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Huang D, Huang Y, Adams N, Nguyen TT, Nguyen QC. Twitter-Characterized Sentiment Towards Racial/Ethnic Minorities and Cardiovascular Disease (CVD) Outcomes. J Racial Ethn Health Disparities 2020; 7:888-900. [PMID: 32020547 PMCID: PMC7398843 DOI: 10.1007/s40615-020-00712-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 01/16/2020] [Accepted: 01/26/2020] [Indexed: 01/14/2023]
Abstract
Sentiments towards racial/ethnic minorities may impact cardiovascular disease (CVD) through direct and indirect pathways. In this study, we assessed the association between Twitter-derived sentiments towards racial/ethnic minorities at state-level and individual-level CVD-related outcomes from the 2017 Behavioral Risk Factor Surveillance System (BRFSS). Outcomes included hypertension, diabetes, obesity, stroke, myocardial infarction (MI), coronary heart disease (CHD), and any CVD from BRFSS 2017 (N = 433,434 to 433,680 across outcomes). A total of 30 million race-related tweets were collected using Twitter Streaming Application Programming Interface (API) from 2015 to 2018. Prevalence of negative and positive sentiment towards racial/ethnic minorities were constructed at the state level and merged with CVD outcomes. Poisson regression was used, and all the models adjusted for individual-level demographics as well as state-level demographics. Individuals living in states with the highest level of negative sentiment towards racial/ethnic minorities had 11% higher prevalence of hypertension (PR 1.11, 95% CI 1.08, 1.14), 15% higher prevalence of diabetes (PR 1.15, 95% CI 1.08, 1.22), 14% higher prevalence of obesity (PR 1.14, 95% CI 1.10, 1.18), 30% higher prevalence of stroke (PR 1.30, 95% CI 1.16, 1.46), 14% higher prevalence of MI (PR 1.14, 95% CI 1.03, 1.25), 9% higher prevalence of CHD (PR 1.09, 95% CI 1.00, 1.19), and 16% higher prevalence of any CVD outcomes (PR 1.16, 95% CI 1.09, 1.24). Conversely, Twitter-derived positive sentiment towards racial/ethnic minorities was associated with a lower prevalence of CVD outcomes. Programs and policies that promote racially inclusive environments may improve population health.
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Affiliation(s)
- Dina Huang
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD, 20742, USA
| | - Yuru Huang
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD, 20742, USA
| | - Nikki Adams
- Center for Substance Abuse Research, University of Maryland, College Park, MD, 20742, USA
| | - Thu T Nguyen
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA, 94110, USA
| | - Quynh C Nguyen
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD, 20742, USA.
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Zahodne LB, Morris EP, Sharifian N, Zaheed AB, Kraal AZ, Sol K. Everyday discrimination and subsequent cognitive abilities across five domains. Neuropsychology 2020; 34:2020-56961-001. [PMID: 32744838 PMCID: PMC8006470 DOI: 10.1037/neu0000693] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE Previous research suggests that everyday discrimination is associated with worse concomitant performance in several cognitive domains, as well as faster subsequent declines in episodic memory. This study aimed to extend knowledge on the specificity, durability, and mechanisms of associations between everyday discrimination and cognition by using a comprehensive neuropsychological battery and a longitudinal mediation design. METHOD Participants included 3,304 older adults in the Health and Retirement Study Harmonized Cognitive Assessment Protocol. Discrimination was assessed using the Everyday Discrimination Scale. Depressive symptoms were assessed with the 8-item Center for Epidemiological Studies Depression Scale. Vascular diseases were quantified as the self-reported presence of hypertension, diabetes, and heart disease. Confirmatory factor analysis was used to estimate episodic memory, executive functioning, processing speed, language, and visuoconstruction across a battery of 13 neuropsychological tests. Structural equation models controlled for sociodemographics and baseline cognition ascertained 2 to 4 years prior. RESULTS Discrimination was associated with more depressive symptoms and vascular diseases. Depressive symptoms mediated negative effects of discrimination on subsequent functioning across all 5 cognitive domains. Vascular diseases additionally mediated negative effects of discrimination on processing speed. After accounting for mediators, direct negative effects of discrimination remained for executive functioning and visuoconstruction. CONCLUSIONS This national longitudinal study in the United States provides evidence for broad and enduring effects of everyday discrimination on cognitive aging, which appear to be partially mediated by mental and physical health. Future research should examine additional mechanisms as well as moderators of these associations to better understand points of intervention. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | | | - Ketlyne Sol
