title: Disparities in the diagnostic process of Duchenne and Becker muscular dystrophy.
abstract: OBJECTIVE
  To determine whether sociodemographic factors are associated with delays at specific steps in the diagnostic process of Duchenne and Becker muscular dystrophy.
  
  
  METHODS
  We examined abstracted medical records for 540 males from population-based surveillance sites in Arizona, Colorado, Georgia, Iowa, and western New York. We used linear regressions to model the association of three sociodemographic characteristics with age at initial medical evaluation, first creatine kinase measurement, and earliest DNA analysis while controlling for changes in the diagnostic process over time. The analytical dataset included 375 males with information on family history of Duchenne and Becker muscular dystrophy, neighborhood poverty levels, and race/ethnicity.
  
  
  RESULTS
  Black and Hispanic race/ethnicity predicted older ages at initial evaluation, creatine kinase measurement, and DNA testing (P < 0.05). A positive family history of Duchenne and Becker muscular dystrophy predicted younger ages at initial evaluation, creatine kinase measurement and DNA testing (P < 0.001). Higher neighborhood poverty was associated with earlier ages of evaluation (P < 0.05).
  
  
  CONCLUSIONS
  Racial and ethnic disparities in the diagnostic process for Duchenne and Becker muscular dystrophy are evident even after adjustment for family history of Duchenne and Becker muscular dystrophy and changes in the diagnostic process over time. Black and Hispanic children are initially evaluated at older ages than white children, and the gap widens at later steps in the diagnostic process.
authors.affiliation: Department of Pediatrics, The University of Arizona, Tucson, Arizona 85724-5073, USA.
authors.forename: Caleb
authors.initials: C
authors.lastname: Holtzer
authors.forename: F John
authors.initials: FJ
authors.lastname: Meaney
authors.forename: Jennifer
authors.initials: J
authors.lastname: Andrews
authors.forename: Emma
authors.initials: E
authors.lastname: Ciafaloni
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Fox
authors.forename: Katherine A
authors.initials: KA
authors.lastname: James
authors.forename: Zhenqiang
authors.initials: Z
authors.lastname: Lu
authors.forename: Lisa
authors.initials: L
authors.lastname: Miller
authors.forename: Shree
authors.initials: S
authors.lastname: Pandya
authors.forename: Lijing
authors.initials: L
authors.lastname: Ouyang
authors.forename: Christopher
authors.initials: C
authors.lastname: Cunniff
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D001130:Arizona; D002648:Child; D002675:Child, Preschool; D003120:Colorado; D003402:Creatine Kinase / Q000378:metabolism; D005192:Family Health; D005820:Genetic Testing; D005845:Georgia; D054625:Healthcare Disparities / Q000208:ethnology / Q000706:statistics & numerical data*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007484:Iowa; D016014:Linear Models; D008297:Male; D020388:Muscular Dystrophy, Duchenne / Q000175:diagnosis* / Q000208:ethnology / Q000235:genetics; D009518:New York; D011159:Population Surveillance / Q000379:methods*; D013997:Time Factors; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D003402:Creatine Kinase