title: Racial differences in scleroderma among women in Michigan.
abstract: OBJECTIVE
  To examine racial differences in disease onset, extent, manifestations, and survival among women with scleroderma.
  
  
  METHODS
  A retrospective cohort study of women with scleroderma, diagnosed in Michigan between 1980 and 1991, was conducted. Clinical, laboratory, and demographic data were abstracted from the patients' medical records.
  
  
  RESULTS
  A total of 514 women with scleroderma were identified: 117 (23%) were black and 397 (77%) were white. Among black women, the mean age at diagnosis was lower (44.5 years versus 51.5 years; P < 0.001) and diffuse disease was more common (49.6% versus 24.9%; P < 0.001) than among white women. The overall incidence of scleroderma was 14.1 per million per year: 22.5 per million per year in black women versus 12.8 per million per year in white women (P < 0.001). Pericarditis (P = 0.009), pulmonary hypertension (P < 0.001), pleural effusions (P = 0.01), myositis (P = 0.02), and an erythrocyte sedimentation rate >40 mm/hour (P < 0.001) were more frequent among black women, while white women were more likely to have digital infarctions (P < 0.001). Survival at 7 years from diagnosis was 72.5% among black women and 77.6% among white women. Age-adjusted survival was significantly reduced among black women (P = 0.033), most likely because of increased diffuse involvement. Survival among those with renal or pulmonary involvement was also significantly reduced.
  
  
  CONCLUSIONS
  Black women with scleroderma were significantly more likely than white women to develop diffuse disease, be diagnosed at a younger age, have a higher incidence of inflammatory features, and have a worse age-adjusted survival rate.
authors.affiliation: University of Michigan and the Multipurpose Arthritis and Musculoskeletal Disease Center, Ann Arbor, USA.
authors.forename: T J
authors.initials: TJ
authors.lastname: Laing
authors.forename: B W
authors.initials: BW
authors.lastname: Gillespie
authors.forename: M B
authors.initials: MB
authors.lastname: Toth
authors.forename: M D
authors.initials: MD
authors.lastname: Mayes
authors.forename: R H
authors.initials: RH
authors.lastname: Gallavan
authors.forename: C J
authors.initials: CJ
authors.lastname: Burns
authors.forename: J R
authors.initials: JR
authors.lastname: Johanns
authors.forename: B C
authors.initials: BC
authors.lastname: Cooper
authors.forename: B J
authors.initials: BJ
authors.lastname: Keroack
authors.forename: M C
authors.initials: MC
authors.lastname: Wasko
authors.forename: J V
authors.initials: JV
authors.lastname: Lacey
authors.forename: D
authors.initials: D
authors.lastname: Schottenfeld
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044383:Black People; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012595:Scleroderma, Systemic / Q000208:ethnology* / Q000401:mortality; D016019:Survival Analysis; D044465:White People; D001741:Black or African American