- Department of Psychology, University of Michigan
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Caceres BA, Markovic N, Edmondson D, Hughes TL. Sexual Identity, Adverse Life Experiences, and Cardiovascular Health in Women. J Cardiovasc Nurs 2020; 34:380-389. [PMID: 31246631 DOI: 10.1097/jcn.0000000000000588] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Adverse life experiences (ALE; eg, discrimination and sexual abuse) may contribute to cardiovascular disease (CVD) risk in sexual minority women (SMW), but few studies have tested whether ALE explain the association of sexual identity with cardiovascular health (CVH) markers in women. OBJECTIVE The aim of this study was to examine sexual identity differences in CVH among women and the role of ALE. METHODS In the Epidemiologic Study of Risk in Women, we used multinomial logistic regression to assess sexual identity differences (SMW vs heterosexual women [reference group]) in CVH markers (ideal vs poor, intermediate vs poor) using the American Heart Association's Life's Simple 7 metric and the total score. Next, we tested whether the association of sexual identity with the total CVH score was attenuated by traditional CVD risk factors or ALE. RESULTS The sample consisted of 867 women (395 heterosexual, 472 SMW). Sexual minority women were more likely to have experienced discrimination (P < .001) and lifetime sexual abuse (P < .001) than heterosexual women. Sexual minority women were also less likely to meet ideal CVH criteria for current tobacco use (adjusted odds ratio, 0.43; 95% confidence interval, 0.24-0.73) or intermediate CVH criteria for body mass index (adjusted odds ratio, 0.60; 95% confidence interval, 0.40-0.92). Sexual minority women had a lower cumulative CVH score (B [SE] = -0.35 [0.14], P < .01) than heterosexual women. This difference was not explained by traditional CVD risk factors or ALE. CONCLUSIONS Smoking, body mass index, and fasting glucose accounted for much of the CVH disparity due to sexual identity, but those differences were not explained by ALE. Health behavior interventions tailored to SMW should be considered.
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Affiliation(s)
- Billy A Caceres
- Billy A. Caceres, PhD, RN, AGPCNP-BC Postdoctoral Research Fellow, Columbia University School of Nursing, New York, New York. Nina Markovic, PhD Associate Professor, University of Pittsburgh School of Dental Medicine. Donald Edmondson, PhD Associate Professor of Behavioral Medicine (in Medicine and Psychiatry), Columbia University Irving Medical Center. Tonda L. Hughes, PhD, RN, FAAN Henrik H. Bendixen Professor of International Nursing (in Psychiatry), Columbia University School of Nursing, New York, New York
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Wright ML, Lim S, Sales A, Rajagopal S, Nzegwu D, Crusto CA, Taylor JY. The Influence of Discrimination and Coping Style on Blood Pressure Among Black/African American Women in the InterGEN Study. Health Equity 2020; 4:272-279. [PMID: 34095697 PMCID: PMC8175254 DOI: 10.1089/heq.2019.0122] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose: Although research has explored the effects of racism on mental health, few studies have investigated the effects of racism on physical health. In this study, we examined the influence of racial discrimination and race-related stress and coping on blood pressure within a cohort of Black/African American women. Methods: This was a secondary data analysis of 226 Black/African American women from the Intergenerational Impact of Genetic and Psychological Factors on Blood Pressure study. Experiences of racial discrimination and coping, measured by the Experiences of Discrimination scale and the Race-Related Events Scale, were analyzed in relation to systolic blood pressure (SBP) and diastolic blood pressure (DBP). Multiple linear regression was used to explore the interaction effect of coping and discrimination on blood pressure for both scales. Results: Age and elevated body mass index were associated with increased SBP and DBP, and low income was associated with increased DBP. Among individuals who reported no personal experience of discrimination, more active coping strategies were associated with higher DBP. There was no evidence of a relationship between type of coping strategies used and blood pressure among individuals who did report experiences of discrimination. Conclusion: Differences in coping strategy in response to racism were not found to have a significant moderating effect on DBP in Black/African American women.
