Abstract
According to the Centers for Disease Control and Prevention (2013), African Americans have a substantially greater prevalence of a range of health conditions when compared to other racial or ethnic groups. Many of these conditions have been attributed to the historical and contemporary social and economic disparities faced by the African American community. While many health conditions occur at a higher rate in African Americans, it is unclear whether there are specific symptom clusters that may also be more prevalent in African Americans as a result of these disparities. Potential differences in symptomology have not been thoroughly examined between African Americans and White populations. The current study compares the prevalence and pain severity of symptoms among a sample of African Americans and White participants. Significant differences in symptom prevalence were found in disturbed sleep and reproductive areas. African Americans also experience more pain due to symptoms related to orthostatic intolerance. Implications of this finding are discussed.
Keywords: Orthostatic Intolerance, African Americans, Symptoms, Symptomology
According to the Centers for Disease Control and Prevention (CDC) (2013), African Americans endorse a disproportionately greater prevalence of a variety of illnesses and conditions across the life span compared with other racial or ethnic populations. These include, but are not limited to infant mortality, teen pregnancy, asthma, hypertension, tobacco usage, obesity, high cholesterol, lack of physical activity, seasonal influenza, HIV/AIDS, and tuberculosis (CDC, 2013). Additionally, African Americans have been found to experience greater incidence and mortality rates for cancers, such as those of the oropharynx, colorectum, lung and bronchus, cervix, and prostate (Walker, Figgs, & Zahm, 1995).
Along with higher illness prevalence, the National Longitudinal Mortality Study revealed greater mortality rates in African Americans compared to Whites among those under 65 years old (Sorlie, Backlund, & Keller, 1995). Even when controlling for other demographic variables (i.e., income), the health status of minorities has still ranked lower than Whites (Institute of Medicine, 2003). These disparities have been attributed to issues with access and quality of health care, nutrition, housing, education, and employment (Sankar et al., 2003). Others have pointed to additional factors including the effects of social and economic inequalities, prejudice, and systematic bias on the overall health of minority populations (Johnson, Saha, Arbelaez, Beach, & Cooper, 2004). However, the relationship between these factors and the increased prevalence of these types of illnesses and behaviors is still unclear.
In order to better understand and address the disparities among these illnesses, it would be useful to examine differences in the symptom profile or the specific types of symptoms that African Americans and Whites may experience. The experience and consequences of different symptoms are often described within a psychological, physiological, behavioral, and sociocultural context (Dodd et al., 2001; Parker, Kimble, Dunbar, & Clark, 2005). Thus, there may be certain symptom clusters that are more prevalent in African Americans than in Whites as a result of these social or economic difficulties. This, in turn, affects the types of illnesses that might exist for African Americans.
Instead of focusing on symptom clusters that are specific to a single illness or one bodily organ, there is a need to examine more generalized symptoms that may affect the different major systems in the body. These differences are important, as they may be major contributing factors to the health disparities that are present among African American populations. The purpose of the current exploratory study is to examine the prevalence and severity of symptoms experienced among a fatigued sample of African Americans and White participants. It was hypothesized that African Americans would evidence more symptoms than White participants.
METHODS
Data from the current study was derived from a larger community-based study examining the prevalence of chronic fatigue syndrome (CFS) within an ethnically and socioeconomically diverse urban sample (Jason et al., 1999). A total of 28,673 men and women participated in the survey through random interviews conducted over the phone in the general population of Chicago between 1995 and 1997. Data collection involved three phases. After verbal consent was established in the first phase, sociodemographic characteristics and symptom information were collected. Respondents who reported severe fatigue, extreme tiredness, or exhaustion for six months or longer were asked additional questions to assess more specific dimensions of their fatigue. In phase 2 and 3, participants were screened for the presence of CFS and given a medical exam and a structured medical history (for additional information on participant recruitment and screening, refer to Jason et al., 1999).
Measures
The phase 1 CFS Screening Questionnaire (Jason et al., 1997) included: (1) sociodemographic characteristics; (2) the Fatigue Scale (Chalder et al., 1993); and (3) other questions that assess type and severity of fatigue-related mental and physical symptoms in addition to the quality and duration of fatigue. Socioeconomic status was quantified according to scoring rules provided by Wasser’s (1991) revision of the Hollingshead (1975) scale. Questions assessing symptoms of CFS, quality, and duration of fatigue were scored according to the Fukuda et al. (1994) criteria for CFS. The CFS Screening Questionnaire is a valid and reliable measure that differentiates individuals with CFS from those who are healthy (Jason, Ropacki, et al., 1997).
