Hispanics Receive Fewer Surgeries for Vascular Disease

(HealthDay News) -- Compared to the general population, Hispanics in the United States have fewer vascular surgeries, less favorable outcomes for treatment of vascular disease, and often have advanced vascular disease by the time they seek treatment, according to a new study.

While the reasons for these disparities aren't understood, they may be due to a number of socioeconomic and genetic factors, said the study authors, led by a vascular surgery team from New York-Presbyterian Hospital, Columbia University Medical Center and Weill Cornell Medical College.

Their findings were published in the November issue of the Journal of Vascular Surgery.

The research focused on three common vascular surgery procedures -- lower extremity revascularization (LER), carotid revascularization (CR), and abdominal aortic aneurysm (AAA) repair -- performed at hospitals in New York and in Florida between 2000 and 2004.

Compared to whites, Hispanic patients had a higher rate of amputation (6.2 percent vs. 3.4 percent) following LER -- meant to restore blood supply to a body part or organ -- and higher death rates following elective AAA repair (5.0 percent vs. 3.4 percent). The study also found that Hispanic patients were as much as two times more likely than whites to seek treatment only after developing advanced vascular disease, and they had longer hospital recovery times.

"These are significant disparities, and the reasons for them must be determined in order to make improvements," principal investigator Dr. Nicholas J. Morrissey, director of clinical trials and a vascular surgeon at New York-Presbyterian Hospital/Columbia University Medical Center, said in a prepared statement.

"One explanation may be socioeconomic factors, particularly insurance status, which could impede Hispanic patients' access to proper preventive and diagnostic care," said Morrissey, who is also an assistant professor of surgery at Columbia University College of Physicians and Surgeons and Weill Cornell Medical College.

More information
The Society of Interventional Radiology has more about vascular diseases.

A Full and Long Life, Despite Diabetes

(HealthDay News) -- Bob Cleveland may be 87 years old, but he still remembers the day he was first diagnosed with type 1 diabetes -- in 1925.

"I went to the hospital at five years of age, and I thought to myself, 'OK, I'm going to die.' Because never having been to the hospital before, I just thought that's where you went to die," said Cleveland, of Syracuse, N.Y.

He didn't die. The hospital personnel just tested and confirmed that he had type 1 diabetes. But Cleveland has gone on to enjoy life to the fullest, pursuing mountain climbing and other outdoor adventures, having a rewarding career as an accountant at General Motors, and raising a family -- with his wife, Ruth, 86 -- all the while monitoring his blood sugar and taking insulin as needed each day.

"He amazes me," Ruth Cleveland said. "He's still able to take care of the yard, even drive a 32-foot motor home to Florida -- and he does it well."

People like Cleveland -- and his older brother Gerald, who is 91, and also has type 1 diabetes-- serve as a reminder on Nov. 14 , World Diabetes Day, that amid the grim statistics lies the notion that a life with diabetes can be active, healthy and without limits.

According to the World Health Organization, 3.2 million people worldwide die from diabetes each year and, if improperly managed, the illness can shorten lifespans by an average of 12 years. More than 18 million Americans have diabetes, with 95 percent developing the obesity-linked type 2 disease.

Type 1 disease usually begins in childhood and is linked to an inability of the insulin-producing cells to do their job. It typically means a lifetime of blood glucose monitoring and insulin supplementation.

Most type 1 diabetics don't let it overwhelm them, however.

"Yes, diabetes is something that you have to deal with, but it's just another part of your life," said 73-year-old Alan Lewis, professor emeritus of oceanography at the University of British Columbia, Vancouver.

Lewis was first diagnosed with type 1 diabetes 69 years ago but has also spent most of his adult life as a competitive swimmer. He only eased up on the competition at age 71, after a back injury got in the way of his breaststroke.

That setback is only temporary, he said. "The old juices are still flowing, so I have a feeling that I will get back into competitive swimming in about a year," Lewis said.

Experts say that type of can-do attitude, coupled with steadfast attention to blood sugar monitoring, diet and exercise, are the keys that allow diabetics to live well into their 70s, 80s, and even beyond.

Diabetes care has certainly improved since the Clevelands and Lewis were diagnosed as children. Today, high-tech pocket-sized glucose monitors mean quick, easy blood-sugar monitoring is literally at your fingertips. Insulin delivery is also easier than ever.

In the 1930s and 1940s, however, blood sugar could only be tested at home via urine sampling, which provided patients with only a much-delayed look at blood glucose levels. Medical crises -- moments when sugar levels dipped so low a coma might result -- were common.

