What do race and ethnicity mean?
The terms "race" and "ethnicity" are used to refer to people of similar cultural, religious, tribal, or geographic ancestry. However, both terms are notoriously difficult to define, and the divisions are not always based on biology rather than appearance.1,2
Despite these troubled terms, doctors have found differences in health characteristics and treatment patterns between different racial and ethnic groups.3,4 Women who belong to certain groups are more likely to develop conditions that put them at risk for vein disease, so it is especially important that they work with their doctor to reduce their risk.
How do doctors classify racial or ethnic groups?
Racial and ethnic groups are defined in many different ways in different studies. However, the US government recommends using at least the following six major racial groups:5
- American Indian or Alaska Native
- Black or African American
- Hispanic or Latino
- Native Hawaiian or Other Pacific Islander
For ethnicities, the government recognizes two categories: "Hispanic or Latino" and "Not Hispanic or Latino."
How can race or ethnicity influence the health of my veins?
Your race and ethnicity can affect your health in two main ways: your environment and your genes.
Race and ethnicity often influence a person's environment, which includes education level, access to healthcare, cultural practices, and socioeconomic status. Lower socioeconomic status is linked to a unhealthy diet that makes you more likely to become overweight or obese and to develop diabetes, both risk factors for vein disease.6
Some races may also be less likely to have health insurance, or to have access to healthcare services for prevention and treatment. Bias, stereotyping, prejudice, and uncertainty on the part of healthcare providers can also contribute to racial and ethnic disparities in health outcomes.7
The second way that race and ethnicity can affect your health is through your genes. People of similar geographic ancestry share certain biological characteristics that may predispose them to certain diseases, such as diabetes.4 See also: Family History & Vein Disease Risk.
Is vein disease more common in certain races?
Disease in the peripheral veins is more common in certain races. African Americans are at the highest risk, and are 30% more likely than whites to suffer a blood clot in the veins of the legs (deep vein thrombosis, or DVT) that can travel to the lungs and cause a potentially deadly pulmonary embolism.8 People of Asian or Native American backgrounds have a much lower risk, 70% less than whites.9,10
The reasons for these differences are not well understood. Differences in blood clot risk factors may be partly to blame: African-Americans who suffer a DVT or pulmonary embolism are more likely to have diabetes and kidney disease, while whites are more likely to have cancer.11
African Americans who suffer a DVT or PE are five times as likely to have complications, and 30% more likely to die within 30 days than whites are.12,13 However, there is no evidence that African Americans are less likely to receive proper treatment or recommended diagnostic tests.14
Are certain races more likely to have vein disease risk factors?
Yes. Some, but not all, of the racial disparities in vein disease are explained by differences in risk factors, including:
- Diabetes - Diabetes is much more common among African Americans and Hispanics than it is among whites. Thirteen percent of African American women and Mexican American women have diabetes, compared with 6% of white women. The death rate from diabetes is 2.3 times higher for African American women than for white women.15
- Obesity - In the US, African Americans have the highest rates of overweight and obesity. About 80% of African-American women, 74% of Mexican American women, and 70% of Native American and Alaskan Natives are overweight or obese, compared with 58% of white women.15
- Smoking – Smoking and smokeless tobacco use is highest among Native Americans and Alaskan Natives, and 28% of these women are current smokers.16 Meanwhile, 21% of white women, 18% of African-American women, 11% of Hispanic women, and only 5% of Asian women smoke.15
Should I tell my doctor about my racial or ethnic background?
Yes. Telling your doctor about your racial and ethnic background will help him or her to better estimate your disease risks. It is important to include this information on the social and family history section of the patient information form you fill out when you visit a doctor for the first time. Visual clues such as facial features or skin color have only a slim correlation with our race,17 so it is more helpful to tell your doctor where your ancestors are from than to have the doctor guess if you belong to some broad category such as black, white, or Asian.2
It is also important to let your doctor know how long you and your family have been living in the US because where you live now can sometimes reveal more about your health risks than your racial or ethnic background. For example, a study of Japanese and Japanese Americans living in Hawaii found that Japanese Americans were more likely to have diabetes than their peers still living in Japan.18
If I cannot change my race, why it is important that I know how it affects my risk?
Because African American women are more likely to develop blood clots in the veins than women of other races, it is especially important that they take steps to lower their risk. Whatever your race or ethnicity, working with your doctor to get your risk factors under control can reduce your risk of developing vein disease.
