mortality rates of other minority groups are relatively low. The Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute (NCI) is the most authoritative source of information on cancer incidence, mortality, and survival in the United States. According to SEER Cancer Statistics Review, 1975–2002 (November 2004, http://seer.cancer.gov/csr/1975_2002/), the incidence rates of all cancers between 1992 and 2002 were 526.7 per one hundred thousand African-Americans, 483.5 per one hundred thousand whites, 354.6 per one hundred thousand Hispanics, 339.7 per one hundred thousand Asians and Pacific Islanders, and 251.9 per one hundred thousand Native Americans and Alaska Natives. (See Table 6.9.) The mortality rates of all cancers between 1992 and 2002 were 259.3 per one hundred thousand African-Americans, 200.8 per one hundred thousand whites, 137.4 per one hundred thousand Hispanics, 135.3 per one hundred thousand Native Americans and Alaska Natives, and 125.1 per one hundred thousand Asians and Pacific Islanders. (See Table 6.10.)

The SEER Cancer Statistics Review, 1975–2002 states that more whites survived five years after diagnosis of invasive cancer than did African-Americans. More than two-thirds (66.4%) of whites survived five years, compared with only 56% of African-Americans. Much of TABLE 6.3 Health insurance coverage for persons 65 years of age and over, according to type of coverage and selected characteristics, selected years, 1989–2003this difference in survival can be attributed to later diagnosis of cancer in African-Americans due to lower screening rates and less access to health care. Among the most diagnosed cancers for all groups in the United States are breast cancer, prostate cancer, lung and bronchus cancer, and colon and rectum cancer.

TABLE 6.3
Health insurance coverage for persons 65 years of age and over, according to type of coverage and selected characteristics, selected years, 1989–2003
[Data are based on household interviews of a sample of the civilian noninstitutionalized population]
Characteristic	Private insurancea						Private insurance obtained through workplacea,b
	1989	1995	2000	2001	2002	2003	1989	1995	2000	2001	2002	2003
	Number in millions
Totalc	22.4	23.5	21.2	21.3	20.6	21.5	11.2	12.4	12.0	12.2	11.8	11.9
	Percent of population
Totalc	76.5	74.6	63.4	63.1	60.9	62.7	38.4	39.5	35.9	36.2	34.9	34.8
Age
65-74 years	78.2	75.1	63.1	63.4	60.9	62.3	43.7	43.3	39.6	39.8	38.0	38.2
75 years and over	73.9	73.9	63.9	62.7	60.8	63.1	30.2	34.1	31.4	32.0	31.4	31.0
75-84 years	75.9	75.7	64.9	64.2	61.7	64.0	32.0	36.0	33.2	33.4	33.1	32.5
85 years and over	65.5	67.3	59.8	57.4	57.7	59.8	22.8	27.3	24.8	26.8	25.4	26.2
Sex
Male	77.5	76.4	64.7	64.2	62.2	64.1	43.5	44.2	40.4	40.6	39.2	38.6
Female	75.8	73.3	62.5	62.3	59.9	61.6	34.8	36.2	32.6	33.0	31.8	32.0
Raced
White only	80.1	78.3	67.2	66.7	64.3	65.7	39.9	41.0	37.4	37.6	36.0	35.7
Black or African American only	43.0	41.8	36.1	38.3	36.5	37.6	24.8	26.5	25.7	28.5	27.2	28.3
American Indian and Alaska Native only	46.8	39.9	*	32.6	*	37.3	21.3	29.4
Asian only	48.4	45.8	42.9	41.3	40.7	40.2	30.2	27.0	25.0	23.8	28.0	25.9
Native Hawaiian and other Pacific Islander only	—	—					—	—
2 or more races	—	—	65.5	48.5	55.1	53.0	—	—	49.7	31.2	35.2	31.7
Hispanic origin and raced
Hispanic or Latino	44.8	40.9	24.6	25.3	23.8	24.0	24.5	20.3	16.4	17.6	17.3	17.6
Mexican	36.4	33.3	21.7	25.8	22.3	25.7	22.2	17.8	13.8	18.0	16.8	19.5
Not Hispanic or Latino	77.6	76.3	65.5	65.2	63.1	65.1	38.9	40.5	36.9	37.3	35.9	35.9
White only	81.4	80.4	69.1	68.8	66.4	68.6	40.4	42.2	38.3	38.6	37.0	37.0
Black or African American only	43.0	41.5	36.1	38.3	36.6	37.6	24.8	26.1	25.7	28.6	27.2	28.1
Percent of poverty levele
Below 100 percent	46.3	40.3	34.1	32.8	30.7	33.2	11.5	13.9	12.7	15.2	12.7	12.9
100-149 percent	67.5	67.6	47.0	48.3	46.9	47.2	22.3	26.7	18.9	22.6	19.8	16.8
150-199 percent	81.1	75.9	61.8	61.8	58.7	61.8	39.5	38.8	29.2	28.8	28.6	26.9
200 percent or more	86.6	85.7	72.8	71.4	69.7	71.1	52.3	50.6	45.5	44.1	43.4	44.0

BREAST CANCER

While fewer African-American women were diagnosed with breast cancer (120.2 per one hundred thousand) than were white women (138.3 per one hundred thousand) between 1992 and 2002, a higher proportion of African-American women died of the disease (36.2 per one hundred thousand) than did white women (twenty-eight per one hundred thousand). (See Table 6.9 and Table 6.10.) For years experts assumed that the difference in mortality rates was due to poor health care and late treatment for African-American women. However, Susan-LoveMD.org reports in "Study Finds Breast Tumors More Aggressive in African-American Women Than in White Women" (August 26, 2004, http://www.susanlovemd.com/community/flashes/hotflash040826_1.htm) that African-American women may be more susceptible to a more deadly form of the cancer. Tumors from African-American women were found to have more actively dividing cells than tumors from white women. The tumor cells in African-American women also lacked hormone receptors, another indicator of a poor prognosis. After peaking in the early 1990s, the death rate from breast cancer for African-American women had shown some improvement by 2002. (See Figure 6.4.)

Hispanics, Asians and Pacific Islanders, and Native Americans and Alaska Natives are less likely to be diagnosed with breast cancer or to die from breast cancer than either whites or African-Americans. The incidence rates of breast cancer between 1992 and 2002 were 92.8 per one hundred thousand Asians and Pacific Islanders, 88.2 per one hundred thousand Hispanics, and 60.7 per one hundred thousand Native Americans and Alaska Natives. (See Table 6.9.) The mortality rates of breast cancer were lowest for Asian and Pacific Islander women, at 12.9 per one hundred thousand, despite their higher incidence rates. The mortality rate for Hispanic women was highest of the three groups, at 17.7 per one hundred thousand women. (See Table 6.10.)

