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Objectives: To examine whether a care transitions program, Bridges, differentially reduced rehospitalizations among patients who underwent percutaneous coronary intervention (PCI) based on insurance status and zip code poverty level., Study Design: Retrospective observational cohort., Methods: We examined data from a single health system in Delaware, collected as part of a care transitions program for patients who underwent PCI from 2012 to 2015 compared with an unmatched historical control cohort from 2010 to 2011. Socioeconomic status was assessed by insurance status and zip code-level poverty data. Patients were divided into tertiles based on the proportion of their zip code of residence living under 100% of the federal poverty level. Rehospitalization rates were analyzed by negative binomial regression and included interaction terms to examine differential effects of Bridges by insurance and poverty level., Results: There were 4638 patients representing 5710 hospitalizations: 3212 in the historical control and 2498 in the Bridges cohort. Among patients with Medicaid who received the Bridges intervention, those living in the wealthiest zip codes were 15.5% less likely to be rehospitalized than patients with Medicare and 9.4% less likely than patients with commercial insurance (P = .04). However, patients with Medicaid who lived in the poorest zip codes and those with dual Medicare/Medicaid status had higher rates of rehospitalization post intervention., Conclusions: The Bridges intervention was associated with improved rehospitalization rates for Medicaid patients compared with those with Medicare or commercial insurance within Delaware's wealthier communities. Care transitions programs may differentially affect Medicaid patients based on the wealth of the communities in which they reside.

Background: Medicare beneficiaries hospitalized under observation status have significant cost-sharing responsibilities under Medicare Part B. Prior work has demonstrated an association between increased cost-sharing and health care rationing among low-income Medicare beneficiaries. The objective of this study was to explore the potential impact of observation cost-sharing on future medical decision making of Medicare beneficiaries., Methods: Single-center pilot cohort study. A convenience sample of Medicare beneficiaries hospitalized under observation status care was surveyed., Results: Out of 144 respondents, low-income beneficiaries were more likely to be concerned about the cost of their observation stay than higher-income respondents (70.7% vs29.3%, p = 0.015). If hospitalized under observation status again, there was a trend among low-income beneficiaries to request completion of their workup outside of the hospital (56.3% vs 43.8%), and to consider leaving against medical advice (AMA) (100% vs 0%), though these trends were not statistically significant (p = 0.30)., Conclusion: The results of this pilot study suggest that low-income Medicare beneficiaries hospitalized under observation status have greater concerns about their cost-sharing obligations than their higher income peers. Cost-sharing for observation care may have unintended consequences on utilization for low-income beneficiaries. Future studies should examine this potential relationship on a larger scale.

Objective: The higher risk of death among recently released inmates relative to the general population may be because of the higher prevalence of substance dependence among inmates or an independent effect of incarceration. We explored the effects of recent incarceration on health outcomes that may be intermediate markers for mortality., Methods: Longitudinal multivariable regression analyses were conducted on interview data (baseline, 3-, 6-, and 12-month follow-up) from alcohol- and/or drug-dependent individuals (n = 553) participating in a randomized clinical trial to test the effectiveness of chronic disease management for substance dependence in primary care. The main independent variable was recent incarceration (spending ≥1 night in jail or prison in the past 3 months). The 3 main outcomes of this study were any traumatic injury, substance use-related health consequences, and health care utilization--defined as hospitalization (excluding addiction treatment or detoxification) and/or emergency department visit., Results: Recent incarceration was not significantly associated with traumatic injury (adjusted odds ratio [AOR] = 0.98; 95% confidence interval [CI]: 0.65-1.49) or health care utilization (AOR = 0.88; 95% CI: 0.64-1.20). However, recent incarceration was associated with higher odds for substance use-related health consequences (AOR = 1.42; 95% CI: 1.02-1.98)., Conclusions: Among people with alcohol and/or drug dependence, recent incarceration was significantly associated with substance use-related health consequences but not injury or health care utilization after adjustment for covariates. These findings suggest that substance use-related health consequences may be part of the explanation for the increased risk of death faced by former inmates.