The Medical Questionnaire is a modified version of The Chronic Fatigue Questionnaire (Komaroff & Buchwald, 1991), a structured instrument that was used in a study by Komaroff et al. (1996). This comprehensive instrument assessed symptoms related to CFS and chronic fatigue, as well as other medical and psychiatric symptoms. In addition, the Medical Questionnaire measured fatigue severity, fatigue-related social role impairment, psychosocial stressors, job satisfaction, toxic exposures prior to CFS onset, chemical sensitivities, presence of CFS or chronic fatigue in other network members, and family medical history.
Statistical Analyses
Separate chi square analyses were conducted to identify any significant differences between the percentages of symptoms endorsed by African American and White participants. For symptoms that contained an additional question related to current pain severity on a 100-point scale (0 = no pain and 100 = severe pain), separate one-way ANOVAs or Mann-Whitney U Tests were conducted.
RESULTS
Interviews were completed for 18,675 households (65.1% completion rate). Of these individuals, 780 (4.2%) participants endorsed six or more months of fatigue. A randomized group of 213 participants with and without six or more months of fatigue were invited to complete a medical and psychiatric examination. Among these 213 participants, 166 participants endorsed six or more months or fatigue. The current study focused on 115 of these participants who identified as either White or African American.
There were 65.2% who identified as White and 34.8% who identified as African American. Among these participants, 75.7% were female and 24.3% were male. The mean age was 43.2 years old (with a standard deviation of 14.7 years). A total of 47.8% were never married, 21.7% were married, and 30.5% were separated, widowed, or divorced. In regards to education, 40.9% had a GED/high school degree or less, 27.0% had some college or specialty training, and 32.2% had a college or graduate degree. In terms of occupation, 53.0% were on disability or unemployed, while 47.0% were working part or full-time. There were no significant differences between White participants and African Americans on these demographic variables.
As shown in Table 1 and 2, symptoms were distributed into categories based on a prior study conducted on symptom occurrence in individuals (Jason, Torres-Harding, Carrico, & Taylor, 2002). Categories included: Fukuda et al. (1994) Symptoms, Fatigue/Weakness, Disturbed Sleep, Neuropsychiatric, Infections, Rheumatological, Cardiopulmonary, Gastrointestinal, Neurological, and Reproductive.
Table 1.
Separate X2 comparing the endorsement of symptoms after the onset of chronic fatigue by White participants and African Americans (AA) with six of more months of chronic fatigue (n=115).
| AA (n=40) (%) |
White (n=75) (%) |
X2 | p | |
|---|---|---|---|---|
| Fukuda Symptoms | ||||
| Muscle Pain | 95.0 | 94.7 | 0.01 | |
| Memory/Concentration | 87.5 | 81.3 | 0.72 | |
| Joint Pain | 75.0 | 84.0 | 1.37 | |
| Post-Exertional Malaise | 57.5 | 62.7 | 0.29 | |
| Lymph Pain | 40.0 | 48.0 | 0.67 | |
| Headaches | 40.0 | 33.3 | 0.51 | |
| Sore Throat | 37.5 | 49.3 | 1.48 | |