TABLE 6.3 Health insurance coverage for persons 65 years of age and over, according to type of coverag and selected characteristics, selected years, 1989–2003 [CONTINUED] Adapted from "Table 135. Health Insurance Coverage for Persons 65 Years of Age and Over, according to Type of Coverage and Selected Characteristics: United States, Selected Years, 1989–2003," in Health, United States, 2005, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, 2005, http://www.cdc.gov/nchs/data/hus/hus05.pdf (accessed January 25, 2006)

TABLE 6.3
Health insurance coverage for persons 65 years of age and over, according to type of coverage and selected characteristics, selected years, 1989–2003 [CONTINUED]
[Data are based on household interviews of a sample of the civilian noninstitutionalized population]
Characteristic	Medicare health maintenance organizationa,f						Medicaida,g
	1989	1995	2000	2001	2002	2003	1989	1995	2000	2001	2002	2003
Notes: "—" = Data not available. In 1997 the National Health Interview Survey (NHIS) was redesigned, including changes to the questions on health insurance coverage. Percents do not add to 100 because (1) elderly persons with more than one type of insurance in addition to Medicare appear in more than one column, (2) elderly persons with Medicare fee-for-service only are not shown, and (3) the percent of elderly persons without health insurance (1.1 percent in 2003) is not shown.
*Estimates are considered unreliable.
aAlmost all persons 65 years of age and over are also covered by Medicare.
bPrivate insurance originally obtained through a present or former employer or union. Starting in 1997, also includes private insurance obtained through workplace, self-employed, or professional association.
cIncludes all other races not shown separately and, in 1984 and 1989, unknown poverty level.
dThe race groups, white, black, American Indian and Alaska Native, Asian, Native Hawaiian and other Pacific Islander, and 2 or more races, include persons of Hispanic and non-Hispanic origin. Persons of Hispanic origin may be of any race. Starting with data year 1999, race-specific estimates are tabulated according to 1997 Standards for Federal Data on Race and Ethnicity and are not strictly comparable with estimates for earlier years. The five single race categories plus multiple race categories shown in the table conform to 1997 standards Starting with data year 1999, race-specific estimates are for persons who reported only one racial group; the category "2 or more races" includes persons who reported more than one racial group. Prior to data year 1999, data were tabulated according to 1977 standards with four racial groups and the category "Asian only" included Native Hawaiian and other Pacific Islander. Estimates for single race categories prior to 1999 included persons who reported one race or, if they reported more than one race, identified one race as best representing their race.
ePoverty status was unknown for 15-18 percent of persons 65 years of age and over in 1984 and 1989. Missing family income data were imputed for 22-25 percent of persons 65 years of age and over in 1994–96, 36 percent in 1997, 41 percent in 1998, and 44-17 percent in 1999–2003.
fPersons reporting Medicare coverage are considered to have health maintenance organization (HMO) coverage if they responded yes when asked if they were under a Medicare managed care arrangement such as an HMO.
gIncludes public assistance through 1996. Starting with data year 1997 includes state-sponsored health plans. In 2003 the percent of the population 65 years of age and over covered by Medicaid was 7.3 percent, and 0.6 percent were covered by state-sponsored health plans.
SOURCE: Adapted from "Table 135. Health Insurance Coverage for Persons 65 Years of Age and Over, according to Type of Coverage and Selected Characteristics: United States, Selected Years, 1989–2003," in Health, United States, 2005, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, 2005, http://www.cdc.gov/nchs/data/hus/hus05.pdf (accessed January 25, 2006)
	Number in millions
Totalc	—	—	5.1	4.3	4.0	3.4	2.0	3.0	2.5	2.7	2.7	2.7
	Percent of population
Totalc	—	—	15.2	12.9	11.8	10.0	7.0	9.4	7.5	8.0	7.8	8.0
Age	Percent of population
65-74 years	—	—	15.7	12.7	11.7	9.5	6.3	8.4	7.6	7.6	7.9	8.0
75 years and over	—	—	14.5	13.1	11.9	10.6	8.2	10.9	7.4	8.4	7.7	7.9
75-84 years	—	—	15.4	13.4	12.6	10.9	7.9	9.9	7.1	7.9	7.8	7.6
85 years and over	—	—	11.0	11.9	9.2	9.7	9.7	14.3	8.4	10.1	7.3	9.1
Sex
Male	—	—	15.5	12.4	12.3	9.9	4.9	5.7	5.4	5.9	5.6	5.7
Female	—	—	14.9	13.2	11.4	10.2	8.5	12.1	9.0	9.5	9.5	9.6
Raced
White only	—	—	15.1	12.9	11.6	10.0	5.5	7.2	5.5	6.1	6.1	6.2
Black or African American only	—	—	14.6	11.4	10.6	9.4	20.5	27.5	19.4	19.9	19.5	19.2
American Indian and Alaska Native only	—	—	*	*	*	*	30.9	*	35.4	*	*	32.7
Asian only	—	—	16.7	13.4	18.6	15.2	21.3	33.6	21.0	22.9	20.0	28.5
Native Hawaiian and other Pacific Islander only	—	—	*	*	*	*	—	—	*	*	*	*
2 or more races	—	—	30.4	16.5	15.2	*	—	—	*	19.1	*	15.5
Hispanic origin and raced
Hispanic or Latino	—	—	24.7	19.9	21.8	18.9	25.6	31.1	28.4	29.0	27.9	27.3
Mexican	—	—	23.7	18.2	19.0	14.5	27.4	31.6	26.6	25.7	23.6	25.7
Not Hispanic or Latino	—	—	14.6	12.5	11.2	9.5	6.4	8.3	6.3	6.8	6.6	6.8
White only	—	—	14.5	12.5	11.1	9.3	4.8	5.9	4.6	4.9	5.0	4.8
Black or African American only	—	—	14.5	11.4	10.5	9.5	20.4	27.6	19.4	19.8	19.4	18.8
Percent of poverty levele
Below 100 percent	—	—	15.1	9.1	9.1	9.4	28.1	36.2	28.1	31.0	29.5	31.8
100-149 percent	—	—	16.4	12.8	11.8	10.7	9.0	12.8	13.7	15.0	12.8	13.3
150-199 percent	—	—	15.7	14.1	12.8	11.7	4.7	5.8	5.4	6.8	6.6	6.4
200 percent or more	—	—	14.8	13.3	12.0	9.7	2.2	2.2	2.8	3.0	3.1	3.1

PROSTATE CANCER

African-American men have a particularly high incidence of and mortality rate for prostate cancer. Between 1992 and 2002 the prostate cancer incidence rate among African-American men was 283.8 cases per one hundred thousand population, compared with a rate of only 175.5 cases per one hundred thousand population among whites. (See Table 6.9.) African-American men averaged 73.7 deaths from prostate cancer TABLE 6.4 Health care visits to doctor's offices, emergency departments, and home visits within the past 12 months, according to selected characteristics, selected years, 1997–2003per one hundred thousand population during those same years, compared with 31.2 deaths per one hundred thousand white men. (See Table 6.10.) Even though the incidence rate and the mortality rate for prostate cancer decreased for both groups between the early 1990s and 2002, the incidence and mortality rates for African-American men remained higher than for all other race and ethnic groups. (See Figure 6.5.)