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Affiliation(s)
- Michelle L. Wright
- School of Nursing, University of Texas at Austin, Austin, Texas, USA
- Department of Women's Health, Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Sungju Lim
- School of Nursing, University of Texas at Austin, Austin, Texas, USA
| | - Adam Sales
- SMARTER Consulting, College of Education, University of Texas at Austin, Austin, Texas, USA
| | - Shilpa Rajagopal
- Department of Biology, College of Natural Science, University of Texas at Austin, Austin, Texas, USA
| | - Dumebi Nzegwu
- Department of Health and Society, College of Liberal Arts, University of Texas at Austin, Austin, Texas, USA
| | - Cindy A. Crusto
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
- Department of Psychology, University of Pretoria, Pretoria, South Africa
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Tabb LP, McClure LA, Ortiz A, Melly S, Jones MR, Kershaw KN, Roux AVD. Assessing the spatial heterogeneity in black-white differences in optimal cardiovascular health and the impact of individual- and neighborhood-level risk factors: The Multi-Ethnic Study of Atherosclerosis (MESA). Spat Spatiotemporal Epidemiol 2020; 33:100332. [PMID: 32370943 PMCID: PMC7205896 DOI: 10.1016/j.sste.2020.100332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 11/08/2019] [Accepted: 12/27/2019] [Indexed: 11/24/2022]
Abstract
Racial disparities in cardiovascular health (CVH) continue to remain a public health concern in the United States. We use unique population-based data from the Multi-Ethnic Study of Atherosclerosis cohort to explore the black-white differences in optimal CVH. Utilizing geographically weighted regression methods, we assess the spatial heterogeneity in black-white differences in optimal CVH and the impact of both individual- and neighborhood-level risk factors. We found evidence of significant spatial heterogeneity in black-white differences that varied within and between the five sites. Initial models showed decreased odds of optimal CVH for blacks that ranged from 60% to 70% reduced odds - with noticeable variation of these decreased odds within each site. Adjusting for risk factors resulted in reductions in the black-white differences in optimal CVH. Further understanding of the reasons for spatial heterogeneities in black-white differences in nationally representative cohorts may provide important clues regarding the drivers of these differences.
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Affiliation(s)
- Loni Philip Tabb
- Department of Epidemiology & Biostatistics, Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA 19104, USA.
| | - Leslie A McClure
- Department of Epidemiology & Biostatistics, Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA 19104, USA.
| | - Angel Ortiz
- Department of Epidemiology & Biostatistics, Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA 19104, USA.
| | - Steven Melly
- Urban Health Collaborative, Drexel University, 3600 Market Street, Philadelphia, PA 19104, USA.
| | - Miranda R Jones
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, 615N. Wolfe Street, Baltimore, MD 21205, USA.
| | - Kiarri N Kershaw
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680N. Lake Shore Drive, Chicago, IL 60611, USA.
| | - Ana V Diez Roux
- Department of Epidemiology & Biostatistics, Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA 19104, USA.
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Abstract
OBJECTIVE This study aimed to examine associations among race, the accumulation of multiple forms of discriminatory experiences (i.e., "pervasive discrimination"), and allostatic load (AL) in African Americans and whites in midlife. METHODS Using data collected in 2004 to 2006 from 226 African American and 978 white adults (57% female; mean [SD] age = 54.7 [0.11] years) in the Midlife in the United States II Biomarker Project, a pervasive discrimination score was created by combining three discrimination scales, and an AL score was created based on 24 biomarkers representing seven physiological systems. Linear regression models were conducted to examine the association between pervasive discrimination and AL, adjusting for demographics and medical, behavioral, and personality covariates. A race by pervasive discrimination interaction was also examined to determine whether associations varied by race. RESULTS African Americans had higher pervasive discrimination and AL scores than did whites. In models adjusted for demographics, socioeconomic status, medications, health behaviors, neuroticism, and negative affect, a pervasive discrimination score of 2 versus 0 was associated with a greater AL score (b = 0.30, SE = 0.07, p < .001). Although associations seemed to be stronger among African Americans as compared with whites, associations did not statistically differ by race. CONCLUSIONS More pervasive discrimination was related to greater multisystemic physiological dysregulation in a cohort of African American and white adults. Measuring discrimination by combining multiple forms of discriminatory experiences may be important for studying the health effects of discrimination.