| Unrefreshing Sleep | 12.5 | 18.7 | 0.72 | |
| Fatigue/Weakness | ||||
| General Muscle Weakness | 57.5 | 65.3 | 0.68 | |
| Legs Weak | 42.5 | 45.3 | 0.09 | |
| Arms Weak | 42.5 | 44.0 | 0.02 | |
| Shoulders Weak | 40.0 | 25.3 | 2.65 | |
| Neck Weak | 30.0 | 32.0 | 0.05 | |
| Back Weak | 27.5 | 30.7 | 0.13 | |
| Head Weak | 15.0 | 12.0 | 0.21 | |
| Abdomen Weak | 10.0 | 10.7 | 0.01 | |
| Buttocks Weak | 7.5 | 10.7 | 0.30 | |
| Other Weak Muscles | 7.5 | 10.7 | 0.30 | |
| Disturbed Sleep | ||||
| Early Morning Awakening | 80.0 | 53.3 | 7.92 | ** |
| Trouble Staying Asleep | 65.0 | 38.7 | 9.86 | ** |
| Insomnia | 55.5 | 46.7 | 0.73 | |
| Hypersomnia | 20.0 | 40.0 | 4.72 | * |
| Neuropsychiatric | ||||
| Depression | 47.5 | 52.0 | 0.21 | |
| Irritability | 35.0 | 49.3 | 2.17 | |
| Disturbances in Eyesight | 40.0 | 35.3 | 0.04 | |
| Infections | ||||
| Fever/Chills | 20.0 | 29.3 | 1.18 | |
| Shingles | 5.0 | 6.7 | 0.13 | |
| Genital Herpes | 5.0 | 2.7 | 0.42 | |
| Oral Thrush | 2.5 | 2.7 | 0.00 | |
| Oral Herpes | 0.0 | 9.3 | 3.98 | * |
| Rheumatological | ||||
| Morning Stiffness | 37.5 | 50.7 | 1.82 | |
| Stiff After Sitting | 32.5 | 48.0 | 2.56 | |
| Dry Mouth | 30.0 | 29.3 | 0.01 | |
| Night Sweats | 22.5 | 28.0 | 0.41 | |
| Earaches | 17.5 | 14.7 | 0.16 | |
| Puffy Face | 15.0 | 26.7 | 2.03 | |
| Hay Fever | 12.5 | 21.3 | 1.36 | |
| Sinus Infection | 10.0 | 9.3 | 0.01 | |
| Jaw Pain | 7.5 | 14.7 | 1.25 | |
| Dry Eyes | 5.0 | 24.0 | 6.56 | * |
| Eye Pain | 20.0 | 23.5 | 0.03 | |
| Cardiopulmonary | ||||
| Shortness of Breath | 42.5 | 38.7 | 0.16 | |
| Chest Pains | 30.0 | 14.7 | 3.83 | * |
| Rapid Heartbeat | 30.0 | 22.7 | 0.74 | |
| Cough | 17.5 | 14.7 | 0.16 | |
| Heartbeat in Ears | 17.5 | 12.0 | 0.66 | |
| Raynaud’s phenomenon | 5.0 | 10.7 | 1.06 | |
| Gastrointestinal | ||||
| Bloating | 27.5 | 28.0 | 0.00 | |
| Lower Abdominal Pain | 22.5 | 16.0 | 0.74 | |
| Nausea | 22.5 | 22.7 | 0.00 | |
| Upper Abdominal Pain | 17.5 | 10.7 | 1.07 | |
| Blood in Bowel Movement | 10.0 | 2.7 | 2.84 | |
| Diarrhea | 7.5 | 12.0 | 0.57 | |
| Black Bowel Movement | 5.0 | 1.3 | 1.38 | |
| Neurological | ||||
| Often Feel Dizzy | 52.5 | 29.3 | 5.98 | * |
| Dizzy after Standing | 45.0 | 32.0 | 1.90 | |
| Unsteady Upright | 45.0 | 28.0 | 3.36 | |
| Tingling Sensations | 32.5 | 32.0 | 0.00 | |
| Dizzy Moving Head | 30.0 | 22.7 | 0.74 | |
| Ringing in Ears | 20.0 | 14.7 | 0.54 | |
| Skin Sensations | 7.5 | 16.0 | 1.66 | |
| Temporary Blindness | 5.0 | 6.7 | 0.13 | |
| Paralysis | 0.0 | 2.7 | 1.09 | |
| Reproductive | ||||
| Decreased Sexual Interest | 27.5 | 26.7 | 0.01 | |
| Irregular Periods | 54.5 | 24.2 | 5.24 | * |
| Excessive Menstrual Bleeding | 17.5 | 9.3 | 1.63 | |
| Menopause | 17.5 | 17.3 | 0.00 | |
| Positive Pap Smear (n=67) | 20.0 | 2.1 | 6.49 | * |
| Nipple Discharge | 7.5 | 1.3 | 2.96 | |
| Vaginal Discharge | 27.5 | 17.3 | 1.63 | |
| Recurrent Vaginal Infections | 10.0 | 4.0 | 1.64 | |
| Recurrent Urinary Infections | 15.0 | 2.7 | 6.13 | * |
| Nocturia | 35.0 | 30.7 | 0.22 | |
| Dysuria | 12.5 | 1.3 | 6.58 | * |
| Incontinence | 12.5 | 9.3 | 0.28 | |
| Blood in Urine | 7.5 | 0.0 | 5.78 | * |
Notes:
p < 0.05,
p < 0.01
Missing values are treated as 0
Table 2.