TABLE 6.4
Health care visits to doctor's offices, emergency departments, and home visits within the past 12 months, according to selected characteristics, selected years, 1997–2003
[Data are based on household interviews of a sample of the civilian noninstitutionalized population]
Characteristic	Number of health care visitsa
	None			1-3 visits			4-9 visits			10 or more visits
	1997	2002	2003	1997	2002	2003	1997	2002	2003	1997	2002	2003
	Percent distribution
All personsb, c	16.5	15.9	15.8	46.2	45.5	45.8	23.6	25.2	24.8	13.7	13.4	13.6
Racec, d
White only	16.0	15.6	15.7	46.1	45.1	45.6	23.9	25.4	25.1	14.0	13.8	13.6
Black or African American only	16.8	15.3	14.7	46.1	45.8	45.8	23.2	26.0	25.2	13.9	13.0	14.3
American Indian and Alaska Native only	17.1	18.1	23.3	38.0	43.7	41.4	24.2	21.7	20.6	20.7	16.6	14.7
Asian only	22.8	21.2	22.6	49.1	49.7	47.8	19.7	20.3	20.7	8.3	8.8	8.9
Native Hawaiian and other Pacific Islander only	—	*	*	—	*	*	—	*	*	—	*
2 or more races	—	13.5	11.1	—	43.7	44.9	—	27.3	23.0	—	15.4	21.0
Hispanic origin and racec, d
Hispanic or Latino	24.9	25.7	25.3	42.3	41.5	42.9	20.3	21.1	20.3	12.5	11.7	11.5
Mexican	28.9	28.8	27.8	40.8	40.5	42.5	18.5	19.3	18.8	11.8	11.5	11.0
Not Hispanic or Latino	15.4	14.5	14.1	46.7	46.0	46.3	24.0	25.8	25.6	13.9	13.7	14.0
White only	14.7	14.0	13.5	46.6	45.8	46.2	24.4	26.1	26.1	14.3	14.2	14.2
Black or African American only	16.9	15.3	14.6	46.1	45.7	45.9	23.1	26.0	25.3	13.8	13.1	14.2
Respondent-assessed health statusc
Fair or poor	7.8	10.1	8.7	23.3	22.2	23.2	29.0	29.4	28.8	39.9	38.3	39.3
Good to excellent	17.2	16.6	16.4	48.4	47.7	48.1	23.3	24.9	24.5	11.1	10.8	10.9
Poverty statusc, e
Poor	20.6	19.9	20.9	37.8	38.3	37.8	22.7	23.9	23.7	18.9	17.9	17.6
Near poor	20.1	20.0	19.8	43.3	41.2	41.5	21.7	23.8	23.6	14.9	15.0	15.1
Nonpoor	14.5	14.2	13.7	48.7	47.6	48.4	24.2	25.7	25.4	12.6	12.4	12.6
Hispanic origin and race and poverty statusc, d, e
Hispanic or Latino:
Poor	30.2	30.0	29.9	34.8	35.4	37.0	19.9	18.9	18.5	15.0	15.7	14.6
Near poor	28.7	30.2	28.6	39.7	37.8	40.2	20.4	19.9	20.6	11.2	12.2	10.5
Nonpoor	18.9	21.1	20.7	48.8	46.8	47.7	20.4	22.3	21.2	11.9	9.8	10.3
Not Hispanic or Latino:
White only:
Poor	17.0	16.1	17.0	38.3	38.4	37.5	23.9	25.6	25.9	20.9	19.9	19.5
Near poor	17.3	16.7	16.6	44.1	41.3	41.0	22.2	25.0	24.9	16.3	17.0	17.4
Nonpoor	13.8	13.3	12.5	48.2	47.3	48.1	24.9	26.4	26.3	13.1	13.1	13.1
Black or African American only:
Poor	17.4	17.3	15.7	38.5	39.7	38.1	23.4	25.9	26.5	20.7	17.1	19.6
Near poor	18.8	15.6	15.4	43.7	43.4	44.2	22.9	26.9	25.9	14.5	14.1	14.5
Nonpoor	15.6	14.4	13.7	51.7	49.1	50.6	22.7	25.3	24.3	10.0	11.1	11.4

Hispanics, Asians and Pacific Islanders, and Native Americans and Alaska Natives have both lower rates of prostate cancer incidence and lower rates of prostate cancer mortality than do African-Americans or whites. (See Figure 6.5.) The incidence rates of prostate cancer between 1992 and 2002 were 143.1 per one hundred thousand Hispanics, 104.6 per one hundred thousand Asians and Pacific Islanders, and 63.4 per one hundred thousand Native Americans and Alaska Natives. (See Table 6.9.) The mortality rates of prostate cancer were lowest for Asian and Pacific Islander males, at 14.1 per one hundred thousand, despite their higher incidence rates. The mortality rate for Hispanic males was highest of the three groups, at 24.7 per one hundred thousand. (See Table 6.10.)

LUNG AND BRONCHUS CANCER

According to the SEER Cancer Statistics Review, 1975–2002, lung cancer is the deadliest cancer for whites, Asians and Pacific Islanders, Native Americans and Alaska Natives, and Hispanics, and the second-deadliest cancer for African-Americans; the five-year survival rate for all races was only 15.3% of those diagnosed between 1995 and 2001. African-Americans have a particularly high incidence of lung cancer and mortality rate compared with other groups. Between 1992 and 2002 the lung cancer incidence rate among African-Americans TABLE 6.4 Health care visits to doctor's offices, emergency departments, and home visits within the past 12 months, according to selected characteristics, selected years, 1997–2003 [CONTINUED] Adapted from "Table 75. Health Care Visits to Doctor's Offices, Emergency Departments, and Home Visits within the Past 12 Months, according to Selected Characteristics: United States, Selected Years, 1997–2003," in Health, United States, 2005, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, 2005, http://www.cdc.gov/nchs/data/hus/hus05.pdf (accessed January 25, 2006)was 81.6 cases per one hundred thousand population, compared with a rate of 63.7 cases per one hundred thousand whites, 42.8 cases per one hundred thousand Asians and Pacific Islanders, 36.3 cases per one hundred thousand Native Americans and Alaska Natives, and 33.4 per one hundred thousand Hispanics. (See Table 6.9.) Both the incidence rate and the mortality rate for lung cancer decreased between the early 1990s and 2002, especially for African-Americans; however, the incidence and mortality rates for African-Americans remained substantially higher than for all other race and ethnic groups. (See Figure 6.6.)

