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Detroit, MI
To the Editor:
We read with interest the study by Minagar et al.,1 in which the authors reported that ventricular size was smaller in Hispanic than white non-Hispanic patients with AD. We agree that studies investigating and comparing the different aspects of AD across ethnic groups are needed. We do not believe, however, that the classification of the two subgroups studied, Hispanic versus non-Hispanic white based on identification of ethnicity by the caregiver, was a proper one.
Ethnic classification may vary between members of different communities, especially if done by someone other than the participating patient him- or herself. As mentioned in another recent article, "what is black to someone from the United States may be white to a Brazilian or a Caribbean islander."2 Many examples can be given in which classification of ethnicity can be very difficult or misleading. The authors of a recent editorial, both of whom were of European descent but were born and raised in South American Spanish-speaking countries, mention that they would be probably classified as "Hispanic" in the United States, although neither is of Spanish descent.3 A partial solution to this problem, which has been proposed and used in several current reports, is that patients participating in population studies self-classify their ethnicity.4 Furthermore, instead of the use of such ill-defined terms as "Hispanic," mentioning a specific subgroup such as "Cuban," "PuertoRican," or "Native South American" could be much more informative for similar population studies, provided that there are no misunderstandings of the categories used. Even the term "white" or "non-Hispanic white" is too generalized; a Swedish person and a Greek person may both be called "Caucasian," but do they really belong to the same ethnic group?
Ethnicity as a variable in population studies is difficult to define and, therefore, its impact is hard to measure. More precise research methodology, perhaps based on genetic variables, could help to avoid inappropriate generalizations.
Miami, FL
Reply from the Authors:
We welcome the important comments by Burneo et al. regarding the difficulties involved in classifying individuals according to ethnicity. Their first point—that self-classification of ethnicity is to be preferred in most situations—is well taken. However, many of our patients were too demented to provide self-classification, so we relied on their caregivers’ classification as a reasonable alternative. We believe little was lost by this method because in most of our cases, the caregiver was an immediate family member of the same ethnicity and same country of origin.
Their second point, that the terms "Hispanic" and "white non-Hispanic" are crude classifications that combine distinguishable subgroups, is an important one5 and emphasizes the preliminary nature of our study. However, it is notable that a robust difference between groups was found even with the simple Hispanic versus white non-Hispanic dichotomous classification, indicating that at least some degree of commonality was present within each of the groups. Nevertheless, future work involving more finely delineated subgroups is certainly warranted.
Footnotes
Copyright © 2001 by AAN Enterprises, Inc.
References
This article has been cited by other articles:
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  J. R. Orland, J. Engstrom, J. Fridey, R. A. Sacher, J. W. Smith, C. Nass, G. Garratty, B. Newman, D. Smith, B. Wang, et al. Prevalence and clinical features of HTLV neurologic disease in the HTLV Outcomes Study Neurology, December 9, 2003; 61(11): 1588 - 1594. [Abstract] [Full Text] [PDF]
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