African Americans may be at particularly high risk for blood clots after "triggers" like surgery or hospitalization.8 Because of this, African-American women in particular need to know their DVT risk and work with their healthcare team to prevent blood clots when undergoing surgery or long periods of immobility.
There is no evidence that treatment of blood clots should be different for women of different races, or that minority women receive less benefit from proven prevention strategies.19
See Preventing DVT: The Basics to learn how you can control your risk factors and reduce your risk of developing blood clots in the veins.
See also: Race, Ethnicity, & PAD Risk
For More Information
Why the Difference? An Initiative on Racial/Ethnic Disparities in Medical Care
U.S. Department of Health & Human Services Office of Minority Health
CDC Office of Minority Health and Health Disparities
- Burchard EG, Ziv E, Coyle N, et al. The importance of race and ethnic background in biomedical research and clinical practice. N Engl J Med. Mar 20 2003;348(12):1170-1175.
- Tishkoff S, Kidd K. Implications of biogeography of human populations for 'race' and medicine. Nat Genet. Oct 26 2004;36(11):S21-S27.
- Jorgenson E, Tang H, Gadde M, et al. Ethnicity and human genetic linkage maps. Am J Hum Genet. Feb 2005;76(2):276-290.
- Collins F. What we do and don't know about 'race', 'ethnicity', genetics and health at the dawn of the genome era. Nat Genet. Oct 26 2004;36(11):S13=S15.
- Revisions to the Standards for the Classification of Federal Data on Race and Ethnicity. Washington, DC: Office of the President, Office on Management and Budget; Jan, 1 2003.
- Gary TL, Baptiste-Roberts K, Gregg EW, et al. Fruit, vegetable and fat intake in a population-based sample of African Americans. J Natl Med Assoc. Dec 2004;96(12):1599-1605.
- Nelson A. Unequal treatment: confronting racial and ethnic disparities in health care. J Natl Med Assoc. Aug 2002;94(8):666-668.
- White RH, Keenan CR. Effects of race and ethnicity on the incidence of venous thromboembolism. Thromb Res. 2009;123 Suppl 4:S11-17.
- White RH, Zhou H, Romano PS. Incidence of idiopathic deep venous thrombosis and secondary thromboembolism among ethnic groups in California. Ann Intern Med. May 1 1998;128(9):737-740.
- White RH, Zhou H, Murin S, Harvey D. Effect of ethnicity and gender on the incidence of venous thromboembolism in a diverse population in California in 1996. Thromb Haemost. Feb 2005;93(2):298-305.
- Dowling NF, Austin H, Dilley A, Whitsett C, Evatt BL, Hooper WC. The epidemiology of venous thromboembolism in Caucasians and African-Americans: the GATE Study. J Thromb Haemost. Jan 2003;1(1):80-87.
- Aujesky D, Long JA, Fine MJ, Ibrahim SA. African American race was associated with an increased risk of complications following venous thromboembolism. J Clin Epidemiol. Apr 2007;60(4):410-416.
- Ibrahim SA, Stone RA, Obrosky DS, Sartorius J, Fine MJ, Aujesky D. Racial differences in 30-day mortality for pulmonary embolism. Am J Public Health. Dec 2006;96(12):2161-2164.
- Stein PD, Hull RD, Patel KC, et al. Venous thromboembolic disease: comparison of the diagnostic process in blacks and whites. Arch Intern Med. Aug 11-25 2003;163(15):1843-1848.
- American Heart Association. Statistical Fact Sheet - Women and Cardiovascular Diseases 2010.
- Barnes PM, Adams PF, Powell-Griner E. Health Characteristics of the American Indian or Alaska native Adult Population: United States, 2004-2008. Hyattsville, MD: National Center for Health Statistics; March 9 2010.
- Parra EJ, Kittles RA, Shriver MD. Implications of correlations between skin color and genetic ancestry for biomedical research. Nat Genet. Oct 26 2004;36(11):S54-S60.
- Nakanishi S, Okubo M, Yoneda M, Jitsuiki K, Yamane K, Kohno N. A comparison between Japanese-Americans living in Hawaii and Los Angeles and native Japanese: the impact of lifestyle westernization on diabetes mellitus. Biomed Pharmacother. Dec 2004;58(10):571-577.
- Saunders E, Ofili E. Epidemiology of atherothrombotic disease and the effectiveness and risks of antiplatelet therapy: race and ethnicity considerations. Cardiol Rev. Mar-Apr 2008;16(2):82-88.