TABLE 6.4
Health care visits to doctor's offices, emergency departments, and home visits within the past 12 months, according to selected characteristics, selected years, 1997–2003 [CONTINUED]
[Data are based on household interviews of a sample of the civilian noninstitutionalized population]
Characteristic	Number of health care visitsa
	None			1-3 visits			4-9 visits			10 or more visits
	1997	2002	2003	1997	2002	2003	1997	2002	2003	1997	2002	2003
Notes: "—" = Data not available. In 1997 the National Health Interview Survey (NHIS) questionnaire was redesigned
*Estimates are considered unreliable.
aThis table presents a summary measure of health care visits to doctor's offices, emergency departments, and home visits during a 12-month period.
bIncludes all other races not shown separately and unknown health insurance status.
cEstimates are age adjusted to the year 2000 standard population using six age groups: Under 18 years, 18-44 years, 45-54 years, 55-64 years, 65-74 years, and 75 years and over.
dThe race groups, white, black, American Indian and Alaska Native, Asian, Native Hawaiian and other Pacific Islander, and 2 or more races, include persons of Hispanic and non-Hispanic origin. Persons of Hispanic origin may be of any race. Starting with data year 1999 race-specific estimates are tabulated according to 1997 Standards for Federal Data on Race and Ethnicity and are not strictly comparable with estimates for earlier years. The five single race categories plus multiple race categories shown in the table conform to 1997 standards. Starting with data year 1999, race-specific estimates are for persons who reported only one racial group; the category "2 or more races" includes persons who reported more than one racial group. Prior to data year 1999, data were tabulated according to 1977 standards with four racial groups and the category "Asian only" included Native Hawaiian and other Pacific Islander. Estimates for single race categories prior to 1999 included persons who reported one race or, if they reported more than one race, identified one race as best representing their race.
ePoor persons are defined as below the poverty threshold. Near poor persons have incomes of 100 percent to less than 200 percent of poverty threshold. Nonpoor persons have incomes of 200 percent or greater than the poverty threshold. Missing family income data were imputed for 25-29 percent of persons in 1997–98 and 32-35 percent in 1999–2003.
fEstimates for persons under 65 years of age are age adjusted to the year 2000 standard using four age groups: Under 18 years, 18-44 years, 45-54 years, and 55-64 years of age. Estimates for persons 65 years of age and over are age adjusted to the year 2000 standard using two age groups: 65-74 years and 75 years and over.
gHealth insurance categories are mutually exclusive. Persons who reported both Medicaid and private coverage are classified as having private coverage. Starting in 1997 Medicaid includes state-sponsored health plans and State Children's Health Insurance Program (SCHIP). In addition to private and Medicaid the category "insured" also includes military plans, other government-sponsored health plans, and Medicare, not shown separately. Persons 65 years of age and over who reported Medicare HMO (health maintenance organization) and some other type of health insurance coverage are classified as having Medicare HMO. For persons 65 years of age and over the category "private" includes private and Medicare coverage.
SOURCE: Adapted from "Table 75. Health Care Visits to Doctor's Offices, Emergency Departments, and Home Visits within the Past 12 Months, according to Selected Characteristics: United States, Selected Years, 1997–2003," in Health, United States, 2005, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, 2005, http://www.cdc.gov/nchs/data/hus/hus05.pdf (accessed January 25, 2006)
Health insurance statusf, g
Under 65 years of age:
Insured	14.3	13.3	12.8	49.0	48.7	49.1	23.6	25.1	25.2	13.1	12.9	12.9
Private	14.7	13.6	13.2	50.6	50.5	51.1	23.1	24.8	24.6	11.6	11.1	11.1
Medicaid	9.8	9.9	9.9	35.5	34.9	35.2	26.5	27.4	28.1	28.2	27.7	26.8
Uninsured	33.7	36.3	38.1	42.8	42.1	42.4	15.3	14.7	13.4	8.2	6.9	6.1
65 years of age and over:
Medicare HMO	8.9	7.7	5.4	35.8	30.9	30.6	33.1	40.9	38.9	22.3	20.5	25.2
Private	7.3	6.1	4.8	35.9	32.0	33.5	34.0	38.1	35.9	22.7	23.8	25.8
Medicaid	9.3	9.3	4.9	19.2	15.8	21.1	27.9	34.2	29.7	43.7	40.8	44.3
Medicare fee-for-service only	15.5	14.4	11.6	34.0	33.4	28.7	28.1	30.7	35.3	22.4	21.4	24.5

COLON AND RECTUM CANCER

Colon and rectum cancer is the fourth most frequently diagnosed cancer in the United States; it is also the fourth deadliest. African-Americans are diagnosed more frequently than other groups. Between 1992 and 2002 African-Americans had an incidence of 62.6 cases per one hundred thousand population, compared with a rate of 53.6 per one hundred thousand whites, forty-seven per one hundred thousand Asians and Pacific Islanders, 38.9 per one hundred thousand Hispanics, and thirty-six per one hundred thousand Native Americans and Alaska Natives. (See Table 6.9.) African-Americans also had the highest mortality rate from colon and rectum cancer, at 28.6 deaths per one hundred thousand, compared with 21.1 deaths per one hundred thousand whites, 14.2 deaths per one hundred thousand Hispanics, 13.8 deaths per one hundred thousand Native Americans and Alaska Natives, and 13.5 deaths per one hundred thousand Asians and Pacific Islanders. (See Table 6.10.) Furthermore, while both the incidence rate of and the mortality rate from colon and rectum cancer steadily decreased for whites between the mid-1980s and 2002, the incidence and mortality rates for African-Americans remained static. (See Figure 6.7.)

Heart Disease and Stroke

Heart disease includes coronary and hypertensive heart diseases and heart failure. According to the 2004 TABLE 6.5 Prenatal care for live births, according to detailed race and Hispanic origin of mother, 1970–2003 "Table 7. Prenatal Care for Live Births, according to Detailed Race and Hispanic Origin of Mother: United States, Selected Years, 1970–2003," in Health, United States, 2005, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, 2005, http://www.cdc.gov/nchs/data/hus/hus05.pdf (accessed January 25, 2006)National Healthcare Disparities Report, about 13.2 million Americans had coronary heart disease, 1.2 million heart attacks occurred each year, and about five million Americans had heart failure annually.