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LeBrón AMW, Schulz AJ, Mentz G, Reyes AG, Gamboa C, Israel BA, Viruell-Fuentes EA, House JS. Impact of change over time in self-reported discrimination on blood pressure: implications for inequities in cardiovascular risk for a multi-racial urban community. ETHNICITY & HEALTH 2020; 25:323-341. [PMID: 29355028 PMCID: PMC6054822 DOI: 10.1080/13557858.2018.1425378] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 12/06/2017] [Indexed: 05/10/2023]
Abstract
Objectives: The 21st century has seen a rise in racism and xenophobia in the United States. Few studies have examined the health implications of heightened institutional and interpersonal racism. This study examines changes in reported discrimination and associations with blood pressure over time among non-Latino Blacks (NLBs), Latinos, and non-Latino Whites (NLWs) in an urban area, and variations by nativity among Latinos.Design: Data from a probability sample of NLB, Latino, and NLW Detroit, Michigan residents were collected in 2002-2003, with follow-up at the same addresses in 2007-2008. Surveys were completed at 80% of eligible housing units in 2008 (n = 460). Of those, 219 participants were interviewed at both time points and were thus included in this analysis. Discrimination patterns across racial/ethnic groups and associations with blood pressure were examined using generalized estimating equations.Results: From 2002 to 2008, NLBs and Latinos reported heightened interpersonal and institutional discrimination, respectively, compared with NLWs. There were no differences in associations between interpersonal discrimination and blood pressure. Increased institutional discrimination was associated with stronger increases in systolic and diastolic blood pressure for NLBs than NLWs, with no differences between Latinos and NLWs. Latino immigrants experienced greater increases in blood pressure with increased interpersonal and institutional discrimination compared to US-born Latinos.Conclusions: Together, these findings suggest that NLBs and Latinos experienced heightened discrimination from 2002 to 2008, and that increases in institutional discrimination were more strongly associated with blood pressure elevation among NLBs and Latino immigrants compared to NLWs and US-born Latinos, respectively. These findings suggest recent increases in discrimination experienced by NLBs and Latinos, and that these increases may exacerbate racial/ethnic health inequities.
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Affiliation(s)
- Alana M W LeBrón
- Department of Population Health & Disease Prevention & Department of Chicano/Latino Studies, University of California, Irvine, Irvine, CA, USA
| | - Amy J Schulz
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Graciela Mentz
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Angela G Reyes
- Detroit Hispanic Development Corporation, Detroit, MI, USA
| | - Cindy Gamboa
- Detroit Hispanic Development Corporation, Detroit, MI, USA
| | - Barbara A Israel
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Edna A Viruell-Fuentes
- Department of Latina/Latino Studies, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - James S House
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
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Hailu EM, Needham BL, Lewis TT, Lin J, Seeman TE, Roux AD, Mujahid MS. Discrimination, social support, and telomere length: the Multi-Ethnic Study of Atherosclerosis (MESA). Ann Epidemiol 2020; 42:58-63.e2. [PMID: 32070634 PMCID: PMC11019778 DOI: 10.1016/j.annepidem.2019.12.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 12/16/2019] [Accepted: 12/22/2019] [Indexed: 01/02/2023]
Abstract
PURPOSE We sought to assess the association of reports of discrimination with leukocyte telomere length (LTL) and effect measure modification by social support. METHODS This study used data from the Multi-Ethnic Study of Atherosclerosis Stress Ancillary Study (n = 1153). Discrimination was measured using the everyday discrimination and the major experiences of discrimination scales. LTL was defined as the ratio of telomeric DNA to single-copy control gene (mean = 0.916, SD = 0.205). Linear regression models were used to examine the relationship between discrimination and LTL. RESULTS We found no association between either measure of discrimination and LTL, but there was evidence of effect modification by social support (P (χ2) = 0.001) for everyday discrimination only. Among those with low social support, reporting moderate and high everyday discrimination was associated with a 0.35 (95% CI: -0.54 to -0.16) and a 0.17 (95% CI: -0.34 to -0.01) shorter telomere length, respectively, compared to reporting no discrimination, after adjusting for demographic factors, health behaviors, and health conditions. There were no associations between discrimination and LTL among those reporting moderate or high social support. CONCLUSIONS These findings underscore the importance of continued investigation of the potential health consequences of chronic unfair treatment in the absence of supportive resources.
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Affiliation(s)
- Elleni M Hailu
- Division of Epidemiology, School of Public Health, University of California Berkeley, Berkeley, CA.
