Prevalence and features of colorectal lesions among Hispanics: A hospital-based study

AIM: To evaluate the prevalence and characteristics of colorectal adenoma and carcinoma in an inner city Hispanic population.METHODS: We reviewed the reports of 1628 Hispanic patients who underwent colonoscopy at Howard University from 2000 to 2010. Advanced adenoma was defined as adenoma ≥ 1 cm in size,adenomas with villous histology,high grade dysplasia and/or invasive cancer. Statistical analysis was performed using χ2 statistics and t-test.RESULTS: The median age of the patients was 54 years,64.2% were females. Polyps were observed in 489(30.0%) of patients. Adenoma prevalence was 16.8%(n = 273),advanced adenoma 2.4%(n = 39),and colorectal cancer 0.4%(n = 7). Hyperplastic polyps were seen in 6.6% of the cohort(n = 107). Adenomas predominantly exhibited a proximal colonic distribution(53.7%,n = 144); while hyperplastic polyps were mostly located in the distal colon(70%,n = 75). Among 11.7%(n = 191) patients who underwent screening colonoscopy,the prevalence of colorectal lesions was 21.4% adenoma,2.6% advanced adenoma; and 8.3% hyperplastic polyps.CONCLUSION: Our data showed low colorectal cancer prevalence among Hispanics in the Washington DC area. However,the pre-neoplastic pattern of colonic lesions in Hispanics likely points toward a shift in this population that needs to be monitored closely through large epidemiological studies.

Features of hepatocellular carcinoma in Hispanics differ from African Americans and non-Hispanic Whites

AIM To compare features of hepatocellular carcinoma(HCC) in Hispanics to those of African Americans and Whites.METHODS Patients treated for HCC at an urban tertiary medical center from 2005 to 2011 were identified from a tumor registry. Data were collected retrospectively, including demographics, comorbidities, liver disease characteristics, tumor parameters, treatment, and survival(OS) outcomes. OS analyses were performed using Kaplan-Meier method.RESULTS One hundred and ninety-five patients with HCC were identified: 80.5% were male, and 22% were age 65 or older. Mean age at HCC diagnosis was 59.7 ± 9.8 years. Sixty-one point five percent of patients had Medicare or Medicaid; 4.1% were uninsured. Compared to African American(31.2%) and White(46.2%) patients, Hispanic patients(22.6%) were more likely to have diabetes(P = 0.0019), hyperlipidemia(P = 0.0001), nonalcoholic steatohepatitis(NASH)(P = 0.0021), end stage renal disease(P = 0.0057), and less likely to have hepatitis C virus(P < 0.0001) or a smoking history(P < 0.0001). Compared to African Americans, Hispanics were more likely to meet criteria for metabolic syndrome(P = 0.0491), had higher median MELD scores(P = 0.0159), ascites(P = 0.008), and encephalopathy(P = 0.0087). Hispanic patients with HCC had shorter OS than the other racial groups(P = 0.020), despite similarities in HCC parameters and treatment. CONCLUSION In conclusion, Hispanic patients with HCC have higher incidence of modifiable metabolic risk factors including NASH, and shorter OS than African American and White patients.

COVID-19 among African Americans and Hispanics:Does gastrointestinal symptoms impact the outcome?