TABLE 6.5
Prenatal care for live births, according to detailed race and Hispanic origin of mother, 1970–2003
[Data are based on birth certificates]
Prenatal care, race, and Hispanic origin of mother	1970	1975	1980	1985	1990	1995	1997	1999	2000	2001	2002	2003
Notes: "—" = Data not available. Data for 2003 exclude Pennsylvania and Washington that implemented the 2003 revision to the U.S. Standard Certificate of Live Birth. Prenatal care data based on the 2003 revision are not comparable with data based on the 1989 revision to the U.S. Standard Certificate of Live Birth. Data for 1970 and 1975 exclude births that occurred in states not reporting prenatal care. The race groups, white, black, American Indian or Alaska Native, and Asian or Pacific Islander, include persons of Hispanic and non-Hispanic origin. Persons of Hispanic origin may be of any race. Interpretation of trend data should take into consideration expansion of reporting areas and immigration. Data for additional years are available. Some data for 1980–88 were revised and differ from previous editions of Health, United States.
aExcludes live births for whom trimester when prenatal care began is unknown.
bFor 2003, data are not shown for Asian or Pacific Islander subgroups during the transition from single race to multiple race reporting.
cPrior to 1993, data from states lacking an Hispanic-origin item on the birth certificate were excluded. Data for non-Hispanic white and non-Hispanic black women for years prior to 1989 are not nationally representative and are provided for comparison with Hispanic data.
SOURCE: "Table 7. Prenatal Care for Live Births, according to Detailed Race and Hispanic Origin of Mother: United States, Selected Years, 1970–2003," in Health, United States, 2005, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, 2005, http://www.cdc.gov/nchs/data/hus/hus05.pdf (accessed January 25, 2006)
Prenaatal care began during 1st trimester	Percent of live birthsa
All races	68.0	72.4	76.3	76.2	75.8	81.3	82.5	83.2	83.2	83.4	83.7	84.1
White	72.3	75.8	79.2	79.3	79.2	83.6	84.7	85.1	85.0	85.2	85.4	85.7
Black or African American	44.2	55.5	62.4	61.5	60.6	70.4	72.3	74.1	74.3	74.5	75.2	75.9
American Indian or Alaska Native	38.2	55.8	57.5	57.9	66.7	68.1	69.5	69.3	69.3	69.8	70.8
Asian or Pacific Islanderb	—	—	73.7	74.1	75.1	79.9	82.1	83.7	84.0	84.0	84.8	85.4
Chinese	71.8	76.7	82.6	82.0	81.3	85.7	87.4	88.5	87.6	87.0	87.2	—
Japanese	78.1	82.7	86.1	84.7	87.0	89.7	89.3	90.7	91.0	90.1	90.5	—
Filipino	60.6	70.6	77.3	76.5	77.1	80.9	83.3	84.2	84.9	85.0	85.4	—
Hawaiian	—	—	68.8	67.7	65.8	75.9	78.0	79.6	79.9	79.1	78.1	—
Other Asian or Pacific Islander	—	—	67.4	69.9	71.9	77.0	79.7	81.8	82.5	82.7	83.9	—
Hispanic or Latinoc	—	—	60.2	61.2	60.2	70.8	73.7	74.4	74.4	75.7	76.7	77.5
Mexican	—	—	59.6	60.0	57.8	69.1	72.1	73.1	72.9	74.6	75.7	76.5
Puerto Rican	—	—	55.1	58.3	63.5	74.0	76.5	77.7	78.5	79.1	79.9	81.2
Cuban	—	—	82.7	82.5	84.8	89.2	90.4	91.4	91.7	91.8	92.0	92.1
Central and South American	—	—	58.8	60.6	61.5	73.2	76.9	77.6	77.6	77.4	78.7	79.2
Other and unknown Hispanic or Latino	—	—	66.4	65.8	66.4	74.3	76.0	74.8	75.8	77.3	76.7	77.0
Not Hispanic or Latino:c
White	—	—	81.2	81.4	83.3	87.1	87.9	88.4	88.5	88.5	88.6	89.0
Black or African American	—	—	60.8	60.2	60.7	70.4	72.3	74.1	74.3	74.5	75.2	75.9
Prenatal care began during 3rd trimester or no prenatal care
All races	7.9	6.0	5.1	5.7	6.1	4.2	3.9	3.8	3.9	3.7	3.6	3.5
White	6.3	5.0	4.3	4.8	4.9	3.5	3.2	3.2	3.3	3.2	3.1	3.0
Black or African American	16.6	10.5	8.9	10.2	11.3	7.6	7.3	6.6	6.7	6.5	6.2	6.0
American Indian or Alaska Native	28.9	22.4	15.2	12.9	12.9	9.5	8.6	8.2	8.6	8.2	8.0	7.6
Asian or Pacific Islanderb	—	—	6.5	6.5	5.8	4.3	3.8	3.5	3.3	3.4	3.1	3.1
Chinese	6.5	4.4	3.7	4.4	3.4	3.0	2.4	2.0	2.2	2.4	2.1	—
Japanese	4.1	2.7	2.1	3.1	2.9	2.3	2.7	2.1	1.8	2.0	2.1	—
Filipino	7.2	4.1	4.0	4.8	4.5	4.1	3.3	2.8	3.0	3.0	2.8	—
Hawaiian	—	—	6.7	7.4	8.7	5.1	5.4	4.0	4.2	4.8	4.7	—
Other Asian or Pacific Islander	—	—	9.3	8.2	7.1	5.0	4.4	4.1	3.8	3.8	3.5	—
Hispanic or Latinoc	—	—	12.0	12.4	12.0	7.4	6.2	6.3	6.3	5.9	5.5	5.3
Mexican	—	—	11.8	12.9	13.2	8.1	6.7	6.7	6.9	6.2	5.8	5.6
Puerto Rican	—	—	16.2	15.5	10.6	5.5	5.4	5.0	4.5	4.6	4.1	3.7
Cuban	—	—	3.9	3.7	2.8	2.1	1.5	1.4	1.4	1.3	1.3	1.3
Central and South American	—	—	13.1	12.5	10.9	6.1	5.0	5.2	5.4	5.7	4.9	4.7
Other and unknown Hispanic or Latino	—	—	9.2	9.4	8.5	6.0	5.3	6.3	5.9	5.4	5.3	5.4
Not Hispanic or Latino:c
White	—	—	3.5	4.0	3.4	2.5	2.4	2.3	2.3	2.2	2.2	2.1
Black or African American	—	—	9.7	10.9	11.2	7.6	7.3	6.6	6.7	6.5	6.2	6.0

Rates of heart disease vary considerably by race, with higher rates for African-Americans. Along with age, sex, and race, heredity is one of the risk factors for heart disease that cannot be changed. However, due to their higher rates of incidence of heart disease and stroke, African-Americans are encouraged to control other risk factors, including use of tobacco and alcohol, blood pressure and cholesterol levels, physical activity, weight, and stress.

HYPERTENSION

According to the American Heart Association in Heart Disease and Stroke Statistics: 2006 Update (2006, http://circ.ahajournals.org/cgi/reprint/CIRCULATIONAHA.105.171600v1), the prevalence of TABLE 6.6 Total births and percentage of births with selected demographic characteristics, by race and Hispanic origin of mother, 2003–04 "Table A. Total Births and Percentage of Births with Selected Demographic Characteristics, by Race and Hispanic Origin of Mother: United States, Final 2003 and Preliminary 2004," in "Births: Preliminary Data for 2004," National Vital Statistics Reports, vol. 54, no. 8, December 29, 2005, http://www.cdc.gov/nchs/data/nvsr/nvsr54/nvsr54_08.pdf (accessed January 26, 2006)hypertension, or high blood pressure, in both African-American men and women is significantly higher than in white men and women, while prevalence of high blood pressure among Mexican Americans of both sexes is comparable to that in the non-Hispanic white community. Compared with whites, African-Americans develop high blood pressure earlier in life and their average blood pressure is much higher. As a result, African-Americans have a 1.3 times greater rate of nonfatal stroke, a 1.8 times greater rate of fatal stroke, and a 1.5 times greater rate of death from heart disease than do whites. Native American and Alaska Native adults are also more likely (29.7%) than white adults (22.8%) or Asian-American adults (19.3%) to ever have been told they had high blood pressure.

