Addressing Health Disparities
Research Directions Outlined at NIAMS Conference
By Connie Raab
Arthritis and musculoskeletal and skin conditions are among the
most frequent chronic health problems in the United States, but not
all population groups are equally affected. There are marked
differences in the prevalence, morbidity and disability associated
with specific diseases in African American, Hispanic, Native
American and Caucasian populations.
Recognizing these disparities, NIAMS recently convened experts in
many disciplines from around the country for a health disparities
conference. The goals were threefold: to highlight current knowledge
about genetic, environmental, social and behavioral factors that play
a role in health disparities; to identify intervention strategies that
could provide models to reduce disparities; and to define challenges
and emerging opportunities for research.
Attendees at the NIAMS conference included (from l) Dr. David
Satcher, assistant secretary for health and surgeon general; Reva
Lawrence, conference organizer; Dr. Ruth Kirschstein, NIH acting
director; and Dr. Stephen Katz, NIAMS director.
In his opening remarks, Dr. David Satcher, assistant secretary for
health and surgeon general, commented that he had not been to a
conference that dealt so well with both major goals of Healthy
People 2010 (DHHS' national health blueprint): to increase quality
and years of life and to eliminate health disparities. He said that
NIAMS topics were some of the best examples of challenges to
one's quality of life, in that millions suffer from arthritis, back pain,
osteoporosis, skin diseases and other disorders within the institute's
Dr. Susan Taylor, director of the Skin of Color Center at St.
Luke's-Roosevelt Hospital Center in New York City, speaks about
the differences in skin and hair structure between ethnic groups.
Conference speakers raised a number of issues, including the
Examples of interventions in Hispanic and African American
communities that have yielded positive results in arthritis care also
- Race and ethnicity are not defined consistently and are
sometimes used interchangeably, when they are two different
constructs. Given the strong association between some "racial"
groups and socioeconomic status (SES), the contribution of
race and SES to disease outcome is difficult to sort out.
However, the use of SES as a variable may be justified in
research if we are to eliminate health disparities and improve
the overall health of the population.
- There is a need for basic descriptive data on the structure and
function of hair and skin in people of color, along with studies
of the epidemiology, clinical presentation, natural history,
complications and other aspects of common skin diseases.
Valid measurement tools for diseases in skin of all hues are
needed as well.
- Studies have found that osteoarthritis (OA) of the hip and knee
occurs more often in African American men than in Caucasian
men. Systemic lupus erythematosus (SLE), another
autoimmune disease, occurs more often and more severely in
African Americans and Hispanics than in Caucasians. Keloids
(an overgrowth of scar tissue after a skin injury) and vitiligo
(formation of white patches on the skin) occur more often in
- Some populations experience disparities in treatments received;
the reasons for this should be studied. For example, although
acne vulgaris is a common skin condition in African Americans
and isotretinoin is considered an effective therapy, the drug is
prescribed less often for African American acne patients than
for others. African Americans are less likely than Caucasians
to undergo total joint replacement surgery, and they also
receive less intense diagnostic and treatment courses for low
back pain when compared with Caucasians.
- Researchers are studying gene expression and biomarkers in
scleroderma, SLE and OA. They are also studying modifiable
behaviors and environmental exposures to determine their links
to disease. It was suggested that researchers collect data of a
broad nature from behavioral, psychosocial, clinical and
Dr. Graciela Alarcón discusses race and ethnicity.
Some broad questions posed by the conference included: What
research initiatives would have the widest impact across the range of
diseases and conditions where disparities exist? Where should the
research focus be: Genetic pathways? Behavioral interventions?
Gene/environment interactions? What are barriers to getting this
Conference cosponsors included several components of NIH: the
National Center on Minority Health and Health Disparities, the
Office of Research on Women's Health, the Office of Disease
Prevention and the Office of Behavioral and Social Sciences
Research. Other cosponsors were the Centers for Disease Control
and Prevention, Arthritis Foundation, American College of
Rheumatology, American Academy of Orthopaedic Surgeons and
American Academy of Dermatology.
Jose Cordero, an NIH Academy trainee from the University of
Tampa, Florida, who is now with NIAMS, questions a speaker.
Tarice Barnes asks a question at NIAMS's health disparities
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