Separate one way ANOVAs comparing pain due to symptoms on a 100-pt scale between White participants and African Americans (AA) with six of more months of chronic fatigue (n=115).
| Symptoms | AA (n=40) Mean (SD) |
White (n=75) Mean (SD) |
df | F | p |
|---|---|---|---|---|---|
| Fukuda Symptoms | |||||
| Muscle Pain | 29.50 (37.19) | 38.68 (38.40) | 1, 113 | 1.52 | |
| Memory/Concentrationa | 37.88 (39.21) | 35.38 (32.14) | 1,67.4 | 0.12 | |
| Joint Pain | 31.63 (39.49) | 33.31 (37.44) | 1, 113 | 0.05 | |
| Post-Exertional Malaise | 25.00 (38.48) | 34.79 (35.33) | 1, 113 | 1.88 | |
| Lymph Paina | 17.50 (32.26) | 8.36 (20.94) | 1,57.0 | 2.62 | |
| Headachesa | 35.00 (39.66) | 24.65 (31.24) | 1,65.3 | 2.05 | |
| Sore Throata | 19.50 (32.89) | 13.95 (23.79) | 1,61.3 | 0.89 | |
| Unrefreshing Sleep | 48.00 (37.72) | 44.11 (35.01) | 1, 113 | 0.30 | |
| Neuropsychiatric | |||||
| Depression | 34.50 (38.74) | 31.37 (34.2) | 1, 113 | 0.20 | |
| Disturbances in Eyesighta | 22.98 (33.01) | 8.85 (19.89) | 1,54.5 | 6.13 | * |
| Irritabilitya | 27.38 (35.43) | 19.11 (26.88) | 1,63.5 | 1.67 | |
| Infectious | |||||
| Oral Herpes | 3.50 (14.24) | 4.35 (15.93) | 1, 113 | 0.08 | |
| Shinglesa | 0.00 (0.00) | 1.64 (8.39) | -- | -- | |
| Oral Thrush | 2.00 (9.11) | 2.44 (14.69) | 1, 113 | 0.03 | |
| Genital Herpesa | 2.88 (12.19) | 0.20 (1.73) | 1,39.8 | 1.91 | |
| Rheumatological | |||||
| Morning Stiffness | 38.00 (43.59) | 38.80 (39.74) | 1, 113 | 0.01 | |
| Stiff After Sitting | 29.15 (40.55) | 37.85 (39.05) | 1, 113 | 1.26 | |
| Hay Fevera | 20.13 (32.20) | 10.40 (20.25) | 1, 55.9 | 3.01 | |
| Puffy Face | 9.98 (27.56) | 14.04 (28.02) | 1, 113 | 0.56 | |
| Dry Mouth | 20.50 (30.73) | 12.77 (25.22) | 1, 113 | 2.10 | |
| Night Sweats | 10.50 (25.03) | 8.25 (19.14) | 1, 113 | 0.29 | |
| Sinus Infection | 7.38 (23.29) | 4.13 (14.53) | 1, 113 | 0.84 | |
| Earachesa | 14.25 (30.22) | 6.20 (18.01) | 1,54.1 | 2.39 | |
| Dry Eyes | 9.23 (24.34) | 12.00 (26.75) | 1, 113 | 0.30 | |
| Eye Paina | 11.50 (28.42) | 6.40 (18.45) | 1,57.0 | 1.05 | |
| Jaw Pain | 6.75 (19.50) | 6.49 (17.60) | 1, 113 | 0.01 | |
| Shortness of Breath | 34.25 (34.41) | 20.00 (27.62) | 1, 113 | 5.83 | * |
| Chest Painsa | 18.00 (29.17) | 9.31 (23.72) | 1,67.0 | 2.63 | |
| Rapid Heartbeata | 20.70 (32.90) | 10.89 (23.22) | 1,60.2 | 2.81 | |
| Cougha | 14.00 (30.20) | 8.07 (20.89) | 1,59.4 | 1.23 | |
| Heartbeat in Earsa | 14.28 (30.60) | 4.48 (13.67) | 1,47.5 | 3.70 | |
| Gastrointestinal | |||||
| Bloating | 23.00 (35.33) | 18.52 (30.03) | 1, 113 | 0.51 | |
| Lower Abdominal Paina | 19.38 (30.60) | 10.40 (24.78) | 1,66.8 | 2.55 | |
| Upper Abdominal Pain | 16.63 (30.50) | 10.67 (26.23) | 1, 113 | 1.20 | |
| Nausea | 12.98 (24.66) | 10.13 (20.45) | 1, 113 | 0.44 | |
| Diarrheaa | 4.38 (18.30) | 9.40 (24.19) | 1,99.9 | 1.56 | |
| Black Bowel Movement | 1.75 (8.44) | 1.20 (10.39) | 1, 113 | 0.08 | |
| Blood in Bowel Movementa | 6.13 (20.58) | 2.07 (10.97) | 1,51.1 | 1.35 | |
| Neurological | |||||
| Often Feel Dizzya | 31.13 (33.92) | 11.67 (23.79) | 1,60.0 | 10.43 | ** |
