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Despite impressive progress over the past several decades, diseases of the heart remain the leading cause of death for American men and women and the major cause of excess deaths in African Americans. The greatest proportion of these deaths are due to heart disease, hypertension and stroke. Life expectancy and rates of illness and death from heart disease have not improved as much for blacks as for whites. The difference in life expectancy between white males and black males widened from 6.8 years in 1985 to 8.3 years in 1991 and between white females and black females from 5.3 years in 1985 to 5.8 years in 1991. Heart disease mortality in 1991 was almost 40 percent greater for black men than for white men and was 64 percent greater for black women than for white women. Blacks have not experienced the full benefit of research advancements for a variety of reasons, including insufficient scientific data, lack of research focused on minority populations and limited access to primary care physicians, health care resources and technology. Available data indicate that there is a higher prevalence of smoking, hypertension, diabetes, obesity, and left ventricular hypertrophy (LVH) in blacks. Blacks are also less likely to receive coronary angiography or coronary revascularization.
The research in hypertension and heart disease at the Urban Health Institute is highly interactive and involves multiple disciplines and investigators throughout the hospital and medical school. A major long term effort of this project involves the computerization, analysis and interpretation of data collected from the Harlem Hospital Hypertension Program patients between 1975 to 1990. These data includes laboratory, demographics, social and family history, health profile, medication and blood pressure history. Several substudies from this database have already been completed. However, final analysis and interpretation is expected to begin in 1996. Hypertension and Heart Disease Projects
Harlem is the epicenter of the recrudescence of tuberculosis and the acquired immunodeficiency syndrome that has ravaged the inner city minority communities of the United States. The prevalence of tuberculosis and AIDS in Harlem remains among the highest in New York City. The number of admissions to the Harlem Hospital Center for HIV related diseases and tuberculosis remains excessively high, accounting for approximately 30% of admissions. The epidemiology of tuberculosis has changed with the growth in the prevalence of HIV infection so that tuberculosis is now considered a major marker for possible HIV infection in Harlem. Approximately 50% of patients with AIDS are coinfected with mycobacterium, either M. tuberculosis or M. avium. Latent tuberculosis may become active when individuals are also infected with the HIV virus.
In part through the efforts of the Harlem Hospital Divisions of Pulmonary Disease and Infectious Disease, tuberculosis and AIDS were identified as important areas for study by the Urban Health Institute when the Center was conceived. Because of the coincident increase in tuberculosis control activities in the hospital through receipt of a Tuberculosis Control Grant from the City of New York and ongoing support by the NAIAD for a Community Programs for Clinical Research on AIDS (CPCRA) at Harlem Hospital, research and service programs have grown significantly since the Urban Health Institute was conceived. Research questions originally viewed as possible Urban Health Institute projects have been able to be accomplished through the Harlem Model Tuberculosis Clinic and Training Center and the CPCRA. Therefore, this project activities will focus on synthesis activities and meta analyses of the literature on behavioral change in the management of HIV and AIDS in urban African American communities, as well as conduct studies of practice variations and dissemination strategies. TB AND A.I.D.S. Projects
This research program brings together two long standing interests: injury prevention and teenage pregnancy. For over thirty years Harlem Hospital Center has studied injuries to children and has developed a very successful injury prevention program. Injury is the leading cause of childhood morbidity, disability and mortality in the United States. Since patterns of injury vary by age and geographic setting, a clear understanding of the epidemiology of injuries is essential for the development of injury prevention (primary, secondary or tertiary) programs. An unexplored area is the relationship of violence and pregnancy. Teenage pregnancy is a significant problem especially in Harlem. In 1990, of all students grades 9-12 surveyed, 54.2% reported having had sexual intercourse, and 39.4% reported having had sexual intercourse during the 3 months preceding the survey. Paralleling these rates of adolescent sexual activity are the well known high rates of adolescent pregnancy nationwide and of sexually transmitted diseases. In addition, adolescents are predicted to be the next group to be involved in the HIV/AIDS epidemic. Health of Children and Adolescents, and Teen Pregnancy Projects
