We assessed the relation of experiences of racism to the incidence of obesity and the modifying impact of residential racial segregation in the Black Women's Health Study, a follow-up study of US ...black women. Racism scores were created from 8 questions asked in 1997 and 2009 about the frequency of "everyday" racism (e.g., "people act as if you are dishonest") and of "lifetime" racism (e.g., unfair treatment on the job). Residential segregation was measured by linking participant addresses to 2000 and 2010 US Census block group data on the percent of black residents. We used Cox proportional hazard models to estimate incidence rate ratios and 95% confidence intervals. Based on 4,315 incident cases of obesity identified from 1997 through 2009, both everyday racism and lifetime racism were positively associated with increased incidence. The incidence rate ratios for women who were in the highest category of everyday racism or lifetime racism in both 1997 and 2009, relative to those in the lowest category, were 1.69 (95% confidence interval: 1.45, 1.96; Ptrend < 0.01) and 1.38 (95% confidence interval: 1.15, 1.66; Ptrend < 0.01), respectively. These associations were not modified by residential segregation. These results suggest that racism contributes to the higher incidence of obesity among African American women.
Incidence of pancreatic cancer is higher in African Americans than in U.S. whites. We hypothesized that poor oral health, disproportionately common in African Americans and associated with increased ...risk of pancreatic cancer in several studies of predominantly white populations, may play a role in this disparity.
We examined the relation of self-reported measures of oral health (periodontal disease and adult tooth loss) in relation to pancreatic cancer incidence in the prospective Black Women's Health Study (BWHS). Cox proportional hazard analyses were used to calculate HRs of pancreatic cancer for women with periodontal disease, tooth loss, or both, relative to women who reported neither. Multivariable models adjusted for age, cigarette smoking, body mass index (BMI), type 2 diabetes, and alcohol consumption.
Participants aged 33 to 81 were followed for an average of 9.85 years from 2007 through 2016, with occurrence of 78 incidence cases of pancreatic cancer. Multivariable HRs for pancreatic cancer incidence were 1.77 95% confidence interval (CI) 0.57-5.49 for periodontal disease with no tooth loss, 2.05 (95% CI, 1.08-3.88) for tooth loss without report of periodontal disease, and 1.58 (95% CI, 0.70-3.57) for both tooth loss and periodontal disease. The HR for loss of at least five teeth, regardless of whether periodontal disease was reported, was 2.20 (95% CI, 1.11-4.33).
The poor oral health experienced by many African Americans may contribute to their higher incidence of pancreatic cancer.
Future research will assess associations between the oral microbiome and pancreatic cancer risk in this population.
Objective
Exposure to psychosocial stressors may contribute to the onset of systemic lupus erythematosus (SLE) through dysregulation of the adaptive stress response. The present study was undertaken ...to assess the relationship of childhood physical and sexual abuse to risk of SLE among Black women.
Methods
Using data from the Black Women’s Health Study, we followed 36,152 women from 1995 through 2015 with biennial questionnaires. Women reported on exposure to abuse during childhood (up to age 11) in 2005. Self‐reported cases of incident SLE were confirmed as meeting the American College of Rheumatology SLE classification criteria by medical record review. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for SLE among women exposed to physical or sexual abuse during childhood, controlling for potential confounders.
Results
We confirmed 101 cases of incident SLE and identified patients who had completed questions on child abuse during 670,822 person‐years of follow‐up. Both physical and sexual abuse during childhood were associated with statistically significant increases in SLE incidence. The HR for SLE associated with ≥2 episodes of severe sexual abuse compared to no abuse was 2.51 (95% CI 1.29–4.85) after adjustment for alcohol consumption, smoking, body mass index, oral contraceptive use, age at menarche, and parental education. The multivariable‐adjusted HR for SLE with ≥5 episodes of severe physical abuse was 2.37 (95% CI 1.13–4.99).
Conclusion
Our results suggest that sexual and physical abuse during childhood increase SLE risk during adulthood among Black women. Research is necessary both to confirm this finding and to understand potential mediating mechanisms.
Objective
Systemic lupus erythematosus (SLE) affects black women more frequently than other racial/gender groups. In past studies, largely consisting of white and Asian cohorts, cigarette smoking was ...associated with increased SLE risk, and moderate alcohol consumption was associated with decreased SLE risk. The aim of this study was to assess associations of smoking and alcohol consumption with the risk of incident SLE among black women, using data from a long‐term, prospective, follow‐up study.