BACKGROUND The coronavirus disease 2019(COVID-19)disproportionately affected African Americans(AA)and Hispanics(HSP).AIM To analyze the significant effectors of outcome in African American patient population and make special emphasis on gastrointestinal(GI)symptoms,laboratory values and comorbidities METHODS We retrospectively evaluated the medical records of 386 COVID-19 positive patients admitted at Howard University Hospital between March and May 2020.We assessed the symptoms,including the GI manifestations,comorbidities,and mortality,using logistic regression analysis.RESULTS Of these 386 COVID-19 positive patients,257(63.7%)were AAs,102(25.3%)HSP,and 26(6.45%)Whites.There were 257(63.7%)AA,102(25.3%)HSP,26(6.45%)Whites.The mean age was 55.6 years(SD=18.5).However,the mean age of HSP was the lowest(43.7 years vs 61.2 for Whites vs 60 for AAs).The mortality rate was highest among the AAs(20.6%)and lowest among HSP(6.9%).Patients with shortness of breath(SOB)(OR2=3.64,CI=1.73-7.65)and elevated AST(OR2=8.01,CI=3.79-16.9)elevated Procalcitonin(OR2=8.27,CI=3.95-17.3),AST(OR2=8.01,CI=3.79-16.9),ferritin(OR2=2.69,CI=1.24-5.82),and Lymphopenia(OR2=2.77,CI=1.41-5.45)had a high mortality rate.Cough and fever were common but unrelated to the outcome.Hypertension and diabetes mellitus were the most common comorbidities.Glucocorticoid treatment was associated with higher mortality(OR2=5.40,CI=2.72-10.7).Diarrhea was prevalent(18.8%),and GI symptoms did not affect the outcome.CONCLUSION African Americans in our study had the highest mortality as they consisted of an older population and comorbidities.Age is the most important factor along with SOB in determining the mortality rate.Overall,elevated liver enzymes,ferritin,procalcitonin and C-reactive protein were associated with poor prognosis.GI symptoms did not affect the outcome.Glucocorticoids should be used judiciously,considering the poor outcomes associated with it.Attention should also be paid to monitor liver function during COVID-19,especially in AA and HSP patients with higher disease severity.

Assessing Colorectal Cancer Screening Behaviors and Knowledge among At-Risk Hispanics in Southern New Mexico

Purpose: Colorectal cancer (CRC) mortality rates in New Mexico (NM) continue to be higher than national rates. Hispanic CRC mortality rates in NM surpass those of overall Hispanics in the US. This study was designed to characterize and understand factors contributing to low CRC screening rates in this border region. Methods: A CRC Knowledge Assessment Survey (KAS) was administered in either English or Spanish to 247 individuals attending community events throughout southern NM. A subset of these individuals completed an online CRC risk assessment survey managed by the National Cancer Institute (NCI). Data analysis tested for significant differences in knowledge, physician-patient CRC interactions, CRC risk level perception, and screening rates across diverse ethnic and age groups. Results: Both CRC knowledge and physician-patient CRC interactions were positively associated with participant screening history. Significant age and ethnic differences for CRC knowledge, physician-patient CRC interactions, and screening history in the NM border sample were also seen. Age-eligible Hispanics (50+) as well as those less than 50 years of age had lower CRC knowledge and were less likely to engage in physician-patient CRC interactions than non-Hispanic Whites (NHWs). The age-eligible Hispanics also reported lower CRC screening rates than their NHW counterparts. Conclusions: Low CRC knowledge and limited physician-patient CRC interactions appear to contribute to low screening rates in this NM population. Expanding education and outreach efforts for this border population are essential to promote early CRC detection and thereby decrease overall CRC mortality rates.

Sleep Quality among Hispanics of Mexican Descent and Non-Hispanic Whites: Results from the Sleep Health and Knowledge in US Hispanics Study

Objectives: To investigate differences in sleep quality between Hispanics of Mexican descent (HMD) and Non-Hispanic Whites (NHW) and evaluate the effect of acculturation to the US lifestyle in sleep health. We hypothesize that the detrimental effect of acculturation on health outcomes will impact sleep quality among HMD. Design: We performed a population-based random digit dialing telephone survey to determine sleep quality in HMD and NHW. We collected from 3667 subjects, demographics, previous diagnosis of depression or anxiety, past treatment for sleep disorders, the Pittsburgh Sleep Quality Index (PSQI) and the Short Acculturation Scale for Hispanics. Results: The prevalence of poor sleep quality (PSQI > 5) was 64.4% for HMD and 64.3% for NHW (p = 0.93). A prior diagnosis of depression or anxiety was an independent predictor of poor sleep quality in both groups (OR 3.4 and 2.7 for HMD and NHW. Ethnicity was not a predictor of poor sleep quality in HMD or NHW. Acculturation was not a predictor of poor sleep quality in HMD. However, highly acculturated young HMD males had significantly more prevalence of poor sleep quality compared to NHW (64.8% vs. 49.8%, p Conclusion: The absence of sleep quality differences in a large sample of HMD and NHW living in San Diego County is contrary to current data of having poorer sleep quality among Latinos. We found that neither ethnicity nor acculturation were predictors of poor sleep quality in HMD. However, we demonstrated a highly prevalent poor sleep quality among the two ethnic groups. The finding of significantly lower sleep quality in young highly acculturated HMD men may represent the heterogeneity of ethnicity related to sleep. Programs to improve sleep quality in subjects with depression and/or anxiety, and in young highly-acculturated HMD seems warranted.