| Dizzy after Standinga | 37.88 (41.49) | 11.87 (21.05) | 1,49.9 | 13.82 | *** |
| Dizzy Moving Heada | 24.75 (36.34) | 8.16 (19.68) | 1,51.5 | 7.21 | ** |
| Unsteady Uprighta | 25.75 (34.2) | 12.33 (25.00) | 1,61.8 | 4.79 | * |
| Skin Sensations | 5.75 (18.52) | 7.87 (23.16) | 1, 113 | 0.25 | |
| Ringing in Earsa | 16.75 (29.47) | 4.52 (12.63) | 1,46.8 | 6.27 | * |
| Tingling Sensationsa | 24.63 (35.94) | 16.53 (27.53) | 1,63.9 | 1.54 | |
| Paralysis | 0.00 (0.00) | 1.73 (12.01) | 1, 113 | 0.83 | |
| Temporary Blindnessa | 4.75 (17.5) | 1.93 (11.12) | 1,56.2 | 0.85 | |
| Reproductive | |||||
| Decreased Sexual Interest | 19.13 (35.77) | 19.71 (32.5) | 1,113 | 0.01 | |
| Recurrent Vaginal Infectionsa | 11.63 (28.56) | 1.73 (11.32) | 1,45.6 | 4.43 | * |
| Recurrent Urinary Infectionsa | 9.50 (22.53) | 1.13 (9.25) | 1,46.1 | 5.06 | * |
| Nocturiaa | 35.58 (41.19) | 23.95 (36.00) | 1,71.0 | 2.27 | |
| Dysuriaa | 7.55 (25.06) | 0.47 (3.50) | 1,39.8 | 3.16 | |
| Incontinence | 4.13 (15.14) | 4.13 (15.52) | 1,113 | 0.00 | |
| Blood in Urinea | 0.63 (3.95) | 0.00 (0.00) | -- | -- |
Notes:
p < 0.05,
p < 0.01,
p < 0.001
Missing values are treated as 0.
Due to significance in Levene’s Test, the Brown–Forsythe test is used. Tests for Shingles and Blood in Urine could not be conducted because at least one group had a variance of 0.999
As shown in Table 1, separate chi square analyses were conducted to examine any differences between the percentage of White participants and African Americans on the endorsement of each symptom. Several significant relationships were found. While a greater percentage of African Americans endorsed early morning awakening and trouble staying asleep, a greater percentage of White participants endorsed hypersomnia. A greater percentage of White participants endorsed oral herpes and dry eyes. However, a greater percentage of African Americans endorsed chest pains, often feel dizzy, irregular periods, a positive pap smear, recurrent urinary infections, dysuria, and blood in urine. No significant differences were found in the endorsement of Fukuda et al. (1994) CFS symptoms or for the other symptoms analyzed.
In Table 2, separate one-way ANOVAs were conducted between White participants and African Americans to examine the differences in pain severity for a subset of these symptoms for which we had data. Items were rated on a 0 to 100 scale, with 0 referring to no pain and 100 referring to severe pain. Due to significance in Levene’s Test, the Brown–Forsythe test was used to determine significant findings for symptoms as denoted in Table 2. As compared to White participants, African Americans experienced significantly greater pain in relation to disturbances in eyesight, shortness of breath, often feeling dizzy, feeling dizzy after standing, feeling dizzy while moving the head, feeling unsteady upright, ringing in the ears, recurrent urinary infections, and recurrent vaginal infections. No significant differences in the severity of pain experience were found for the Fukuda et al. (1994) symptoms or the other symptoms analyzed.
