Interpretations of differences in population hemoglobin means: a critical review of the literature

Numerous large-scale studies have conclusively established that North American blacks have a lower population mean of serum hemoglobin concentrations than North American whites. An increasing number of researchers interpret the reduced hemoglobin levels as a genetic racial trait and recommend lowering the normal range for blacks. However, other hematological parameters among blacks indicate an alternative view. The same medical surveys also document higher ESR (erythrocyte sedimentation rate) and higher serum ferritin means in the black population. These, in association with low hemoglobin levels, are the definition of the anemia of chronic disease. A range of disorders, from infectious and inflammatory diseases to neoplasia, lead to the anemia of chronic disease. The prevalence of this hematological profile in North American blacks may indicate that the population has a higher morbidity than whites. A literature review suggests that these particular hematological means differ from whites, regardless of socioeconomic class, because of increased frequency and virulence of disease among blacks. The increase appears to be the consequence of social, rather than racial, causes.