Objective: Access to rheumatology care can expedite diagnosis and treatment of rheumatic diseases and reduce disparities. We surveyed community health center (CHC) medical directors to evaluate rheumatology care in underserved areas and potential strategies for improvement., Methods: We identified 77 Massachusetts CHCs that provide adult medical services and sent a 40-item survey to their physician medical directors. Survey questions assessed the centers' prevalence of rheumatic diseases, prescribing practices of immunosuppressive medications, and possible interventions to improve care. We compared CHC characteristics and rheumatology-specific items and then stratified our data by the response to whether improved access to rheumatology care was needed. Qualitative data were analyzed thematically., Results: Thirty-six CHC physician medical directors returned surveys (47% response rate). Fifty-five percent indicated a need for better access to rheumatology care. Eighty-six percent of CHC physicians would not start a patient with rheumatoid arthritis on a disease-modifying antirheumatic drug; 94% would not start a patient with systemic lupus erythematosus on an immunosuppressant. When we compared CHCs that reported needing better access to rheumatology care to those that did not, the former described a significantly greater percentage of patients with private insurance or Medicaid who required outside rheumatology referrals (P < 0.05). Language differences and insurance status were highlighted as barriers to obtaining rheumatology care. Sixteen directors (57%) ranked the patient navigator-a layperson to assist with care coordination-as their first-choice intervention., Conclusions: Community health center medical directors expressed a need for better access to rheumatology services. A patient navigator for rheumatic diseases was proposed to help improve care and reduce health disparities.

Background: Proposed changes to financing of teaching hospitals and new quality-based performance incentives may differentially impact the financial health of teaching and safety-net institutions. Few data have examined the potential impact of these financial changes on teaching institutions., Objectives: To determine the association of hospital teaching intensity with processes and outcomes of care for the most common inpatient diagnoses in the United States., Research Design: Cross-sectional analysis of the 2008 Hospital Quality Alliance and 2007 American Hospital Association databases, adjusted for hospital characteristics., Subjects: A total of 2418 hospitals distributed across the country with available data on teaching intensity (resident-to-bed ratio), quality-of-care process measures, and risk-adjusted readmission and mortality rates for acute myocardial infarction (AMI), congestive heart failure (CHF), and pneumonia., Measures: Hospital-level quality-of-care process indicators and 30-day risk-adjusted readmission and mortality rates for AMI, CHF, and pneumonia., Results: Multivariable analysis demonstrates that all hospitals perform uniformly well on quality-of-care process measures for AMI, CHF, and pneumonia. However, when compared with nonteaching hospitals, increasing hospital teaching intensity is significantly associated with improved risk-adjusted mortality for AMI and CHF, but higher risk-adjusted readmission rates for all 3 conditions. Among high teaching intensity hospitals, those with larger Medicaid populations (safety-net institutions) had particularly high readmission rates for AMI and CHF., Conclusions: In this nationally representative evaluation, we found significant variation in performance on risk-adjusted mortality and readmission rates, and differences in readmission rates based on safety-net status. Our findings suggest that high teaching intensity and safety-net institutions may be disproportionately affected by upcoming changes in hospital payment models.

Although racial and ethnic minorities are more likely to be involved with the criminal justice system than whites in the U.S.A., critical scientific gaps exist in our understanding of the relationship between the criminal justice system and the persistence of racial/ethnic health disparities. Individuals engaged with the criminal justice system are at risk for poor health outcomes. Furthermore, criminal justice involvement may have direct or indirect effects on health and health care. Racial/ethnic health disparities may be exacerbated or mitigated at several stages of the criminal justice system. Understanding and addressing the health of individuals involved in the criminal justice system is one component of a comprehensive strategy to reduce population health disparities and improve the health of our urban communities.