Among the 115 African American and White participants who endorsed six or more months of fatigue, 22 were found to have CFS. There were 77.3% who identified as White and 22.7% who identified as African American. Chi square analyses were conducted and a statistically greater percentage of White participants endorsed shortness of breath (X2(1) = 4.48, p = 0.03). No other significant differences were found in the in the endorsement of Fukuda et al. (1994) CFS symptoms or for the other symptoms analyzed. Given the small sample size of participants with CFS, an independent samples Mann-Whitney U Test was conducted to examine any differences in the severity of pain experience. White participants experience significantly greater pain severity due to post-exertional malaise compared to African Americans (U = 5.00, z = −3.01, p = .001). No significant differences in the severity of pain experience were found for any of the other symptoms for participants with CFS.
DISCUSSION
In the current sample, the greatest number of significant differences in symptom prevalence was found in the Disturbed Sleep and Reproductive categories. Patterns revealed that compared to White participants, more African Americans may experience problems with irregular periods, positive pap smears, recurrent urinary infections, dysuria, or blood in urine. Around half of the African American participants experienced irregular periods, which may point to the need for healthcare providers or researchers to address this symptom in African American individuals experiencing chronic fatigue.
It appears that African Americans may have more disturbances related to insomnia, while White participants may have more problems with hypersomnia. Similarly, in a study conducted on clusters of African American and White individuals with chronic pain, Green, Ndao-Brumblay, Nagrant, Baker, and Rothman (2004) found that more African Americans reported trouble falling asleep compared to White participants. Additionally, Profant, Ancoli-Israel, and Dimsdale (2002) have examined the sleep architecture of individuals with sleep apnea as well as those who are hypertensive and normotensive but otherwise healthy. In both studies, African Americans had a longer total sleep time, greater minutes of REM, and a lower percentage of deep sleep. Thus, African Americans may generally have slightly different circadian rhythm patterns when compared to White participants, but sleep difficulties may be exacerbated by chronic pain or fatigue in African Americans.
Interestingly, although ‘often feel dizzy’ was the only Neurological symptom that differed significantly in prevalence between the two groups, African Americans experienced significantly greater pain severity due to often feeling dizzy, feeling dizzy after standing, feeling dizzy while moving the head, and feeling unsteady upright. Along with the reported differences in sleep difficulties, these are examples of symptoms related to orthostatic intolerance (OI). OI is an illness characterized by headaches, fatigue, sleep disorders, weakness, hyperventilation/dyspnea, tremulousness, sweating, anxiety/palpitations, dizziness/vertigo, and pre-syncope/syncope (Agarwal, Garg, Ritch, & Sarkar, 2007). These types of symptoms tend to stem from inadequate cerebral perfusion during standing and are relieved by recumbency (Ocon, Medow, Taneja, Clarke, & Stewart, 2009). OI has been associated with CFS and chronic fatigue (Narkiewicz & Somers, 1998); and given the significant findings from the current study, OI symptoms may be an important symptom to examine among African Americans with six or more months of fatigue.
Given that the aim of the original study was to examine the prevalence of CFS, we also looked at any differences in symptomology between African American and White participants with CFS. Compared to African Americans, a greater percentage of White participants endorsed shortness of breath and they also reported more severe pain due to post-exertional malaise. However, there were only five African American participants in the current sample of patients with CFS, so we are tentative about drawing any firm conclusions from these significant findings.
With regards to additional limitations of the study, the data were derived from a study examining the prevalence of CFS; therefore, the symptom clusters identified may be limited to patients with chronic fatigue or CFS. However, CFS has been shown to affect every major system in the body (Friedberg & Jason, 1998), so the range of symptoms analyzed would still provide interesting data on the differences in symptomology between African Americans and White participants. In addition, separate one-way ANOVAs were not conducted on all the symptoms because participants were not asked to rate every symptom on a 100-point scale. Thus, data on the severity of each symptom could not be compared across every category. Nonetheless, the general experience of a majority of the symptoms in each category were still examined and compared between White participants and African Americans. Future research should replicate this study with larger samples and additional symptoms to discern further differences in symptomology between African American and White populations.
