This study examined the ethnic difference in the association between increased serum ferritin (SF) (>300 μg/l) and acute inflammation (AI) (C-reactive protein ⩾1·0 mg/dl) between black and white males aged ⩾20 years. Using data from the third National Health and Nutrition Examination Survey (NHANES III), we determined the risk for having elevated SF in black males (n=164) and white males (n=325) with AI present as well as black males (n=1731) and white males (n=2877) with AI absent. Black subjects with AI present were 1·71 times (95% CI 1·18–2·49), and 1·87 times (95% CI 1·46–2·40) more likely to have increased SF than AI absent blacks and AI present whites, respectively. Furthermore, with AI present, every increment of C-reactive protein, white blood cell count, serum albumin, lymphocyte count and platelet count was associated with higher odds of having elevations in SF in blacks than whites. Regardless of AI status, blacks were more likely to have elevations in SF than whites, and the prevalence of elevated SF was significantly higher in blacks than whites. This finding suggested that black males may respond to inflammation with a more aggressive rise in SF compared to white males. Future research is needed to investigate the underlying mechanisms
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