TABLE 6.6
Total births and percentage of births with selected demographic characteristics, by race and Hispanic origin of mother, 2003–04
[Data for 2004 are based on a continuous file of records received from the states. Figures for 2004 are based on weighted data rounded to the nearest individual. Birth rates are live births per 1,000 population in specified group. Fertility rates are live births per 1,000 women aged 15-44 years in specified group. Total fertility rates are sums of birth rates for 5-year age groups in specified group multiplied by 5.]
Race and Hispanic origin of mother	Number		Birth rate		Fertility rate		Total fertility rate		Percent of births to unmarried mothers
	2004	2003	2004	2003	2004	2003	2004	2003	2004	2003
aIncludes data for women of unknown Hispanic origin.
bRace and Hispanic origin are reported separately on the birth certificate.
cData for persons of Hispanic origin are included in the data for each race group according to the mother's reported race.
dIncludes births to Aleuts and Eskimos.
eIncludes all persons of Hispanic origin of any race.
SOURCE: "Table A. Total Births and Percentage of Births with Selected Demographic Characteristics, by Race and Hispanic Origin of Mother: United States, Final 2003 and Preliminary 2004," in "Births: Preliminary Data for 2004," National Vital Statistics Reports, vol. 54, no. 8, December 29, 2005, http://www.cdc.gov/nchs/data/nvsr/nvsr54/nvsr54_08.pdf (accessed January 26, 2006)
All races and originsa	4,115,590	4,089,950	14.0	14.1	66.3	66.1	2,048.5	2,042.5	35.7	34.6
Non-Hispanic whiteb	2,304,181	2,321,904	11.7	11.8	58.5	58.5	1,852.5	1,856.5	24.5	23.6
Non-Hispanic blackb	576,105	576,033	15.1	15.9	66.7	67.1	2,010.5	2,027.5	69.2	68.5
American Indian totalb, c, d	43,931	43,052	14.0	13.8	58.9	58.4	1,735.0	1,731.5	62.3	61.3
Asian or Pacific Islander totalb, c	229,352	221,203	16.8	16.8	67.2	66.3	1,900.5	1,873.0	15.5	15.0
Hispanice	944,993	912,329	22.9	22.9	97.7	96.9	2,820.5	2,785.5	46.4	45.0

Researchers are not yet sure why African-Americans have a greater tendency toward high blood pressure, but a possible genetic predisposition toward high blood pressure in African-Americans may stem from a strong tendency to retain salt in their bodies. Scientists hypothesize that this developed as an adaptation to living in a very hot climate where excessive salt loss could result in death.

DEATHS FROM HEART DISEASE

According to the NCHS in Health, United States, 2005 (2005, http://www.cdc.gov/nchs/data/hus/hus05.pdf), the death rate from heart disease was higher for males among all racial and ethnic groups, but it declined between 1990 and 2002 for all groups. African-American males had the highest death rate from heart disease in 2002, at 371 deaths per one hundred thousand people, down from 485.4 in 1990. Hispanic males (219.8), Native American and Alaska Native males (201.2), and Asian and Pacific Islander males (169.8) all had lower death rates from heart disease than did non-Hispanic white males.

Health, United States, 2005 reports that females die of heart disease at high rates as well, although not at the rate that males do. In 2002 African-American females had the highest death rate for heart disease of all racial and ethnic groups, at 263.2 per one hundred thousand people, followed by non-Hispanic white females (193.7), Hispanic females (149.7), Native American and Alaska Native females (123.6), and Asian and Pacific Islander females (108.1). Death rates for all groups from heart disease had declined since 1990.

Alzheimer's Disease

Alzheimer's disease is a progressive brain disorder that gradually destroys a person's memory and ability to reason, communicate, and carry out daily activities. As it progresses, it also tends to affect personality and behavior and may result in anxiety, paranoia, and delusions or hallucinations. The disease can last from three to twenty years and eventually the loss of brain function will cause death. While the underlying causes of Alzheimer's disease remain unclear, some research indicates that minorities, particularly African-Americans, are at a greater risk of developing the disease.

The results of the study "APOE-ε4 Allele and the Risk of Alzheimer Disease among African-Americans, Whites, and Hispanics," conducted between 1991 and 1996 by Columbia University, were published in the Journal of the American Medical Association (March 1998). The findings indicate that African-Americans and Hispanics might be at greater risk for Alzheimer's TABLE 6.7 Low-birth-weight live births, according to mother's detailed race, Hispanic origin, and smoking status, 1970–2003 "Table 13. Low-Birthweight Live Births, according to Mother's Detailed Race, Hispanic Origin, and Smoking Status: United States, Selected Years, 1970–2003," in Health, United States, 2005, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, 2005, http://www.cdc.gov/nchs/data/hus/hus05.pdf (accessed January 25, 2006)disease than whites. In 1992 scientists first discovered that people with the apolipoprotein E gene, or APOE-ε4 (approximately 25% of the total population), have a greater risk for developing the disease. However, the Columbia University research shows that the increased risk associated with the APOE-ε4 gene applies only to whites. The study shows that African-Americans and a group of Hispanic Americans, mainly from the Caribbean, who do not have the gene, are still at a greater risk for Alzheimer's disease than whites.