In line with the health care disparities literature, Green et al. (2004) reported that African Americans with chronic pain had higher pain severity, depression, and disability when compared to White participants with chronic pain. Likewise, African Americans with six or more months of fatigue may also experience greater pain in relation to symptoms, especially in regards to OI. This is problematic, as functional disability associated with OI results in a marked interruption of work and family life. Costigan, Elliott, McDonald, and Newton (2010) have found that orthostatic symptoms and the underlying autonomic dysfunction were independently associated with functional impairment in individuals with CFS. Thus, it may be important for treatments to have a focus on orthostatic symptoms along with other symptoms that accompany fatigue among African Americans.
In order to establish useful treatments for individuals suffering from OI and other debilitating symptoms, it is necessary to establish whether differences in symptomology are due to biological and/or contextual factors. While societal injustices could potentially be the cause of health disparities in general, targeting research on specific symptom clusters may provide a more detailed link among these complex relationships. For example, do such disabling illnesses exacerbate societal injustices and disparities, or do these societal injustices cause additional symptoms and illnesses? Regardless, by exploring the mechanisms that underlie disease and symptom clusters, more efficient and cost-effective approaches to symptom management could be identified (Miaskowski, Dodd, & Lee, 2004). Future directions should include additional studies that compare the prevalence and experience of OI, as well as differences in reproductive and sleep disturbance, in-depth among African American and White individuals.
Acknowledgments
Financial support for this study was provided by NIAID grant number AI36295.
Contributor Information
Indu Taneja, Pellissippi State Technical Community College.
Suzanna So, DePaul University.
Julian M. Stewart, New York Medical College.
Meredyth Evans, DePaul University.
Leonard A. Jason, DePaul University.
REFERENCES
- Agarwal AK, Garg R, Ritch A, Sarkar P. Postural orthostatic tachycardia syndrome. Postgraduate Medical Journal. 2007;83(981):478–480. doi: 10.1136/pgmj.2006.055046. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Centers for Disease Control and Prevention. Black or African American populations. [Accessed March 27, 2013];2013 Feb 4; Retrieved from http://www.cdc.gov/minorityhealth/populations/REMP/black.html.
- Chalder T, Berelowitz G, Pawlikowska J, Watts L, Wessely D. Development of a fatigue scale. Journal of Psychosomatic Research. 1993;37:147–153. doi: 10.1016/0022-3999(93)90081-p. [DOI] [PubMed] [Google Scholar]
- Costigan A, Elliott C, McDonald C, Newton JL. Orthostatic symptoms predict functional capacity in chronic fatigue syndrome: implications for management. QJM: An International journal of Medicine. 2010;103(8):589–595. doi: 10.1093/qjmed/hcq094. [DOI] [PubMed] [Google Scholar]
- Dodd M, Janson S, Facione N, Faucett J, Froelicher ES, Humphreys J, Lee K, Miaskowski C, Puntillo K, Rankin S, Taylor D. Advancing the science of symptom management. Journal of Advanced Nursing. 2001;33:668–676. doi: 10.1046/j.1365-2648.2001.01697.x. [DOI] [PubMed] [Google Scholar]
- Fukuda K, Straus SE, Hickie I, Sharpe MC, Dobbins JG, Komaroff A. The chronic fatigue syndrome: a comprehensive approach to its definition and study. Annals of Internal Medicine. 1994;121:953–959. doi: 10.7326/0003-4819-121-12-199412150-00009. Available at: http://www.ncf-net.org/patents/pdf/Fukuda_Definition.pdf. [DOI] [PubMed] [Google Scholar]
- Green CR, Ndao-Brumblay SK, Nagrant AM, Baker TA, Rothman E. Race, age, and gender influences among clusters of african american and white patients with chronic pain. The Journal of Pain. 2004;5(3):171–182. doi: 10.1016/j.jpain.2004.02.227. [DOI] [PubMed] [Google Scholar]
