What are the medical differences between black and non-black populations?

Medical Differences Between Black and Non-Black Populations

Black individuals experience significant health disparities compared to non-Black populations, with both biological and social determinants contributing to differences in disease presentation, progression, and outcomes that affect morbidity, mortality, and quality of life.

Disease-Specific Differences

Multiple Myeloma

• Black individuals develop multiple myeloma at a younger age (4-5 years earlier than White patients) with 35.3% diagnosed under age 60 compared to 16.5% of White patients 1
• Black patients with multiple myeloma present with more adverse disease characteristics including:
  • Higher rates of renal dysfunction and anemia at diagnosis 1
  • Lower hemoglobin levels (≤10 g/dL) and higher mean LDH 1
  • Higher incidence of solitary plasmacytomas and extramedullary plasmacytomas 1
  • Higher rates of all myeloma-defining events except bone fractures (which are more common in White patients) 1

Cardiovascular Disease

• Black patients have the highest mortality from coronary heart disease of any racial/ethnic group 1
• Black individuals have higher prevalence of cardiovascular risk factors including diabetes, hypertension, and hyperlipidemia than White peers 1
• Black patients develop heart failure symptoms at an earlier average age than non-Black patients 1
• Heart failure progresses more rapidly in Black patients, with higher risk of initial and recurrent hospitalizations 1
• Black patients are less likely to receive care that adheres to clinical guidelines, including treatment intensification and invasive cardiac procedures 1

Diabetes and Complications

• Black individuals with diabetes have a 56% higher risk of developing end-stage renal disease (ESRD) compared to White patients, even after adjusting for confounders 1
• Several biological mechanisms may explain increased kidney disease risk in Black patients:
  • APOL1 gene variants (G1 and G2) that are more common in those of African descent increase risk for glomerular disease 1
  • Higher rates of preterm birth in Black populations may contribute to reduced nephron mass and increased vulnerability to blood pressure-related factors 1

Pulmonary Disease

• Black patients with Chronic Obstructive Pulmonary Disease (COPD) are twice as likely to require emergency department visits and hospitalizations compared to White patients 1
• Black individuals bear a higher burden of disease and death due to COPD and asthma 1
• COPD mortality in Black women is increasing 1
• Black patients have lower rates of pulmonary rehabilitation utilization (median 1.19%) compared to White patients (median 2.08%) 1

Musculoskeletal Conditions

• Black patients have worse outcomes after hip fractures, including:
  • 49% higher risk for delayed surgery 1
  • 13% higher risk for 1-year mortality 1
  • 21% higher risk for reoperation 1
  • 17% higher risk for readmission 1
• Black patients receive less rehabilitation after hip fractures:
  • 32% of Black vs. 43% of White patients receive inpatient rehabilitation 1
  • 16% of Black vs. 23% of White patients receive outpatient or home therapy 1
• Black patients have worse pain scores post-operatively, especially at 6 months after lower extremity fractures 1

Access to Care and Treatment Disparities

• Black patients experience delays in diagnosis and treatment for multiple conditions 1
  • For multiple myeloma, the average time between diagnosis and treatment with novel therapy is 5.2 months for Black patients compared to 2.7 months for White patients 1
• Black patients are less likely to receive guideline-concordant care across multiple conditions 1
• Black individuals have lower access to rehabilitation services, fewer referrals, and lower utilization rates 1
• Black patients are less likely to be admitted to cardiac care units and wait longer to be admitted to ICUs 1
• Black patients are more likely to be admitted to hospitals with longer ICU lengths of stay and higher mortality rates 1

Pharmacological Considerations

• Some evidence suggests Black patients may experience different responses to certain medications:
  • Black patients with heart failure may experience less efficacy from ACE inhibitors compared to non-Black patients 1
  • Different beta-blockers may have varying effects in Black patients (bucindolol showed a nonsignificant increase in risk of serious clinical events in Black patients while reducing deaths and hospitalizations in non-Black patients) 1
  • Race-based pharmacokinetic differences are being studied but require more research 2

Social Determinants of Health Impact

• Systemic racism has been a significant driver of health disparities 1
• Socioeconomic factors contribute substantially to health disparities:
  • Lower median incomes, higher unemployment rates, and lower-paying jobs among Black individuals 1
  • Higher likelihood of living in areas with environmental pollution and psychosocial stressors 1
  • Financial distress associated with managing chronic diseases disproportionately affects socioeconomically disadvantaged populations 1
• The interaction between race and poverty shows a stronger negative impact on health outcomes for Black individuals 1
  • For example, the relationship between community poverty level and worse pain/function after knee arthroplasty is more pronounced among Black than White patients 1

Important Caveats

• Race is a social construct with limited biological significance 3
• Racial health disparities result primarily from variations in exposure or vulnerability to behavioral, psychosocial, material, and environmental risk factors 3
• While biological differences exist, they account for only a small fraction of health disparities between Black and White populations 1, 4, 5
• Racism operates through multiple pathways to affect health:
  • Restricting socioeconomic opportunities and mobility 5, 6
  • Creating stressful experiences of discrimination 5, 6
  • Promoting residence in disadvantaged neighborhoods 5, 6
  • Contributing to bias in medical care 5, 6
• Social inequalities become "embodied" in the biological well-being of racialized groups through complex pathways across the life course 7

Clinical Implications

• Healthcare providers should recognize both biological differences and social determinants when treating Black patients 1
• Awareness of disease presentation differences can help with earlier diagnosis and intervention 1
• Providers should be vigilant about ensuring equitable access to guideline-concordant care, including rehabilitation services 1
• Addressing systemic barriers to care is essential for improving outcomes in Black populations 1
• More research is needed on the specific biological, social, and environmental factors that contribute to health disparities 3, 6