Objectives: Adding clinical decision support (CDS) to electronic health records (EHRs) is required under meaningful use legislation, but there has been little national data on effectiveness in improving clinical outcomes. We sought to determine whether EHRs with CDS improved blood pressure control in US primary care visits., Study Design: We used a cross-sectional, nationally representative survey., Methods: We examined adult visits to primary care physicians using the 2007 and 2008 National Ambulatory Medical Care Survey (NAMCS)., Results: We found that patients had a mean age of 52 years, 34% were male, 15% had diabetes, and 70% were white. Rates of blood pressure control were significantly higher in visits where both an EHR and CDS (79%) were used, compared with visits where physicians used neither tool (74%; P = .004). Blood pressure control rates remained higher after adjusting for potential confounders. In unadjusted analyses, mean systolic blood pressure was 2 mm Hg lower in visits with the use of both an EHR and CDS, compared with visits where physicians used neither tool (P = .03), and this difference remained significant after adjustment., Conclusions: The NAMCS shows that physician use of an EHR with CDS is associated with improved blood pressure control. These findings are important because small improvements in blood pressure control are associated with reductions in cardiovascular morbidity and mortality.

Previous studies documented racial and gender disparities in implantable cardioverter-defibrillator (ICD) placement. The authors examined whether racial and gender disparities in ICD placement are due to underutilization or overutilization. Among 1,054 adults hospitalized from 2001 to 2004 with ventricular arrhythmias in a large academic hospital, the study found that 17% of patients had clinical indicators concordant with ICD placement criteria. Among those, Blacks were less likely than Whites to receive an ICD (adjusted odds ratio [OR] = 0.24; 95% CI = 0.08-0.71). Among the 83% who were discordant with ICD placement criteria, Blacks (adjusted OR = 0.30; 95% CI = 0.18-0.52) and Hispanics (adjusted OR = 0.24, 95% CI = 0.10-0.57) were less likely than Whites, and women less likely than men, to receive an ICD (adjusted OR = 0.48; 95% CI = 0.34-0.67). In this cohort, these differences appear related to overutilization among men and Whites who are discordant with ICD placement criteria in addition to underutilization among Blacks concordant with placement criteria.

Minorities have a higher prevalence of hypertension, a major risk factor for cardiovascular disease, which contributes to racial/ethnic disparities in morbidity and mortality in the United States. Many modifiable health behaviors have been associated with improved blood pressure control, but it is unclear how racial/ethnic differences in these behaviors are related to the observed disparities in blood pressure control. Cross-sectional analyses were conducted among 21 489 US adults aged >20 years participating in the National Health and Nutrition Examination Survey from 2001 to 2006. Secondary analyses were conducted among those with a self-reported diagnosis of hypertension. Blood pressure control was defined as systolic values <140 mm Hg and diastolic values <90 mm Hg (or <130 mm Hg and <80 mm Hg among diabetics, respectively). In primary analyses, non-Hispanic blacks had 90% higher odds of poorly controlled blood pressure compared with non-Hispanic whites after adjustment for sociodemographic and clinical characteristics (P<0.001). In secondary analyses among hypertensive subjects, non-Hispanic blacks and Mexican Americans had 40% higher odds of uncontrolled blood pressure compared with non-Hispanic whites after adjustment for sociodemographic and clinical characteristics (P<0.001). For both analyses, the racial/ethnic differences in blood pressure control persisted even after further adjustment for modifiable health behaviors, which included medication adherence in secondary analyses (P<0.001 for both analyses). Although population-level adoption of healthy behaviors may contribute to reduction of the societal burden of cardiovascular disease in general, these findings suggest that racial/ethnic differences in some health behaviors do not explain the disparities in hypertension prevalence and control.

The relative effectiveness of strategies to recruit minority patients, populations traditionally difficult to engage in research, for focus groups is unclear. We conducted a systematic review of all peer-reviewed focus group studies targeting Black and/or Hispanic participants with diabetes, hypertension, asthma, and/or cardiovascular disease reported in Pubmed, MEDLINE, and CINAHL from January 1993 through August 2009. Reviewers extracted data on each study's characteristics, methods, and outcomes. Forty-five studies were eligible. While most described recruitment strategies, only 21 presented any metric of their success in recruiting participants. Among studies with high recruitment success rates, no discernable trends regarding effectiveness of recruitment strategies were found, largely due to variation in reporting of the use of incentives and follow-up mechanisms. Increased rigor is necessary for describing methodology of focus group research in the literature. It is incumbent upon researchers to ensure clear and detailed methodology in qualitative articles.