- Hollingshead AB. Four factor index of social status. Yale University at New Haven, CT: Unpublished manuscript; 1975. [Google Scholar]
- Institute of Medicine. Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare. Washington, DC: National Academy Press; 2003. [Google Scholar]
- Friedberg F, Jason LA. Understanding chronic fatigue syndrome: An empirical guide to assessment and treatment. Washington, DC: American Psychological Association; 1998. [Google Scholar]
- Jason LA, King CP, Richman JA, Taylor RR, Torres SR, Song S. US case definition of chronic fatigue syndrome: Diagnostic and theoretical issues. Journal of Chronic Fatigue Syndrome. 1999;5:3–33. [Google Scholar]
- Jason LA, Ropacki MT, Santoro NB, Richman JA, Heatherly W, Taylor R, et al. A screening instrument for Chronic Fatigue Syndrome. Journal of chronic fatigue syndrome. 1997;3(1):39–59. [Google Scholar]
- Jason LA, Torres-Harding SR, Carrico AW, Taylor RR. Symptom occurrence in persons with chronic fatigue syndrome. Biological Psychology. 2002;59:15–27. doi: 10.1016/s0301-0511(01)00120-x. [DOI] [PubMed] [Google Scholar]
- Johnson RL, Saha S, Arbelaez JJ, Beach MC, Cooper LA. Racial and ethnic differences in patient perceptions of bias and cultural competence in health care. Journal of General Internal Medicine. 2004;29(2):101–110. doi: 10.1111/j.1525-1497.2004.30262.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Komaroff AL, Buchwald D. Symptoms and signs of chronic fatigue syndrome. Review of Infectious Diseases. 1991;13:S8–S11. doi: 10.1093/clinids/13.supplement_1.s8. PMID: 2020806. [DOI] [PubMed] [Google Scholar]
- Komaroff AL, Fagioli LR, Geiger AM, Doolittle TH, Lee J, Kornish J, Guerriero RT. An examination of the working case definition of chronic fatigue syndrome. American Journal of Medicine. 1996;100:56–64. doi: 10.1016/s0002-9343(96)90012-1. [DOI] [PubMed] [Google Scholar]
- Miaskowski C, Dodd M, Lee K. Symptom clusters: The new frontier in symptom management research. Journal of the National Cancer Institute, Monograph. 2004;(32):17–21. doi: 10.1093/jncimonographs/lgh023. [DOI] [PubMed] [Google Scholar]
- Narkiewicz K, Somers VK. Chronic Orthostatic In-tolerance. Part of a spectrum of dysfunction in Orthostatic Cardiovascular Homeostasis? Circulation. 1998;98:2105–2107. doi: 10.1161/01.cir.98.20.2105. [DOI] [PubMed] [Google Scholar]
- Ocon AJ, Medow MS, Taneja I, Clarke D, Stewart JM. Decreased upright cerebral blood flow and cerebral autoregulation in normocapnic postural tachycardia syndrome. American Journal of Physiology-Heart and Circulatory Physiology. 2009;297:H664–H673. doi: 10.1152/ajpheart.00138.2009. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Parker KP, Kimble LP, Dunbar SB, Clark PC. Symptom interactions as mechanisms underlying symptom pairs and clusters. Journal of Nursing Scholarship. 2005;37:209–215. doi: 10.1111/j.1547-5069.2005.00037.x. [DOI] [PubMed] [Google Scholar]
- Profant J, Ancoli-Israel S, Dimsdale JE. Are there ethnic differences in sleep architecture? American journal of Human Biology. 2002;14(3):321–326. doi: 10.1002/ajhb.10032. [DOI] [PubMed] [Google Scholar]
- Sankar P, Cho MK, Condit CM, Hunt LM, Koenig B, Marshall P, Lee SS, Spicer P. Genetic research and health disparities. Journal of the American Medical Association. 2004;292(24):2985–2989. doi: 10.1001/jama.291.24.2985. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Sorlie PD, Backlund E, Keller JB. US mortality by economic, demographic, and social characteristics: the National Longitudinal Mortality Study. American Journal of Public Health. 1995;85(7):949–956. doi: 10.2105/ajph.85.7.949. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Walker B, Figgs LW, Zahm SH. Differences in cancer incidence, mortality, and survival between African Americans and whites. Environmental Health Perspectives. 1995;103(8):275–281. doi: 10.1289/ehp.95103s8275. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Wasser TE. Statistical correction of Hollings-head’s four factor index of social status; Paper presented at the meeting of the American Psychological Association; San Francisco, CA. 1991. Aug, [Google Scholar]