| | - Belinda L Needham
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor
| | - Tené T Lewis
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Jue Lin
- Department of Biochemistry and Biophysics, University of California San Francisco, San Francisco, CA
| | - Teresa E Seeman
- Department of Geriatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Ana Diez Roux
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | - Mahasin S Mujahid
- Division of Epidemiology, School of Public Health, University of California Berkeley, Berkeley, CA
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Gendered Race and Setting Matter: Sources of Complexity in the Relationships Between Reported Interpersonal Discrimination and Cardiovascular Health in the CARDIA Study. J Racial Ethn Health Disparities 2020; 7:687-697. [PMID: 31939080 PMCID: PMC10403804 DOI: 10.1007/s40615-020-00699-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 01/05/2020] [Accepted: 01/06/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Using data from black and white adults enrolled in a community-based, multi-city cohort assembled in the mid-1980s, we examined whether reported experiences of interpersonal racial and gender discrimination differentially impacted on future cardiovascular health (CVH) depending on gendered race and the setting in which the interactions were reported to have occurred. METHODS Discrimination in eight possible settings was assessed using the Experiences of Discrimination scale at year 7; CVH two decades later was examined using a modified Life's Simple 7 score, with higher scores indicating better health. Separate multivariable linear regressions evaluated the associations between reports of racial and gender discrimination and CVH score in each possible setting stratified by gendered race. RESULTS Mean (SD) CVH scores at year 30 were 7.8(1.9), 8.1(1.8), 8.9(2. 0), and 8.8(1.8) among black women, black men, white women, and white men, respectively. For black women, reporting both racial and gender discrimination while receiving medical care was associated with lower CVH score. Among black men, reporting both forms of discrimination while getting a job, at work, at school, and receiving medical care was associated with lower CVH score. Among whites, reported discrimination while obtaining housing and by the police or courts (women), and in public and at work (men), was associated with a lower CVH score. CONCLUSIONS The setting in which discrimination is reported may be an important indicator of whether discriminatory experiences are negatively associated with CVH, providing insight on distinct effect pathways among black and white women and men.
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Interactive Relations Across Dimensions of Interpersonal-Level Discrimination and Depressive Symptoms to Carotid Intimal-Medial Thickening in African Americans. Psychosom Med 2020; 82:234-246. [PMID: 31738316 PMCID: PMC9513678 DOI: 10.1097/psy.0000000000000765] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE This study aimed to examine within-race interactions of multiple dimensions of self-reported discrimination with depressive symptoms in relation to carotid intimal-medial thickness (IMT), a subclinical marker of atherosclerosis prospectively implicated in stroke incidence, in middle-aged to older African American and white adults. METHODS Participants were a socioeconomically diverse group of 1941 African Americans (56.5%) and whites from the Healthy Aging in Neighborhoods of Diversity across the Life Span study (30-64 years old, 47% men, 45.2% with household income <125% federal poverty threshold) who underwent carotid IMT measurement. Discrimination was assessed across four dimensions (everyday, frequency across various social statuses, racial, and lifetime burden). The Center for Epidemiologic Studies Depression scale was used to assess depressive symptoms. RESULTS In cross-sectional hierarchical regression analyses, two interactions were observed in African Americans: more frequent discrimination across various social statuses (b < 0.001, p = .006) and a higher lifetime discrimination burden (b < 0.001, p = .02) were each related to thicker carotid IMT in those with greater depressive symptoms. No significant findings were observed within whites. CONCLUSIONS Among African Americans, those reporting high levels of discrimination and depressive symptoms have increased carotid atherosclerosis and may be at greater risk for clinical end points compared with those reporting one or neither of these risk factors. Findings suggest that assessment of interactive relationships among social and psychological factors may elucidate novel pathways for cardiovascular disease, including stroke, among African Americans.
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Srivastava PK, Fonarow GC, Bahiru E, Ziaeian B. Association of Hospital Racial Composition and Payer Mix With Mortality in Acute Coronary Syndrome. J Am Heart Assoc 2019; 8:e012831. [PMID: 31623505 PMCID: PMC6898803 DOI: 10.1161/jaha.119.012831] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 09/18/2019] [Indexed: 01/16/2023]
Abstract
Background Patient characteristics insufficiently explain disparities in cardiovascular outcomes among hospitalized patients, suggesting a role for community or hospital-level factors. Here, we evaluate the association of hospital racial composition and payer mix with all-cause inpatient mortality for patients hospitalized with acute coronary syndrome (ACS). Methods and Results Using the National Inpatient Sample, we identified adult hospitalizations from 2014 with a primary diagnosis of ACS (n=550 005). We divided National Inpatient Sample hospitals into quartiles based on percent of minority (black, Hispanic, Asian or Pacific Islander, Native American race/ethnicity) and low-income payer (Medicaid or uninsured) discharges in 2014. We utilized logistic regression to determine whether hospital minority or low-income payer makeup associated with all-cause inpatient mortality among those admitted for ACS . In adjusted models, ACS patients admitted to hospitals with >12.4% to 25.4% (Quartile 2), >25.4% to 44.3% (Q3), and >44.3% (Q4) minority discharges experienced a 14% (OR 1.14, 95% CI 1.06-1.23), 13% (OR 1.13, 95% CI 1.04-1.23), and 15% (OR 1.15, 95% CI 1.04-1.26) increased odds of all-cause inpatient mortality compared with hospitals with ≤12.4% (Q1) minority discharges. ACS patients admitted to hospitals with >18.7% to 25.7% (Q2) and >34.0% (Q4) low-income payer discharges experienced a 9% (OR 1.09, 1.01-1.17) and 9% (OR 1.09, 1.00-1.19) increased odds of all-cause inpatient mortality when compared with hospitals with ≤18.7% (Q1) low-income payer discharges. Conclusions Hospital minority and low-income payer makeup positively associate with odds of all-cause inpatient mortality among patients admitted for acute coronary syndrome.