Methods
The Black Women's Health Study enrolled 59,000 black women in 1995 and collected data on demographics, health status, and medical and lifestyle variables. Follow‐up questionnaires that were given every 2 years identified incident disease and updated risk factors. Cases of incident SLE that met the American College of Rheumatology revised criteria for SLE as updated in 1997 were confirmed through medical record review. Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CI) for associations of cigarette smoking and alcohol intake with incidence of SLE.
Results
A total of 127 incident SLE cases from 1995 to 2015 (mean age 43 years at diagnosis) were confirmed. Compared to never smokers, the risk of SLE among ever smokers was elevated, but not significantly (HR 1.45 95% CI 0.97–2.18). Risk was similar for current and past smoking and increased nonsignificantly with increasing pack‐years. The HR was 0.71 (95% CI 0.45–1.12) for current drinking relative to never drinking, with a HR of 0.43 (95% CI 0.19–0.96) for ≥4 drinks/week.
Conclusion
Findings from this large study of SLE risk among black women are consistent with previous results from studies in other populations of increased risk of SLE associated with cigarette smoking and decreased risk with moderate alcohol consumption.
Several epidemiological studies show a co-occurrence of sarcoidosis with other immune-mediated diseases (IMD). There are many similarities between sarcoidosis and IMDs in their geographical ...distribution and risk factors. Understanding these similarities and identifying the differences can help us to better understand sarcoidosis and put it into context with other IMDs. In this review, we present the current knowledge about the overlap between sarcoidosis and other IMDs derived from epidemiological studies. Epidemiologic methods utilize study design and statistical analysis to describe the patterns in data and, ideally, identify causal relationships between an exposure and a health outcome. We discuss how study design and analysis may affect the interpretation of epidemiological studies on this topic and highlight some theories that attempt to explain the relation between sarcoidosis and other IMDs.
•Sarcoidosis patients are more likely to have a history of immune-mediated diseases (IMD) and have an increased risk of IMD after sarcoidosis diagnosis.•The similar rates in males and females and younger age of onset in males is unique in sarcoidosis compared to other IMDs.•Sarcoidosis risk is increased in first degree relatives of patients with IMD, indicating some genetic overlap.•Studies on the overlap between sarcoidosis and IMD are limited by several biases which affect interpretations of their results.
Abstract
Background and Aims
Inflammatory bowel disease (IBD), including ulcerative colitis and Crohn’s disease, are inflammatory diseases of the gastrointestinal tract. The incidence of IBD is ...increasing in minority populations; however, little is known about the epidemiology and disease characteristics of IBD in Black women.
Methods
Our study population included participants in the Black Women’s Health Study. Diagnosis of IBD was self-reported through the biennial questionnaires starting at baseline in 1995. We estimated the incidence of IBD according to age and geographic region. A follow-up supplementary questionnaire was also sent to a subset of participants who reported diagnosis of IBD to evaluate the accuracy of self-reported diagnosis and to assess disease characteristics.
Results
Through December 31, 2021, a total of 609 cases of IBD were reported, of which 142 were prevalent at baseline (prevalence, 0.24%), and 467 were incident (crude incidence rate, 33.2/100 000 person-years). The incidence of IBD was highest in the younger than 30 years age group and similar across geographic region. Among the participants who responded to the supplementary questionnaire, 57.1% had confirmed diagnosis of IBD.
Conclusions
In a large prospective cohort of US Black women, we found that the incidence of IBD was similar to previously published estimates in US White women. Future studies should focus on identifying risk factors for IBD in Black individuals in the United States.
The authors examined the relation between individual and neighborhood socioeconomic status (SES) and type 2 diabetes incidence among African-American women in the prospective Black Women's Health ...Study. Participants have completed mailed biennial follow-up questionnaires since 1995. US Census block group characteristics were used to measure neighborhood SES. Incidence rate ratios were estimated in clustered survival regression models. During 12 years of follow-up of 46,382 participants aged 30–69 years, 3,833 new cases of type 2 diabetes occurred. In models that included both individual and neighborhood SES factors, incidence rate ratios were 1.28 (95% confidence interval: 1.15, 1.43) for ≤12 years of education relative to ≥17 years, 1.57 (95% confidence interval: 1.30, 1.90) for household income <$15,000 relative to >$100,000, and 1.65 (95% confidence interval: 1.46, 1.85) for lowest quintile of neighborhood SES relative to highest. The associations were attenuated after adjustment for body mass index, suggesting it is the key intermediate factor in the pathway between SES and diabetes. The association of neighborhood SES with diabetes incidence was present even among women who were more educated and had a higher family income. Efforts to reduce the alarming rate of diabetes in African-American women must focus on both individual lifestyle changes and structural changes in disadvantaged neighborhoods.