TABLE 6.7
Low-birth-weight live births, according to mother's detailed race, Hispanic origin, and smoking status, 1970–2003
[Data are based on birth certificates]
Birthweight, race, Hispanic origin of mother, and smoking status of mother	1970	1975	1980	1985	1990	1995	1998	1999	2000	2001	2002	2003
Notes: "—" = Data not available. The race groups, white, black, American Indian or Alaska Native, and Asian or Pacific Islander, include persons of Hispanic and non-Hispanic origin. Persons of Hispanic origin may be of any race. Interpretation of trend data should take into consideration expansion of reporting areas and immigration. Data for additional years are available.
aExcludes live births with unknown birthweight. Percent based on live births with known birthweight.
bFor 2003, data are not shown for Asian or Pacific Islander subgroups during the transition from single race to multiple race reporting.
cPrior to 1993, data from states lacking an Hispanic-origin item on the birth certificate were excluded. Data for non-Hispanic white and non-Hispanic black women for years prior to 1989 are not nationally representative and are provided for comparison with Hispanic data.
dPercent based on live births with known smoking status of mother and known birthweight. Data from states that did not require the reporting of mother's tobacco use during pregnancy on the birth certificate are not included. Reporting area for tobacco use increased from 43 states and the District of Columbia (DC) in 1989 to 49 states and DC in 2000–02. In 2003 California did not require reporting of tobacco use during pregnancy. Data for 2003 also exclude Pennsylvania and Washington that implemented the 2003 revision to the U.S. Standard Certificate of Live Birth. Tobacco use data based on the 2003 revision are not comparable with data based on the 1989 revision to the U.S. Standard Certificate of Live Birth.
SOURCE: "Table 13. Low-Birthweight Live Births, according to Mother's Detailed Race, Hispanic Origin, and Smoking Status: United States, Selected Years, 1970–2003," in Health, United States, 2005, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, 2005, http://www.cdc.gov/nchs/data/hus/hus05.pdf (accessed January 25, 2006)
Low birthweight (less than 2,500 grams)	Percent of live birthsa
All races	7.93	7.38	6.84	6.75	6.97	7.32	7.57	7.62	7.57	7.68	7.82	7.93
White	6.85	6.27	5.72	5.65	5.70	6.22	6.52	6.57	6.55	6.68	6.80	6.94
Black or African American	13.90	13.19	12.69	12.65	13.25	13.13	13.05	13.11	12.99	12.95	13.29	13.37
American Indian or Alaska Native	7.97	6.41	6.44	5.86	6.11	6.61	6.81	7.15	6.76	7.33	7.23	7.37
Asian or Pacific Islanderb	—	—	6.68	6.16	6.45	6.90	7.42	7.45	7.31	7.51	7.78	7.78
Chinese	6.67	5.29	5.21	4.98	4.69	5.29	5.34	5.19	5.10	5.33	5.52	—
Japanese	9.03	7.47	6.60	6.21	6.16	7.26	7.50	7.95	7.14	7.28	7.57	—
Filipino	10.02	8.08	7.40	6.95	7.30	7.83	8.23	8.30	8.46	8.66	8.61	—
Hawaiian	—	—	7.23	6.49	7.24	6.84	7.15	7.69	6.76	7.91	8.14	—
Other Asian or Pacific Islander	—	—	6.83	6.19	6.65	7.05	7.76	7.76	7.67	7.76	8.16	—
Hispanic or Latinoc	—	—	6.12	6.16	6.06	6.29	6.44	6.38	6.41	6.47	6.55	6.69
Mexican	—	—	5.62	5.77	5.55	5.81	5.97	5.94	6.01	6.08	6.16	6.28
Puerto Rican	—	—	8.95	8.69	8.99	9.41	9.68	9.30	9.30	9.34	9.68	10.01
Cuban	—	—	5.62	6.02	5.67	6.50	6.50	6.80	6.49	6.49	6.50	7.04
Central and South American	—	—	5.76	5.68	5.84	6.20	6.47	6.38	6.34	6.49	6.53	6.70
Other and unknown Hispanic or Latino	—	—	6.96	6.83	6.87	7.55	7.59	7.63	7.84	7.96	7.87	8.01
Not Hispanic or Latino:c
White	—	—	5.69	5.61	5.61	6.20	6.55	6.64	6.60	6.76	6.91	7.04
Black or African American	—	—	12.71	12.62	13.32	13.21	13.17	13.23	13.13	13.07	13.39	13.55
Cigarette smokerd	—	—	—	—	11.25	12.18	12.01	12.06	11.88	11.90	12.15	12.40
Nonsmokerd	—	—	—	—	6.14	6.79	7.18	7.21	7.19	7.32	7.48	7.66
Very low birthweight (less than 1,500 grams)
All races	1.17	1.16	1.15	1.21	1.27	1.35	1.45	1.45	1.43	1.44	1.46	1.45
White	0.95	0.92	0.90	0.94	0.95	1.06	1.15	1.15	1.14	1.16	1.17	1.17
Black or African American	2.40	2.40	2.48	2.71	2.92	2.97	3.08	3.14	3.07	3.04	3.13	3.07
American Indian or Alaska Native	0.98	0.95	0.92	1.01	1.01	1.10	1.24	1.26	1.16	1.26	1.28	1.30
Asian or Pacific Islanderb	—	—	0.92	0.85	0.87	0.91	1.10	1.08	1.05	1.03	1.12	1.09
Chinese	0.80	0.52	0.66	0.57	0.51	0.67	0.75	0.68	0.77	0.69	0.74	—
Japanese	1.48	0.89	0.94	0.84	0.73	0.87	0.84	0.86	0.75	0.71	0.97	—
Filipino	1.08	0.93	0.99	0.86	1.05	1.13	1.35	1.41	1.38	1.23	1.31	—
Hawaiian	—	—	1.05	1.03	0.97	0.94	1.53	1.41	1.39	1.50	1.55	—
Other Asian or Pacific Islander	—	—	0.96	0.91	0.92	0.91	1.12	1.09	1.04	1.06	1.17	—
Hispanic or Latinoc	—	—	0.98	1.01	1.03	1.11	1.15	1.14	1.14	1.14	1.17	1.16
Mexican	—	—	0.92	0.97	0.92	1.01	1.02	1.04	1.03	1.05	1.06	1.06
Puerto Rican	—	—	1.29	1.30	1.62	1.79	1.86	1.86	1.93	1.85	1.96	2.01
Cuban	—	—	1.02	1.18	1.20	1.19	1.33	1.49	1.21	1.27	1.15	1.37
Central and South American	—	—	0.99	1.01	1.05	1.13	1.23	1.15	1.20	1.19	1.20	1.17
Other and unknown Hispanic or Latino	—	—	1.01	0.96	1.09	1.28	1.38	1.32	1.42	1.27	1.44	1.28
Not Hispanic or Latino:c
White	—	—	0.87	0.91	0.93	1.04	1.15	1.15	1.14	1.17	1.17	1.18
Black or African American	—	—	12.71	12.62	2.93	2.98	3.11	3.18	3.10	3.08	3.15	3.12
Cigarette smokerd	—	—	—	—	1.73	1.85	1.87	1.91	1.91	1.88	1.88	1.92
Nonsmokerd	—	—	—	—	1.18	1.31	1.44	1.43	1.40	1.42	1.45	1.44

TABLE 6.8 Number of infant deaths and infant mortality rates, by age at death and by race and Hispanic origin of mother, 2001–02 "Table A. Number of Infant Deaths and Infant Mortality Rates, by Age at Death and by Race and Hispanic Origin of Mother: United States, 2001–02 Linked Files," in "Explaining the 2001–02 Infant Mortality Increase: Data from the Linked Birth/Infant Death Data Set," National Vital Statistics Reports, vol. 53, no. 12, January 24, 2005, http://www.cdc.gov/nchs/data/nvsr/nvsr53/nvsr53_12.pdf (accessed January 25, 2006)

