BLACK HISTORY MONTH: RECOGNIZING AND ADDRESSING HEALTH DISPARITIES OF AFRICAN AMERICANS
February is recognized as Black History Month. In 1976, President Gerald Ford recognized Black History Month as a nationally celebrated event to be observed every February so this year marks 45 years of this annual celebration. In the words of Carter G. Woodson, an early historian who advocated such recognition, “What we need is not a history of selected races or nations, but the history of the world void of national bias, race hate, and religious prejudice.”
While we, as a society, have come a long way in racial equality, what remains is an unacceptable disparity in the health of African Americans.
Health Disparities: African Americans vs Other Ethnic Groups
Compared to non-hispanic Caucasians, African Americans are at a much higher risk for heart diseases, stroke, cancer, asthma, influenza and pneumonia, diabetes, and HIV/AIDS, according to the Office of Minority Health.
Furthermore African Americans are more likely to die at an earlier age for all causes.
African Americans suffer from higher incidence of nearly every major disease compared to other ethnic groups. For example, high blood pressure occurs in 12% vs. 10% of blacks vs. whites aged 18-34 years, respectively. It is even more common in 33% vs. 22% of those aged 35-49 years, respectively.
Diabetes occurs in 10% of blacks aged 35-49 compared to 6% of whites. Stroke is present in 0.7% of blacks aged 18-34 compared to 0.4% of whites the same age, 2% compared to 1% aged 35-49 and 7% vs. 4%, respectively, in those aged 50-64. African Americans suffer from kidney failure at a rate as much as 3 times the rate of Caucasians. Blacks make up roughly 13% of the U.S. population but make up roughly 33% of all patients in the U.S. receiving dialysis for kidney failure.
Factors Explaining Health Disparities
There are social factors that contribute to the health issues but also genetic and physiological contributors to the increased incidence of disease in African Americans.
Racial disparities in health can be useful to study gene-environment interactions as historically, American people of different races originated from different continents, thereby providing different gene-environment interactions as major factors that result in observed racial health disparities.
For example, genetic variations in genes that encode for sodium channels are more common in African Americans than Caucasians and are associated with the development of a salt-sensitive hypertension. This can explain the increased incidence of high blood pressure in some African Americans.
Several polymorphisms (genetic mutations) in the enzyme that makes nitric oxide (eNOS) gene have been identified that can decrease nitric oxide production. One of these variants, the 4a/4b polymorphism, is consistently more common among African Americans (30%–36%) compared to Caucasians (15%–18%). This reveals that African Americans make less nitric oxide than Caucasians.
Difference in Nitric Oxide Production
Other genes involved in racial differences in endothelial function and nitric oxide production is the glucose-6-phosphate dehydrogenase (G6PD) gene. G6PD regulates the availability of critical cofactors necessary to make nitric oxide.
A deficiency in G6PD has been shown to be more common in African Americans (~15%) than in Caucasian (~6%) and has been proposed to be responsible for the increased oxidative stress observed in African Americans. In addition, there is evidence of increased NADPH oxidase activity in African Americans as compared with Caucasians, which is another major source of oxidative stress. Oxidative stress decreases nitric oxide production and contributes to chronic disease.
Hence, based on social, genetic, and physiological factors, African Americans have a higher degree of endothelial dysfunction which means they produce less nitric oxide than whites and this single fact explains the increased risk of all major diseases including COVID-19.
The evidence is undeniable. This is critically important as it provides a very strong rationale that African Americans are deficient in nitric oxide and would benefit immensely from therapies and lifestyle strategies that enhance nitric oxide.
Our drug study investigating nitric oxide therapy in African Americans recently diagnosed with COVID is a giant step forward in ending these health disparities. If you or someone you know is African American age 50-85 and recently diagnosed with COVID, please visit www.aacovidstudy.com. We need participation in clinical studies. It is up to all of us to contribute to these efforts.
Historically, many African Americans have broken down barriers and made seminal discoveries in science and medicine that have improved the health of millions of people. The link below recognizes ten African American medical pioneers:
I’m still hoping for the day where we are all judged by the content of our character and not the color of our skin. We are making great strides in science and medicine to provide personalized medicine to African Americans and others to normalize their risks for chronic disease. Once again, a very simple molecule, nitric oxide, has the potential to change the world as we know it and level the playing field for all races.