Design

We performed a cross-sectional analysis of baseline data collected as part of the Ambulatory Care Quality Improvement Project (ACQUIP). ACQUIP was a multicenter, group-randomized trial designed to determine whether health outcomes and satisfaction with care could be improved by giving primary care providers access to regular, systematic assessments of their patients’ health and functional status, combined with routine clinical data and information regarding practice guidelines.

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INTRODUCTION

In several settings, African Americans appear to receive less intense management of ischemic heart disease compared with Caucasians. Explanations of this disparity based on clinical risk factors, socioeconomic factors, geographic location, geographic complexity, health insurance status, and multifactorial provider/patient preferences have been explored. Because health services are available to eligible veterans irrespective of whether they have health insurance, it would be expected that disparities related to socioeconomic factors would be less apparent in the Department of Veteran Affairs (VA) medical system compared with medical systems in which premiums, copayments, or deductibles are required. However, even after adjusting for health insurance, ethnic variations have been observed among veterans who utilize VA health services. Despite these observed ethnic differences, overall mortality following admission to a VA facility is similar for African-American and Caucasian patients, including those admitted for cardiovascular problems.

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Previous studies on dyspepsia did not report their results by race/ethnicity. Therefore, investigating dyspepsia in African-American and Hispanic populations is a distinctive characteristic of our study. We focused on the etiology of dyspepsia in relation to age and alarm features among African-American and Hispanic patients. Our study indicated that the presence of alarm features in our minority population is associated with the presence of underlying lesions. This concurs with what other researchers have found.

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The study included 357 African-American patients (178 males, 179 females) and 321 Hispanic patients (154 males, 167 females) (Table 1). The most frequent alarm features among the study population was age (>50 years) followed by anemia, weight loss, and gastrointestinal bleeding. About three-quarters of the patients (72%) were over 50 years of age. The prevalence of alarm features increased with age, being more frequent among the older age group (76-98 years old) than the younger age group (22-50 years old). All of the alarm features were statistically different between age groups with the exception of gastrointestinal bleeding, loss of appetite, and early satiety (Table 2).

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Study Population and Study Site

The King-Drew Medical Center is an inner-city community teaching hospital serving a predominantly African-American and Hispanic population. Medical records of 764 patients 22-98 years of age with investigated dyspepsia were identified for a retrospective review. Demographic information, presence or absence of alarm features, and the results of the endoscopic and/or radiological evaluations were abstracted. The alarm features investigated were age greater than 50 years, anemia, weight loss, gastrointestinal bleeding, loss of appetite, early satiety, the presence of an abdominal mass, and dysphagia. The source of this information included inpatient and outpatient chart review and gastroenterology consultation reports. Twenty-nine Asian, 29 Caucasian, and 28 patients with incomplete data were excluded. Subsequently 678 patients were reviewed. Patients were stratified according to their age into three groups: 22-50 years (group 1), 51-75 years (group 2), and 76-98 years (group 3).

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INTRODUCTION

Dyspepsia, derived from the Greek “dys” (bad, difficult) and “pepsis” (digestion), is defined as pain or discomfort in the upper abdomen. Dyspepsia is a common symptom with a prevalence of up to 40% in the general population. Dyspepsia is responsible for more than 11 million physician office visits annually. More than half of these patients presenting with dyspepsia have no detectable cause for their symptoms. The common organic causes of dyspepsia include peptic ulcer and esophagitis. Cancer of the upper gastrointestinal (UGI) tract, as an organic cause of dyspepsia, accounts for 1-2% and less in patients under age 50 years. The presence of one or more alarm features may help identify patients with a higher risk for underlying lesions. The common alarm features include age older than 50 years, anemia, weight loss, gastrointestinal bleeding, loss of appetite, early satiety, abdominal mass, and dysphagia.

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Over the last two decades, the ability to diagnose and treat osteoporosis has dramatically improved. The advances in treatment of osteoporosis have unfortunately been underutilized in non-caucasian populations. Researchers have highlighted that the current guidelines for screening and treatment of osteoporosis medication are primarily based on data obtained from studies of postmenopausal Caucasian women, as insufficient data is available in African-American women. This study provides data regarding the frequency of decreased BMD in African-American women.

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