TABLE 6.8
Number of infant deaths and infant mortality rates, by age at death and by race and Hispanic origin of mother, 2001–02
	Infant deaths		Neonatal* deaths						Postneonatal deaths
Total			Early		Late
2002		2001		2002		2001		2002		2001		2002		2001
*Neonatal is less than 28 days of age, early neonatal is less than 7 days, late neonatal is 7-27 days, and postneonatal is 28 days through 11 months.
SOURCE: "Table A. Number of Infant Deaths and Infant Mortality Rates, by Age at Death and by Race and Hispanic Origin of Mother: United States, 2001–02 Linked Files," in "Explaining the 2001–02 Infant Mortality Increase: Data from the Linked Birth/Infant Death Data Set," National Vital Statistics Reports, vol. 53, no. 12, January 24, 2005, http://www.cdc.gov/nchs/data/nvsr/nvsr53/nvsr53_12.pdf (accessed January 25, 2006)
	Rate per 1,000 live births
Total	7.0	6.8	4.7	4.5	3.7	3.6	0.9	0.9	2.3	2.3
White	5.8	5.7	3.9	3.8	3.1	3.0	0.8	0.8	1.9	1.9
Black	13.8	13.3	9.3	8.9	7.6	7.3	1.7	1.6	4.5	4.4
American Indian	8.6	9.7	4.6	4.2	3.2	3.1	1.4	1.1	4.0	5.4
Asian or Pacific Islander	4.8	4.7	3.4	3.1	2.7	2.5	0.7	0.6	1.4	1.6
Hispanic	5.6	5.4	3.8	3.6	3.0	2.9	0.8	0.8	1.8	1.8
Non-Hispanic white	5.8	5.7	3.9	3.8	3.0	3.0	0.8	0.8	1.9	1.9
Non-Hispanic black	13.9	13.5	9.3	9.0	7.6	7.4	1.8	1.6	4.6	4.5
	Number
Total	27,970	27,523	18,791	18,275	15,020	14,622	3,771	3,653	9,179	9,248
White	18,395	18,087	12,352	12,078	9,804	9,571	2,548	2,506	6,044	6,009
Black	8,201	8,084	5,533	5,396	4,506	4,425	1,027	971	2,668	2,688
American Indian	366	404	195	176	137	129	58	47	171	228
Asian or Pacific Islander	1,006	947	710	624	573	496	138	128	296	323
Hispanic	4,927	4,630	3,360	3,105	2,673	2,439	687	666	1,567	1,526
Non-Hispanic white	13,327	13,300	8,853	8,817	7,002	6,979	1,851	1,839	4,474	4,483
Non-Hispanic black	8,031	7,938	5,399	5,293	4,386	4,337	1,014	956	2,632	2,645

The researchers surveyed 1,079 elderly men and women and found that African-Americans who lacked the APOE-ε4 gene were four times more likely than whites to get Alzheimer's disease. Since the APOE-ε4 could not account for the increased cases in African-Americans and Hispanics, researchers now believe that there are other genetic or environmental factors affecting minorities that increase their risk of developing Alzheimer's disease. None of the subjects of the study had the disease when the study began, but 221 developed it by the time the study ended.

The Alzheimer's Association emphasizes in African-Americans and Alzheimer's Disease: The Silent Epidemic (2003, http://www.alz.org/Media/newsreleases/2003/AA_ALZ.pdf) that the prevalence of Alzheimer's disease among African-Americans is estimated to be 14% to 100% higher than among whites. Since the turn of the twenty-first century, discoveries of risk factors for Alzheimer's disease—hypertension and high cholesterol—have begun to provide some explanation for this increased risk, as these risk factors are disproportionately present in the African-American community. The report stresses the importance of getting effective medical therapies for vascular disease and its risk factors, as these drugs could potentially protect against Alzheimer's disease as well.

Diabetes

Diabetes is a chronic disease in which the body does not produce or use insulin properly, leading to cells being starved for sugar and often resulting in damage to the heart, kidneys, and eyes. Diabetes is the fifth-deadliest disease in the United States; in fact, the death rate due to diabetes is on the rise at the same time that the death rates due to other diseases like cancer and heart disease have declined. In "Age-Adjusted Prevalence of Diagnosed Diabetes per 100 Population, by Race/Ethnicity and Sex, United States, 1980–2004" (October 6, 2005, http://www.cdc.gov/diabetes/statistics/prev/national/tableraceethsex.htm), the CDC reports that in 2004, 7.6% of African-American males and 7.8% of African-American females had been diagnosed with diabetes, 7% of Hispanic males and 6.8% of Hispanic females had diabetes, while only 5.1% of non-Hispanic white males and 4.3% of white females had diabetes.

Diabetes is a dangerous disease because it can cause many different complications, including heart disease, kidney failure, and loss of circulation in the extremities. The lack of circulation in the lower limbs can lead to infection of small wounds and gangrene, which eventually requires leg amputation. Diabetes requires effective management of hemoglobin A1c and lipids, as well as regular examination of eyes and feet and yearly influenza immunizations. However, the rates of receiving all five diabetic management services vary by race and ethnic group. Non-Hispanic whites were much more likely than either African-Americans or Hispanics to receive the recommended services. (See Figure 6.8.)

TABLE 6.9 Cancer incidence rates and trends for the top 15 cancer sites, by race/ethnicity, 1992–2002 "Table I-19. Age-Adjusted Rates and Trends for the Top 15 Cancer Sites by Race/Ethnicity: SEER Cancer Incidence, 1992–2002," in SEER Cancer Statistics Review, 1975–2002, National Cancer Institute, 2005, http://seer.cancer.gov/csr/1975_2002/results_merged/topic_race_ethnicity.pdf (accessed January 25, 2006)

TABLE 6.9
Cancer incidence rates and trends for the top 15 cancer sites, by race/ethnicity, 1992–2002
Both sexes
Note: "—" = statistic not shown. Rate based on less than 25 cases for the time interval. Trend based on less than 10 cases for at least one year within the time interval.
aThe APC is the annual percent change over the time interval.
bIncidence data are from the 13 SEER (Surveillance, Epidemiology, and End Results) areas (San Francisco, Connecticut, Detroit, Hawaii, Iowa, New Mexico, Seattle, Utah, Atlanta, San Jose-Monterey, Los Angeles, Alaska Native Registry and rural Georgia).
cHispanic is not mutually exclusive from whites, blacks, Asian Pacific Islanders, and American Indians/Alaska Natives. Incidence data for Hispanics does not include cases from Detroit, Hawaii, Alaska Native Registry and rural Georgia.
dThe APC is significantly different from zero.
eIBD = Intrahepatic bile duct. NOS = Not otherwise specified.
SOURCE: "Table I-19. Age-Adjusted Rates and Trends for the Top 15 Cancer Sites by Race/Ethnicity: SEER Cancer Incidence, 1992–2002," in SEER Cancer Statistics Review, 1975–2002, National Cancer Institute, 2005, http://seer.cancer.gov/csr/1975_2002/results_merged/topic_race_ethnicity.pdf (accessed January 25, 2006)
All races			White			Black
	Rate	APCa		Rate	APCa		Rate	APCa
All sites	475.4	−0.6d	All sites	483.5	−0.4d	All sites	526.7	−1.0d
Prostate	180.1	−2.0d	Prostate	175.5	−2.1d	Prostate	283.8	−1.9d
Breast (females)	132.4	0.4	Breast (females)	138.3	0.5	Breast (females)	120.2	−0.2
Lung and bronchus	63.2	−1.3d	Lung and bronchus	63.7	−1.1d	Lung and bronchus	81.6	−1.4d
Colon and rectum	53.9	−0.8d	Colon and rectum	53.6