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Studies examine black-white differences in low birthweight, uterine surgery outcomes, and organ donations

The gap in the incidence of low-birthweight (LBW) babies (less than 5.5 pounds) between black and white women in the United States has widened over the past two decades. A new study supported by the Agency for Healthcare Research and Quality (HS10061) found that smoking and being uninsured are bigger risk factors for LBW babies among black women than white women. A second AHRQ-supported study (contract 290-97-0014) found that black women are more likely than white women to have in-hospital complications or need blood transfusions when undergoing myomectomy (surgical removal of fibroids). A third AHRQ-supported study (HS08209) found that black families have less favorable attitudes than white families toward organ donation. The three studies are briefly described here.

Jaffee, K.D., and Perloff, J.D. (2003, February). "An ecological analysis of racial differences in low birthweight: Implications for maternal and child health social work." Health & Social Work 28(1), pp. 9-22.

Black women are more likely than white women to live in high-poverty, drug-infested neighborhoods with few health care resources. To sort out the impact of neighborhood and access factors from individual risk factors on LBW, these researchers examined the association of neighborhood economic indicators, neighborhood quality, access to prenatal care, and individual perinatal risk factors and subsequent birthweight among 78,415 black and 60,346 white residents of New York City (NYC). They used data from NYC birth records, the 1990 U.S. Census, and a NYC community health database.

Overall, black women were twice as likely as white women to have an LBW baby. When only neighborhood factors were included in the analysis, LBW among babies of black and white women was strongly associated with living in a neighborhood that was low income, had a high proportion of black or Hispanic residents, and had a high rate of hospitalizations for substance abuse. However, when individual risk factors were included in the analysis, most of the neighborhood effect was eliminated, and odds of black women having an LBW baby shrunk from 2.9 to 2.1 times higher than white women.

Black women were at 58 percent higher risk of having LBW babies when they were uninsured, but white women were not. Being uninsured may be a function of neighborhood-level mechanisms that restrict access to health care in black communities but not in white communities. Also, black women who smoked were at greater risk of having an LBW infant than white women who smoked (OR 2.40 and 1.61, respectively). Previous studies suggest that black women are less likely to quit smoking and more likely to smoke higher nicotine cigarette brands.

Roth, T.M., Gustilo-Ashby, T., Barber, M.D., and Myers, E.R. (2003, May). "Effects of race and clinical factors on short-term outcomes of abdominal myomectomy." Obstetrics & Gynecology 101, pp. 881-884.

Black women undergoing surgery to remove uterine fibroids (leiomyomata or benign tumors) are more than twice as likely to have in-hospital complications or blood transfusion as white women, according to this study. These greater problems among black women compared with white women are largely attributable to differences in uterine size and number of fibroids. Black women undergoing hysterectomy have more fibroids and larger uterine size compared with white women who have a hysterectomy. The researchers examined medical charts of 225 women (53 percent black and 47 percent white) who underwent abdominal myomectomies at one university medical center from 1992 to 1998. They examined patient characteristics, surgical indications, preoperative hematocrit, operative findings, and complications, including transfusion.

Black women were more likely to have uteri with more than four fibroids and less likely to have only one fibroid. Black women were also 2.48 times more likely to have a complication and 2.28 times more likely to require a transfusion than white women. However, race was no longer a significant predictor of complications after adjustment for uterine size, number of fibroids, and coexisting illnesses. A uterine size more than 500 g and more than four uterine fibroids each nearly doubled the likelihood of complications. Coexisting illnesses nearly tripled the risk. A similar pattern was seen for blood transfusion.

Siminoff, L.A., Lawrence, R.H., and Arnold, R.M. (2003). "Comparison of black and white families' experiences and perceptions regarding organ donation requests." Critical Care Medicine 31(1), pp. 146-151.

Black families are less likely than white families to agree to organ donation and experience different interactions with the health care team related to donation. The researchers reviewed the medical charts of 415 organ donor-eligible deceased patients (61 black and 354 white) and conducted interviews with family members of the decedents and with health care providers and organ procurement organization staff about encounters with these families.

Black families had less knowledge than white families about their family member's wishes and expressed less-favorable attitudes toward organ donation and the health care system. They were less likely to believe that they would be treated fairly or that the system is equitable. Black families were less likely to be correctly perceived as receptive to organ donation at initial request. Black families were also less likely to have spoken to an organ procurement organization representative and were given fewer opportunities to consider the decision with members of the health care team.

The researchers suggest that openness about organ donation should be encouraged in the black community, and health care providers and organ procurement organizations should change their attitudes and practices toward black families as potential donor families.

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