Background: The Health Resources and Services Administration Health Disparities Collaboratives (HDCs) were developed to improve care for chronic medical conditions in community health centers (CHCs)., Methods: We examined whether HDCs reduced disparities in quality by race/ethnicity or insurance status in CHCs nationally. We performed a controlled preintervention/postintervention study of 44 CHCs participating in HDCs for asthma, diabetes mellitus, or hypertension and 20 "external" control CHCs that had not participated. Each intervention center also served as an "internal" control for another condition. For each condition, we created an overall quality score, defined disparities in care as the differences in care between racial/ethnic groups and insurance groups, and examined changes in disparity through a series of hierarchical models using a 3-way interaction term among period, patient characteristics of interest, and treatment group., Results: Overall, HDCs had little effect on disparities in composite measures for asthma, diabetes, and hypertension. For asthma care, collaborative centers had a baseline Hispanic-white disparity of 6.5%, which changed to a higher quality of recommended care for Hispanic patients over white patients by 0.8%, resulting in a significantly reduced Hispanic-white disparity compared with the change in disparity seen in external controls (P = .04). There were no other improvements in racial/ethnic or insurance disparities for any other conditions., Conclusions: Although HDCs are known to improve quality of care in CHCs, they had minimal effect on racial/ethnic and insurance disparities. In addition to targeting improvement in overall quality, future initiatives should include activities aimed at disparity reduction as an outcome.

Nationally, a higher proportion of the medically underserved than of the general population suffer from hypertension. Poorer adherence to recommended therapies (including medication regimens, salt intake reduction, and regular visits with provider) has been linked to poorer blood pressure control. To identify whether differences in adherence are associated with racial/ethnic and socioeconomic characteristics, we administered a survey to 141 African American and non-Hispanic White hypertensive patients within two hospital-based clinics in an urban setting in the Northeast U.S. There were no differences in adherence to follow-up appointments or dietary recommendations between racial/ ethnic or income groups. However, there were differences between groups in adherence to medication regimens, with African Americans and lower-income groups significantly more likely to be non-adherent to medication regimens. When treating patients or implementing interventions aimed at improving adherence, special attention should be paid to African Americans and patients from low-income communities.

Background: Little is known about the link between hospitalists and performance on hospital-level quality indicators., Methods: From October 1, 2005, through September 31, 2006, we linked the Hospital Quality Alliance (HQA) data to the American Hospital Association data on the presence of hospitalists. Main outcome measures included composite measurements of hospital-level quality of care for 3 conditions (acute myocardial infarction [AMI], congestive heart failure [CHF], and pneumonia) and 2 dimensions of care (treatment and diagnosis, as well as counseling and prevention). We fitted a series of logistic regression models to examine the relationship between hospitalists and overall quality of care for each condition, controlling for all other hospital characteristics., Results: Of 3619 hospitals reporting HQA data, 1461 (40.4%) had hospitalists. Hospitals with hospitalists tended to be large, private, not-for-profit, teaching institutions located in the southern United States. The mean unadjusted composite scores were higher for hospitals with hospitalists vs those with no hospitalists for all 3 conditions (93% vs 86% for AMI, 82% vs 72% for CHF, and 75% vs 71% for pneumonia) and both dimensions of care (87% vs 77% for treatment and diagnosis and 75% vs 66% for counseling and prevention) (P < .001 for all comparisons). After multivariable adjustment, hospitals with hospitalists continued to perform significantly better than those without hospitalists across all composite scores except for CHF., Conclusion: Hospitals with hospitalists were associated with better performance on HQA indicators for AMI, pneumonia, and the domains of overall disease treatment and diagnosis, as well as counseling and prevention.

