Why Your Race Matters to Your Health

Focusing on someone's race or ethnicity, whether in politics or social settings, is widely frowned upon these days—a very good thing. In medicine, though, your ethnic background can play a crucial role in determining certain health risks. Because of my and my husband's eastern European-Jewish background, for instance, I was warned that we had an increased likelihood of giving birth to a baby with the deadly Tay-Sachs disease, which led us to get genetic screening. (Luckily, we weren't carriers.)

Sometimes, ethnic differences can pose risks for a couple. I was quite surprised by a new finding showing that Asian women married to white men had a 30 percent higher rate of cesarean sections compared with Asian or white couples and white women married to Asian men. The researchers gave a plausible reason why: Previous studies have shown that the average Asian woman's pelvis is smaller than the average white woman's and thus less able to accommodate babies of a certain size. "We're certainly not concluding that these women always need C-sections," says study coauthor Yasser El-Sayed, an obstetrician-gynecologist at Stanford University Medical Center. But he would be less likely to allow a prolonged labor to continue for hours in such women because a vaginal delivery would be very unlikely.

The study, published in the October issue of the American Journal of Obstetrics and Gynecology, also found that pregnant women who were part of an Asian-white couple had a higher rate of gestational diabetes than those who were part of a white-white couple, a nearly 4 percent risk compared to a 1.6 percent risk for white couples. Asian couples, known to have higher rates of diabetes, had nearly a 6 percent risk. What's intriguing is that white women married to Asian men also had higher rates of gestational diabetes compared with those married to white men, possibly due to a genetic characteristic in the fetus that triggers some sort of interaction with the mother. "It could be that these women should be screened in the first trimester for gestational diabetes instead of waiting until 24 to 28 weeks, but we'll need additional studies before we know that for certain," says El-Sayed.

Ethnicity—rather than race—may also be a factor when it comes to other diseases. Researchers are now studying breast cancer in African-American women to see whether genetic differences exist among groups hailing from different areas of Africa. Those who descended from slaves captured from the Bight of Biafra region (East Nigeria, West Cameroon), for instance have an increased risk of developing a particularly aggressive form of inflammatory breast cancer that often strikes in a woman's 20s or 30s. Other African-American women have a somewhat lower incidence of breast cancer compared with white women, though they still have higher death rates due to later diagnoses and less access to state-of-the-art treatments. Studies are also examining breast cancer differences among Asian women. There are more than 65 subethnic groups that have varying incidences of breast cancer, points out California State University researcher Sora Park Tanjasiri, who spoke at a Susan G. Komen breast cancer conference I attended two years ago.

More research certainly is warranted, but one thing is for certain. While it's great to be colorblind at cocktail parties and at the ballot box, women and their doctors should be talking about race and ethnicity.