Disparate outcomes in Hispanic patients with metabolic dysfunctionassociated steatotic liver disease/steatohepatitis and type 2 diabetes: Large cohort study

BACKGROUND Metabolic dysfunction-associated steatotic liver disease(MASLD)and metabolic dysfunction-associated steatohepatitis(MASH)are a growing health burden across a significant portion of the global patient population.However,these conditions seem to have disparate rates and outcomes between different ethnic populations.The combination of MASLD/MASH and type 2 diabetes increases the risk of hepatocellular carcinoma(HCC),and Hispanic patients experience the greatest burden,particularly those in South Texas.AIM To compare outcomes between Hispanic and non-Hispanic patients in the United States,while further focusing on the Hispanic population within Southeast Texas to determine whether the documented disparity in outcomes is a function of geographical circumstance or if there is a more widespread reason that all clinicians must account for in prognostic consideration.METHODS This cohort analysis was conducted with data obtained from TriNetX,LLC(“TriNetX”),a global federated health research network that provides access to deidentified medical records from healthcare organizations worldwide.Two cohort networks were used:University of Texas Medical Branch(UTMB)hospital and the United States national database collective to determine whether disparities were related to geographic regions,like Southeast Texas.RESULTS This study findings revealed Hispanics/Latinos have a statistically significant higher occurrence of HCC,type 2 diabetes mellitus,and liver fibrosis/cirrhosis in both the United States and the UTMB Hispanic/Latino groups.Allcause mortality in Hispanics/Latinos was lower within the United States group and not statistically elevated in the UTMB cohort.CONCLUSION This would appear to support that Hispanic patients in Southeast Texas are not uniquely affected compared to the national Hispanic population.

Prevalence and resistance of Helicobacter pylori in a predominantly Hispanic population

BACKGROUND Helicobacter pylori(H.pylori)is the most common chronic bacterial infection in humans.The risk of acquiring H.pylori is related to socioeconomic status and living conditions early in life.Treatment regimens must consider local antibiotic resistance patterns.Adventist Health White Memorial Hospital serves a predominantly indigent population in east Los Angeles with a large number of immigrants from South and Central America.Data regarding the prevalence and resistance of H.pylori in this population is scant.AIM To evaluate the prevalence and resistance of H.pylori and correlate with country of origin.METHODS All gastric biopsies were obtained by a single gastroenterologist at the hospital in a consecutive manner from patients with gastritis from 2017 to 2022 and sent to various labs for evaluation.RESULTS Two hundred and sixty-six patients are born in the United States,450,171,70,and 30 patients are immigrants from Mexico,Central and South America(CSA),Asia,and other countries respectively.Overall,14.65%were found to be infected with H.pylori.Rates of infection in United States-born citizens,immigrants from Mexico,CSA,and Asia are 9.02%,18.67%,13.45%,and 11.43%respectively,with Mexican immigrants having a relative risk of 2.3889[95%confidence interval(CI):1.4789-3.8588,P=0.0004]compared to those born in United States.No correlation seen between infection and length of time immigrants were in United States.Relative risk of infection in patients with no proton pump inhibitor use within the past 30 days found to be 1.9276(95%CI:1.3562-2.7398,P=0.0003).Rates of resistance for clarithromycin and levofloxacin are 21.43%and 31.11%.CONCLUSION H.pylori infection appears to be associated with low socioeconomic status and poor living conditions early in life.Clarithromycin and levofloxacin based treatment regimens should be avoided as first line therapy in this region,particularly in patients of Latin American origin.