Background: Lifestyle modification is recommended for all patients with the diagnosis of hypertension., Methods: We examined 3,497 adult hypertensive participants (representing 42 million Americans), from the National Health and Nutrition Examination Survey (NHANES) 1999-2004. We analyzed the rate, demographic, and clinical factors of participants who reported receiving lifestyle counseling and their adherence., Results: Of the 3,497 participants with hypertension, 84% reported receiving lifestyle modification counseling. After adjustment for demographic and clinical characteristics, non-Hispanic blacks were more likely to report receiving counseling (odds ratio (OR), 2.5; P < 0.001) when compared to whites. Men (OR, 1.5; P = 0.02) reported receiving counseling more often than women as well as those with Medicare insurance (OR, 1.5; P = 0.02) compared to the privately insured. Participants who were hypercholesterolemic (OR, 1.7; P < 0.001), diabetic (OR, 3.5; P < 0.001), overweight (OR, 1.5; P < 0.001), or obese (OR 3.0; P < 0.001) reported receiving lifestyle counseling more often than those without these conditions. Of those receiving counseling, 88% reported adhering to those recommendations. After adjustment for demographic and clinical characteristics, only non-Hispanic blacks (OR, 2.8; P < 0.001) and those aged >60 (OR, 1.9; P = 0.04) were more likely to report adhering when advised., Conclusions: High cardiovascular risk hypertensive patients had high rates of lifestyle counseling. However, gaps exist in lifestyle counseling for young and low cardiovascular risk hypertensive patients. In addition, differences in rates of adherence exist especially in those with high cardiovascular risk comorbid conditions. Future work is needed to increase adherence to lifestyle counseling for all hypertensive patients.

Background: Completing pre-transplant evaluations may be a greater barrier to renal transplantation for blacks with end-stage renal disease (ESRD) than for whites., Objective: To determine whether social support networks facilitate completing the pre-transplant evaluation and reduce racial disparities in this aspect of care., Design, Setting, and Participants: We surveyed 742 black and white ESRD patients in four regional networks 9 months after they initiated dialysis in 1996 and 1997. Patients reported instrumental support networks (number of friends or family to help with daily activities), emotional support networks (number of friends or family available for counsel on personal problems) and dialysis center support (support from dialysis center staff and patients). The completion of pre-transplant evaluations, including preoperative risk stratification and testing, was determined by medical record reviews., Outcome Measurement: Complete renal pre-transplant evaluations., Results: Compared to patients with low levels of instrumental support, those with high levels were more likely to have complete evaluations (25% versus 46%, respectively, p < .001). In adjusted analyses, high levels of instrumental support were associated with higher rates of complete evaluations among black women (p < .05), white women (p < .05), and white men (p < .05), but not black men. Among black men, but not other groups, private insurance was a significant predictor of complete evaluations., Conclusions: Instrumental support networks may facilitate completing renal pre-transplant evaluations. Clinical interventions that supplement instrumental support should be evaluated to improve access to renal transplantation. Access to supplemental insurance may also promote complete evaluations for black patients.

Background: The Health Disparities Collaboratives of the Health Resources and Services Administration (HRSA) were designed to improve care in community health centers, where many patients from ethnic and racial minority groups and uninsured patients receive treatment., Methods: We performed a controlled preintervention and postintervention study of community health centers participating in quality-improvement collaboratives (the Health Disparities Collaboratives sponsored by the HRSA) for the care of patients with diabetes, asthma, or hypertension. We enrolled 9658 patients at 44 intervention centers that had participated in the collaboratives and 20 centers that had not participated (external control centers). Each intervention center also served as an internal control for another condition. Quality measures were abstracted from medical records at each health center. We created overall quality scores by standardizing and averaging the scores from all of the applicable measures. Changes in quality were evaluated with the use of hierarchical regression models that controlled for patient characteristics., Results: Overall, the intervention centers had considerably greater improvement than the external and internal control centers in the composite measures of quality for the care of patients with asthma and diabetes, but not for those with hypertension. As compared with the external control centers, the intervention centers had significant improvements in the measures of prevention and screening, including a 21% increase in foot examinations for patients with diabetes, and in disease treatment and monitoring, including a 14% increase in the use of antiinflammatory medication for asthma and a 16% increase in the assessment of glycated hemoglobin. There was no improvement, however, in any of the intermediate outcomes assessed (urgent care or hospitalization for asthma, control of glycated hemoglobin levels for diabetes, and control of blood pressure for hypertension)., Conclusions: The Health Disparities Collaboratives significantly improved the processes of care for two of the three conditions studied. There was no improvement in the clinical outcomes studied., (Copyright 2007 Massachusetts Medical Society.)