Background: There is a paucity of data on the validity of self‐report of periodontal disease in African Americans. The Black Women’s Health Study (BWHS), a United States national cohort study of ...59,000 black women followed via mailed questionnaires since 1995, offered the opportunity to clinically validate self‐reported periodontitis among a sample of participants.
Methods: Oral health questionnaires were sent to study participants residing in Massachusetts. Respondents living in the Boston metro area were invited for clinical examination. Self‐reports were compared with clinical data obtained from the 77 women (mean age: 59 years) who were examined. The authors examined the predictive ability of individual and combined questionnaire items with respect to clinical periodontal disease severity. Validation parameters were calculated for each question, and receiver operating characteristic statistics were generated to compare questionnaire items.
Results: Periodontitis prevalence in the validation sample was 24% for severe periodontitis and 61% for moderate disease. Performance of individual questionnaire items with respect to predicting periodontitis was better for severe compared with moderate disease. Combinations of questionnaire items improved the predictive ability with respect to severe disease beyond that of individual questionnaire items.
Conclusions: Prevalence of severe periodontitis was similar to other age‐comparable populations, without regard for race or sex, whereas prevalence of total periodontitis (moderate and severe) among women of similar age and/or race was much higher. Predictive ability of questionnaire items assessed in the BWHS was similar to that in other studies.
Systemic lupus erythematosus (SLE) affects African-American (AA) women disproportionately. The few prospective studies assessing dietary intake in relation to risk of SLE have been conducted in ...predominantly white populations and have been null.
The present study assessed associations of macronutrients and dietary patterns with risk of SLE in AA women.
Data from the Black Women’s Health Study was collected prospectively via biennial questionnaires starting in 1995. Participants completed a self-administered 68-item FFQ in 1995. Self-reported SLE was verified through medical record review. We used multivariable (MV) Cox regression models to estimate HRs and 95% CIs for macronutrients, carbohydrates, proteins, total fats, PUFAs, ω-3 fatty acids, ω-6 fatty acids, MUFAs, saturated fats, trans fatty acids, Alternative Healthy Eating Index score, vegetable/fruit and meat/fried food dietary patterns, and a reduced rank regression (RRR)-derived dietary pattern in relation to SLE risk.
We confirmed a total of 114 incident cases of SLE among 51,934 women during 1995–2015. MVHRs and 95% CIs for the highest quintile of intake versus the lowest were HR: 1.96, 95% CI: 1.02, 3.67 for carbohydrates; HR: 0.66, 95% CI: 0.37, 1.18 for protein; and HR: 0.54, 95% CI: 0.28, 1.01 for total fats. MUFAs, saturated fatty acids, and trans fatty acids were significantly associated with a lower risk of SLE. An RRR-derived factor, rich in fruits and sugar-sweetened drinks and low in margarines and butter, red and processed meats, fried chicken, poultry, and eggs, which explained 53.4% of the total variation of macronutrients, was the only food pattern associated with increased SLE risk (HR: 1.88, 95% CI: 1.06, 3.35).
These analyses suggest that a diet high in carbohydrates and low in fats is associated with increased SLE risk in AA women.
Hair relaxers and leave-in conditioners and oils, commonly used by Black/African American women, may contain estrogens or estrogen-disrupting compounds. Thus, their use may contribute to breast ...cancer risk. Results of the few previous studies on this topic are inconsistent. We assessed the relation of hair relaxer and leave-in conditioner use to breast cancer incidence in the Black Women's Health Study, a nationwide prospective study of Black women. Among 50 543 women followed from 1997 to 2017, 2311 incident breast cancers occurred. Multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards regression for breast cancer overall and by estrogen receptor (ER) status. For heavy use (≥15 years of use for ≥7 times/year) of hair relaxers relative to never/light use (<4 years, no more than 1-2 times/year), the multivariable HR for breast cancer overall was 1.13 (95%CI: 0.96-1.33). Duration, frequency, age at first use and number of scalp burns were not associated with overall breast cancer risk. For heavy use of hair relaxers containing lye, the corresponding HR for ER+ breast cancer was 1.32 (95% CI: 0.97, 1.80); there was no association for non-lye products. There was no association of conditioner use and breast cancer. Results of this study were largely null, but there was some evidence that heavy use of lye-containing hair relaxers may be associated with increased risk of ER+ breast cancer. Consistent results from several studies are needed before it can be concluded that use of certain hair relaxers impacts breast cancer development.
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