Burden of nonalcoholic fatty liver disease and advanced fibrosis in a Texas Hispanic community cohort

AIM: To investigate the potential burden of nonalcoholic steatohepatitis(NASH) and advanced fibrosis in a hispanic community.METHODS: Four hundred and forty two participants with available ultrasonography data from the Cameron County Hispanic Cohort were included in this study. Each participant completed a comprehensive questionnaire regarding basic demographic information, medical history, medication use, and social and family history including alcohol use. Values of the nonalcoholic fatty liver disease fibrosis score(NFS), FIB4 index, BARD score, and Aspartate aminotransferase to Platelet Ratio Index(APRI) were computed using the blood samples collected within 6 mo of liver ultrasonography from each participant. Hepatic steatosis was determined by ultrasonography. As part of univariable analysis, for continuous variables, comparisons among groups were performed with student-t test, one way analysis of variance, and Mann-Whitney test. Pearson χ2 and the Fisher exact test are used to assess differences in categorical variables. For multivariable analyses, logistic regression analyses were performed to identify characteristics associated with hepatic steatosis. All reported P values are based two-sided tests, and a P value of less than 0.05 was considered to indicate statistical significance.RESULTS: The mean age and body mass index(BMI) of the study participants were 49.1 years and 31.3 kg/m2, respectively. Among them, 65.6% were females, 52% had hepatic steatosis, 49.5% had metabolic syndrome, and 29% had elevated aminotransferases. Based on established cut-offs for diagnostic panels, between 17%-63% of the entire cohort was predicted to have NASH with indeterminate or advanced fibrosis. Participants with hepatic steatosis had significantly higher BMI(32.9 ± 5.6 kg/m2 vs 29.6 ± 6.1 kg/m2, P < 0.001) and higher prevalence rates of elevation of ALT(42.2% vs 14.6%, P < 0.001), elevation of aspartate aminotransferase(38.7% vs 18.9%, P < 0.001), and metabolic syndrome(64.8% vs 33%, P < 0.001) than those without hepatic steatosis. The NFS scores(P = 0.002) and the APRI scores(P = 0.002) were significantly higher in those with steatosis but the scores of the FIB4 index and BARD were similar between the two groups. After adjusting for age, gender and BMI, elevated transaminases, metabolic syndrome and its components, intermediate NFS and APRI scores were associated hepatic steatosis in multivariable analysis. CONCLUSION: The burden of NASH and advanced fibrosis in the Hispanic community in South Texas may be more substantial than predicted from referral clinic studies.

Effect of the Mediterranean Diet on BMI in Middle-Aged Hispanic Women with Pre-Obesity and Obesity Central Washington State

Background: Conclusive evidence has yet to emerge regarding the effectiveness and applicability of the Mediterranean diet on middle-aged Hispanic women, the largest female minority group in the United States who is at-risk of metabolic disorders. Objective: The aim of this study is to evaluate the effect of the Mediterranean diet (MED) on the BMI in middle-aged Hispanic women with pre-obesity and obesity in Central Washington State. Design: A prospective study was performed to determine the effect of Mediterranean diet on the BMI of 67 Hispanic women with pre-obesity and obesity between 45 to 65 years of age in Central Washington State. The study was carried out for eight weeks. Dietary adherence was monitored to ensure consistent results. Results: The proportion of Hispanic women who reported a reduction in BMI was 94%, with a decrease in mean BMI after eight weeks of 2.8 (95% CI: 2.5 to 3.0) and P = 0.02, with an odds ratio of 2.6. Multiple linear regression analysis was used to adjust for age, education, physical activity, and smoking. Conclusion: The reduction in BMI demonstrates that the Mediterranean diet can be a promising, culturally appropriate therapy to address the obesity epidemic that is prevalent among Hispanic women.