Community health centers (CHCs) are responsible for providing care for more than fifteen million Americans, many of whom are members of groups who have been documented to receive low-quality care. This study examines the quality of care for patients with chronic disease in a nationally representative sample of federally funded CHCs. Fewer than half of eligible patients received appropriate care for the majority of indicators measured, and uninsured patients received poorer care than insured patients. Although the quality of chronic disease care in CHCs compares favorably with that of care received in other settings, gaps in quality were observed for the uninsured.

Background: Prior literature has shown that racial/ethnic minorities with hypertension may receive less aggressive treatment for their high blood pressure. However, to date there are few data available regarding the confounders of racial/ethnic disparities in the intensity of hypertension treatment., Methods: We reviewed the medical records of 1,205 patients who had a minimum of two hypertension-related outpatient visits to 12 general internal medicine clinics during 7/1/01-6/30/02. Using logistic regression, we determined the odds of having therapy intensified by patient race/ethnicity after adjustment for clinical characteristics., Results: Blacks (81.9%) and Whites (80.3%) were more likely than Latinos (71.5%) to have therapy intensified (P = 0.03). After adjustment for racial differences in the number of outpatient visits and presence of diabetes, there were no racial differences in rates of intensification., Conclusion: We found that racial/ethnic differences in therapy intensification were largely accounted for by differences in frequency of clinic visits and in the prevalence of diabetes. Given the higher rates of diabetes and hypertension related mortality among Hispanics in the U.S., future interventions to reduce disparities in cardiovascular outcomes should increase physician awareness of the need to intensify drug therapy more agressively in patients without waiting for multiple clinic visits, and should remind providers to treat hypertension more aggressively among diabetic patients.

Although improved control of hypertension is known to attenuate progression of chronic kidney disease (CKD), little is known about the adequacy of hypertension treatment in adults with CKD in the United States. Using data from the Fourth National Health and Nutrition Survey, we assessed adherence to national hypertension guideline targets for patients with CKD (blood pressure <130/80 mm Hg), we assessed control of systolic (<130 mm Hg) and diastolic (<80 mm Hg) blood pressure, and we evaluated determinants of adequate blood pressure control. Presence of CKD was defined as glomerular filtration rate <60 mL/min per 1.73 m2 or presence of albuminuria (albumin:creatinine ratio >30 microg/mg). Multivariable logistic regression with appropriate weights was used to determine predictors of inadequate hypertension control and related outcomes. Among 3213 participants with CKD, 37% had blood pressure <130/80 mm Hg (95% confidence interval [CI], 34.5% to 41.8%). Of those with inadequate blood pressure control, 59% (95% CI, 54% to 64%) had systolic >130 mm Hg, with diastolic < or =80 mm Hg, whereas only 7% (95% CI, 3.9 to 9.8%) had a diastolic pressure >80 mm Hg, with systolic blood pressure < or =130 mm Hg. Non-Hispanic black race (odds ratio [OR], 2.4; 95% CI, 1.5 to 3.9), age >75 years (OR, 4.7; 95% CI, 2.7 to 8.2), and albuminuria (OR, 2.4; 95% CI, 1.4 to 4.1) were independently associated with inadequate blood pressure control. We conclude that control of hypertension is poor in participants with CKD and that lack of control is primarily attributable to systolic hypertension. Future guidelines and antihypertensive therapies for patients with CKD should target isolated systolic hypertension.