"When you talk to the elderly with diabetes who have gotten to live to today, they have lived through a time and place when we really couldn't take care of diabetes very well," said Dr. Larry Deeb, immediate past president for medicine and science at the American Diabetes Association.
"However, even then, they made the commitment to take care of themselves," he added. "They reviewed their urine glucose, they took their insulin every day, they watched their diet and were active."

"It takes a huge commitment to take care of yourself with diabetes, to mind it every day," he said. "There's never a day off."

And yet, most elderly diabetics say that managing their diabetes quickly became routine.
"I think I was so focused on what was of interest to me in my life that diabetes was simply something I got used to," Lewis said. "It became just a hurdle I needed to go through to get someplace."

Indeed, many older diabetics may have lived so long, because "they have turned their diabetes into an asset," explained Dr. Sheri Colberg, a Virginia Beach, Va., exercise physiologist who has done much research on diabetes, longevity and lifestyle.

Colberg -- a type 1 diabetic herself -- interviewed dozens of diabetic seniors for her book, 50 Secrets of the Longest Living People With Diabetes. "I actually had some people who told me, 'Diabetes saved my life,' " she said. "They said to themselves, 'If I don't do this, I am going to die sooner.' They used diabetes as an incentive to adopt a healthier lifestyle, better eating patterns. And to stay physically active -- every one of them was physically active."

That's something Cleveland and Lewis agreed with.

"I've always been more of an outdoor person and more interested in exercise, games, swimming, thing like that," Cleveland said. "They were definitely advantageous for a diabetic."
Lewis added that the discipline and energy expenditure demanded by competitive swimming forced him early on to closely track his blood sugar highs and lows.

"I would advise people to test frequently, to get to know what your own [blood sugar] profile is, and then to set up a game plan to deal with those effects," he said.

Exercise also helps people stay slim, which is always a good thing when it comes to either type 1 or adult-onset type 2 diabetes, Deeb said. Indeed, all of the advice for people with type 1 disease would apply to the greater population of people with type 2 illness, he said.

Another key to a long, healthy life with diabetes: the support of loved ones.

Lewis said his wife, Carolyn, has helped him manage his diabetes for more than 50 years.

Cleveland credits Ruth with helping him get him through the tough times.

"I got married at age 27, and my wife has done the most wonderful job of helping me that anyone ever could," Cleveland said.

Ruth Cleveland said her husband initially kept his diabetes a secret from her when they were first courting more than 60 years ago, due to the stigma then attached to the disease.

"He claims he was afraid to tell me, afraid that I wouldn't want to continue seeing him," she said.
Those fears were unfounded.

"If anything, it made me appreciate him more and want to be a part of his life," Ruth said. "Which has turned out to be wonderful."

More information
Find out more on managing diabetes at the American Diabetes Association.

Arthritis-related disability can have a major impact on a person's employment, forcing them to change work hours, the type and na

(HealthDay News) -- Living farther away from transplant centers doesn't explain why black Americans with end-stage renal (kidney) disease are less apt than whites to be placed on the kidney transplant waiting list, researchers say.

A team that analyzed data on end-stage renal (kidney) disease patients in Georgia and the Carolinas from 1998 to 2002 found that black patients in poorer neighborhoods were 56 percent less likely to than whites to be placed on the transplant waiting list.

"This finding warrants further exploration but suggests that racial disparity in the wait-listing process may indeed be a reflection of differential access to health care," study co-author Dr. Sandra Amaral, of Emory University in Atlanta, said in a prepared statement.

Of the almost 12,600 patients (62 percent of them black) included in the study, 17 percent were placed on the kidney transplant waiting list during the study period. Black patients were more likely than whites (27 percent versus 9 percent) to live in areas where more than 25 percent of the population lived below the poverty line.

The researchers had hypothesized that patients who lived farther from transplant centers would be less likely to be placed on the kidney transplant waiting list. But they found that distance to the transplant center didn't have a major impact on the likelihood of being placed on the list. They did find that black patients living in poorer neighborhoods were 56 percent less likely than whites to make it on the list.

"Racial disparities persist in the U.S. transplantation process," Amaral said. "The reasons for this are poorly understood, but multiple factors are likely involved."

"To our knowledge, this is the first study to examine the impact of community poverty on racial disparity in transplant wait-listing. It also introduces a potential new approach to addressing the disparities: reaching out to poorer communities with advocacy and education," she said.

The study was scheduled to be presented at the American Society of Nephrology annual meeting, in San Francisco.

More information
The U.S. National Institute of Diabetes and Digestive and Kidney Diseases has more about kidney transplantation.