Ayudando a Una LobaSolitaria y Su Cub Moribundo： Helping a Lone Wolf and Her Dying Cub

The purpose of this article is to describe the experience of a young, single, Latina parent whose child has died as a result of a rare, terminal genetic defect in the context of a long standing friendship. The article exantines the communication of an effective bereavement counselor as well as seeks to explore the systematic steps parents could employ to help their children with life limiting illnesses including treatment, palliative care, removing life support, hospice, and managing personal grief. Finally, special considerations were made to be sensitive to pertinent multicultural and spiritual or religious aspects that may be evident in the unique world of parents who have lost a child.

Trust in the State Courts： Hispanic and African American Communities

The paper aims to compare the levels ofa＇ust Caucasians, African Americans, Hispanics, and other minority groups have in state courts. The paper presents four hypothesize which contend that African Americans, Hispanics, and other minority groups have lower levels of trust in state courts in comparison to Caucasians. Using data from a 2001 Justice at Stake Public Survey, a multivariate regression analysis was performed to assess the validity of each hypothesis. The variable for Race/Ethnicity was used as a baseline allowing for the comparison of levels of trust among each racial/ethnic group. The findings indicate that African Americans have a lower level of trust in state courts in comparison to their Caucasian and other minority counterparts and vice versa. Surprisingly, Hispanics were found to have no more or less trust in state courts when compared to Caucasians, African Americans, and other minority groups. Further research regarding trust in state courts should be carried out in both African American and Hispanic communities. Lastly, it is noteworthy to mention that the data set contained some limitations, such as its age and the exclusion of＂Asian＂ in the racial/ethnic categories.

Analysis of Childhood Obesity in Alabama and Delaware: A Cohort Study

Objective: The objective is to evaluate data sets for children aged 24 to 59 months that identified the risk factors of being obese and overweight and compare it between two U.S. states (Alabama and Delaware). Methods: An analysis of survey data sets published between 2013 and 2017, comparing the factors of obesity and its prevalence amongst different races of 50,760 children aged 24 to 59 months in the U.S., was conducted using Microsoft Excel 2016 and IBM SPSS version 1.0.0. Results: Hispanic children have the highest rate of obesity in the U.S compared to all other races. Children aged 2 - 4 years old from Alabama were more at risk for being overweight and obese compared to those from Delaware. Those between the ages of 48 - 59 months of age were more at risk than the other age groups. Conclusions: Childhood obesity is a predisposing factor for adult obesity. There is a need to identify the risk factors of obesity early in a person’s life and address them appropriately.

Border Crossings in Gregory Nava＇s El Norte （1983） and Mi Familia （1995）

This paper presents the experience of border crossing by Hispanic Americans depicted by Gregory Nava in his two films： E1 Norte （1983） and Mi Familia （1995）. The former deals with the journey across the Mexican-American border in a literal sense; the latter describes the metaphorical borderlands separating Latina/os from Anglo-Americans in the USA. Nava＇s depictions emphasize family to counter the popular media stereotypes of Chicana/o as gang members. ＂El Norte＂ expresses immigrants＇ displacement and disillusionment with the American Dream, while ＂Mi Familia＂ places Mexicans within the history of LA （Los Angeles） and translates Latina/o culture into a narrative familiar to the mainstream audience.

Comparative study of breast cancer in Mexican and Mexican-American women

Breast cancer is the number one cause of can- cer deaths among Hispanic women in the United States, and in Mexico, it recently became the primary cause of cancer deaths. This malign- nancy represents a poorly understood and un- derstudied disease in Hispanic women. The ELLA Binational Breast Cancer Study was es- tablished in 2006 as a multi-center study to as- sess patterns of breast tumor markers, clinical characteristics, and their risk factors in women of Mexican descent. We describe the design and implementation of the ELLA Study and provide a risk factor comparison between women in the U.S. and those in Mexico based on a sample of 765 patients (364 in the U.S. and 401 in Mexico). Compared to women in Mexico, U.S. women had significantly (p < 0.05) lower parity (3.2 vs. 3.9 mean live births) and breastfeeding rates (57.5% vs. 80.5%), higher use of oral contraceptives (60.7% vs. 50.1%) and hormone replacement therapy (23.3% vs. 7.6%), and higher family history of breast cancer (15.7% vs. 9.0%). Re- sults show that differences in breast cancer risk factor patterns exist between Mexico and U.S. women. We provide lessons learned from the conduct of our study. Binational studies are an important step in understanding disease pat- terns and etiology for women in both countries.