The relationship between blood pressure control and racial differences in the processes of hypertension care have not been well examined. We reviewed medical records of 15 768 visits to 12 general internal medicine clinics during July 1, 2001 to June 30, 2002 to determine whether visits were adherent to the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) by identifying medications selected for hypertension therapy. We compared JNC adherence, blood pressure control, and intensification of therapy by patient characteristics. Using repeated measures logistic regression, we determined the adjusted odds of obtaining blood pressure control when therapy was intensified the visit before, and tested the interaction of intensification of therapy and patient race/ethnicity in predicting blood pressure control. JNC adherence was more frequent among blacks (83.7%) and Hispanics (83%) than whites (78.4%) (P<0.001). Blood pressure was controlled most often among whites (38.7% versus 34.8% for blacks and 33.3% for Hispanics; P<0.001). Blacks (81.5%) and whites (80.9%) were more likely than Hispanics (70.8%) to have therapy intensified (P=0.02). After adjustment for baseline blood pressure, intensifying therapy was associated with higher odds of subsequent blood pressure control (odds ratio, 1.55; P<0.001). There were no significant interactions between race/ethnicity and intensification in predicting control. We found that therapy intensification is associated with subsequent blood pressure control in all racial/ethnic groups and that Hispanics were least likely to have their therapy intensified. Interventions to reduce disparities in cardiovascular outcomes should consider the need to intensify drug therapy more aggressively among all high-risk populations.

Background: Relatively little is known about racial differences in health-related quality of life (HRQL) among patients receiving dialysis for end-stage renal disease (ESRD) or how such differences may relate to preferences for renal transplantation., Methods: We surveyed 1392 patients, ages 18-54 approximately 10 months after they initiated dialysis in 4 regions of the United States. The HRQL measures analyzed were overall health, emotional health, physical activity, energy level, social activity, and effect of ESRD on daily life. We also examined whether the measures of HRQL were associated with patients' preferences for renal transplantation by race., Results: After adjustment for socioeconomic and clinical characteristics, Black women and men reported better overall health than White women and men, respectively. Black women reported higher energy levels than White women, and Black men reported less negative effects of ESRD on daily life compared to White men. Black men with high levels of physical activity were less likely to be certain about preferring a transplant than White men with similar levels of physical activity., Conclusions: Black patients receiving dialysis reported better HRQL than White patients, even after controlling for potential confounders. Racial differences in preferences for renal transplantation among men may be associated with their levels of physical activity.

Objective: To determine whether current region of residence and immigrant status (born in the United States [US] vs abroad), are associated with the prevalence of hypertension (HTN), uncontrolled HTN, and HTN-related target-organ damage, among African Americans., Methods: We studied the survey and physical examination data from a nationally representative cohort of 3,369 self-designated Black participants, aged 30-79 years, in the third National Health and Nutrition Examination Survey (NHANES III), which took place during 1988-1994. We calculated the age-adjusted prevalence rates of HTN, uncontrolled HTN, and history of HTN-related target-organ damage in US-born northern African Americans, US-born southern African Americans, and foreign-born African Americans., Results: Hypertension (HTN) was more common among southern African-American men and women, compared to northern African-American men and women (42.2% vs 34.1%, P<.002 for men; 42.7% vs 37.2%, P=.02 for women). Uncontrolled HTN was also more common among hypertensive southern African-American women compared to hypertensive northern African-American women (79.8% vs 70.4%, P=.05). Among women, hypertensive Black immigrants had lower rates of HTN-related target-organ damage than either hypertensive US-born southern and northern African Americans (3.3% vs 16.3% and 15.8%, respectively, P=.05)., Conclusions: In this nationally representative cohort, immigrant status and geographic region of residence were associated with HTN prevalence, rates of blood pressure control, and HTN-related target-organ damage. Further examination of environmental exposures, cultural issues, and access to care, factors that can differ between groups, may yield important information about modifiable risk factors associated with HTN and target organ damage.