Helicobacter pylori recurrence after eradication in Latin America:Implications for gastric cancer prevention

To estimate Helicobacter pylori (H. pylori) recurrence rate in Latin America, a region with a significant H. pylori prevalence and gastric cancer burden. METHODSPubMed, LILACS, SciELO, Cochrane databases and abstracts from relevant meetings were reviewed. Information collected included: Participants’ characteristics, recruitment strategy, diagnostic modality, treatment arms, follow-up and recurrence rates. Recurrence was calculated using 100-patients-year rates, and data were pooled using a random effects model. The I2 statistic assessed between study heterogeneity. Meta-regression analyses evaluated for effect modifying variables. RESULTSLiterature search yielded 163 articles. Twelve studies involving 4848 patients from 9 countries met inclusion criteria. Four hundred and thirty-two reinfections were recorded in 5487 person-years of follow-up. Pooled analysis showed a recurrence rate of 7.9 cases per 100 person-years (95%CI: 5.3-10.5). Meta-regression revealed that neither the antibiotic schema, a second antibiotic course, nor the diagnostic modality had an impact on the observed risk of recurrence. The recurrence rate in the first year after treatment, predominantly recrudescence, was 11.2 (6.1-16.4) per 100 patient years. Recurrence in subsequent years, was only 6.2 (3.8-8.7). CONCLUSIONH. pylori recurrence rates in Latin America are significant, and with geographic variability, yet are acceptable based upon the current literature for consideration of large scale intervention trials. Further research in Latin America is warranted to evaluate the efficacy, cost-effectiveness, and potential adverse outcomes of proposed eradication programs.

NAFLD prevalence differs among hispanic subgroups:The multi-ethnic study of atherosclerosis

AIM: To compare prevalence rates of non-alcoholic fatty liver disease (NAFLD) between Hispanics of Mexican origin and Hispanics of Dominican and Puerto Rican origin.

Physical activity and nutrition attitudes in obese Hispanic children with non-alcoholic steatohepatitis

AIM:To assess nutrition,physical activity and health-ful knowledge in obese children with biopsy-proven nonalcoholic steatohepatitis(NASH or NA)compared to children without liver disease.METHODS:Children with biopsy-proven NASH comprised the NASH group.Age,sex and ethnicity matched control groups consisted of obese(OB)and lean(CO) children with no liver disease.Subjects were adminis-tered the School Physical Activity and Nutrition Survey and one blood draw was obtained.RESULTS:Fifty-seven patients were enrolled with a mean age of 12.1±2.1 years,and all were Hispanic.Even though the OB and NA had a similar increased body mass index(%),35%of the NA group always read nutrition labels compared to none in the OB(P<0.05),and more NA children felt their diet is"less healthy".NA consumed the least amount of fruits with only 25%having≥1 fruit/d vs 45%in OB and 64.7% in CO(P<0.05 NA vs CO).Only 15%of NA subjects performed light exercise vs 35%and 59%of OB and CO groups,respectively(P=0.02).The mean physical activity score was lowest in the NA group(P<0.05).Amongst the subjects with NASH,we found that 100% of patients with grade 2 or 3 fibrosis had a sedentary score>2 compared to only 63.6%of those with grade 1 or no fibrosis(P<0.05).CONCLUSION:Children with NASH had increased sedentary behavior,decreased activity,and fruit intake.Larger studies may determine the benefit of changing these behaviors as treatment for NASH.

Predictors of colorectal cancer testing using the California Health Inventory Survey

AIM:To identify key variables associated with colon cancer testing using the 2009 California Health Inventory Survey(CHIS).METHODS:The CHIS has been conducted biennially since 2001 using a two-stage,geographically stratified random-digit-dial sample design to produce a representative sample of the entire State.For this study we used survey data from 2001-2009 inclusive.We restricted our analysis to White,Black,and Hispanic/Latinos aged 50-80 years.Weighted data was used to calculate the proportion of participants who underwent some form of colon cancer testing(colonoscopy,flexible sigmoidoscopy or fecal occult blood testing) within the previous 5 years stratified by race/ethnicity.For inferential analysis,boot-strapping with replacement was performed on the weighted sample to attain variance estimates at the 95%CI.For mean differences among categories we used t-tests and for comparisons of categorical data we used Pearson's χ 2.Binary logistic regression was used to identify independent variables associated with undergoing some form of testing.Trend analysis was performed to determine rates of testing over the study period stratified by race.RESULTS:The CHIS database for 2009 had 30 857 unique respondents corresponding to a weighted sample size of 10.6 million Californians.Overall,63.0%(63.0-63.1) underwent a colon cancer test within the previous 5 years;with 70.5%(70.5%-70.6%) of this subset having undergone colonoscopy.That is 44.5%(44.4%-44.5%) of all individuals 50-80 underwent colonoscopy.By multivariable regression,those tested were more likely to be male(OR = 1.06;95%CI:1.06-1.06),Black(OR = 1.30;95%CI:1.30-1.31),have a family member with colon cancer(OR = 1.71;95%CI:1.70-1.72),and have health insurance(OR = 2.71;95%CI:2.70-2.72).Progressive levels above the poverty line were also associated with receiving a test(100%-199%:1.21;1.20-1.21),(200%-299%:1.41;1.40-1.42),(> 300:1.69;1.68-1.70).The strongest variable was physician recommendation(OR = 3.90;95%CI:3.88-3.91).For the Hispanic/Latino group,additional variables associated with testing were success of physician-patient communication(OR = 2.44;95%CI:2.40-2.48) and naturalized citizenship status(OR = 1.91;95%CI:1.89-1.93).Trend analysis demonstrated increased colon cancer testing for all racial/ethnic subgroups from 2001-2009 although the rate remained considerably lower for the Hispanic/Latino subgroup.CONCLUSION:Using CHIS we identified California citizens most likely to undergo colon cancer testing.The strongest variable associated with testing for all groups was physician recommendation.

Clinical features of alcoholic hepatitis in latinos and caucasians: A single center experience

AIM To study differences of presentation, management, and prognosis of alcoholic hepatitis in Latinos compared to Caucasians. METHODS We retrospectively screened 876 charts of Caucasian and Latino patients who were evaluated at University of California Davis Medical Center between 1/1/2002-12/31/2014 with the diagnosis of alcoholic liver disease. We identified and collected data on 137 Caucasians and 64 Latinos who met criteria for alcoholic hepatitis, including chronic history of heavy alcohol use, at least one episode of jaundice with bilirubin ≥ 3.0 orcoagulopathy, new onset of liver decompensation or acute liver decompensation in known cirrhosis within 12 wk of last drink. RESULTS The mean age at presentation of alcoholic hepatitis was not significantly different between Latinos and Caucasians. There was significant lower rate of overall substance abuse in Caucasians compared to Latinos and Latinos had a higher rate of methamphetamine abuse(12.5% vs 0.7%) compared to Caucasians. Latinos had a higher mean number of hospitalizations(5.3 ± 5.6 vs 2.7 ± 2.7, P = 0.001) and mean Emergency Department visits(9.5 ± 10.8 vs 4.5 ± 4.1, P = 0.017) for alcohol related issues and complications compared to Caucasians. There was significantly higher rate of complications of portal hypertension including gastrointestinal bleeding(79.7% vs 45.3%, P < 0.001), spontaneous bacterial peritonitis(26.6% vs 9.5%, P = 0.003), and encephalopathy(81.2% vs 55.5%, P = 0.001) in Latinos compared to Caucasians.CONCLUSION Latinos have significant higher rates of utilization of acute care services for manifestations alcoholic hepatitis and complications suggesting poor access to outpatient care.