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Affiliation(s)
| | - Gregg C. Fonarow
- Ahmanson‐UCLA Cardiomyopathy CenterUniversity of California, Los Angeles Medical CenterLos AngelesCA
| | - Ehete Bahiru
- Division of CardiologyUniversity of California Los AngelesLos AngelesCA
| | - Boback Ziaeian
- Division of CardiologyUniversity of California Los AngelesLos AngelesCA
- Division of CardiologyVA Greater Los AngelesLos AngelesCA
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Fox RS, Carnethon MR, Gallo LC, Wiley JF, Isasi CR, Daviglus ML, Cai J, Davis SM, Giachello AL, Gonzalez P, McCurley JL, Schneiderman N, Penedo FJ. Perceived Discrimination and Cardiometabolic Risk Among US Hispanics/Latinos in the HCHS/SOL Sociocultural Ancillary Study. Int J Behav Med 2019; 26:331-342. [PMID: 31236872 PMCID: PMC7294575 DOI: 10.1007/s12529-019-09782-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Metabolic syndrome (MetS) is a group of cardiovascular risk factors including elevated blood pressure, elevated triglycerides, decreased high-density lipoprotein cholesterol, impaired fasting glucose, and abdominal obesity, which disproportionately affects Hispanics/Latinos. The present study examined associations between perceived discrimination and MetS in Hispanic/Latino adults from various background groups (i.e., Dominican, Central American, Cuban, Mexican, Puerto Rican, South American). METHODS Data were obtained from 5174 Hispanics/Latinos who participated in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Sociocultural Ancillary Study. MetS components and covariates were measured at a baseline examination, and perceived discrimination was assessed within 9 months of baseline. Path analysis modeled associations of perceived discrimination with MetS prevalence and each of the six components of MetS, controlling for age, sex, income, acculturation, physical activity, diet, smoking, and alcohol use. RESULTS Among the full cohort, perceived discrimination was not associated with MetS prevalence in any of the models evaluated. Higher perceived discrimination at work/school was associated with larger waist circumference. When examining background groups separately, higher perceived ethnicity-associated threat was related to increased MetS prevalence only among individuals of Central American background. Differential patterns of association between perceived discrimination and MetS components were found for different background groups. CONCLUSIONS Overall results suggested that perceived discrimination was not strongly or consistently associated with MetS among Hispanics/Latinos.
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Affiliation(s)
- Rina S Fox
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mercedes R Carnethon
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Linda C Gallo
- Department of Psychology, San Diego State University, San Diego, CA, USA
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Joshua F Wiley
- Monash Institute of Cognitive and Clinical Neurosciences and School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - Carmen R Isasi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY, USA
| | - Martha L Daviglus
- Institute for Minority Health Research, University of Illinois at Chicago, Chicago, IL, USA
| | - Jianwen Cai
- Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sonia M Davis
- Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Aida L Giachello
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Patricia Gonzalez
- Graduate School of Public Health, San Diego State University, San Diego, CA, USA
| | - Jessica L McCurley
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | | | - Frank J Penedo
- Department of Psychology, University of Miami, Miami, FL, USA.
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Bey G, Jesdale B, Forrester S, Person S, Kiefe C. Intersectional effects of racial and gender discrimination on cardiovascular health vary among black and white women and men in the CARDIA study. SSM Popul Health 2019; 8:100446. [PMID: 31334327 PMCID: PMC6620618 DOI: 10.1016/j.ssmph.2019.100446] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/30/2019] [Accepted: 07/02/2019] [Indexed: 12/21/2022] Open
Abstract
Testing hypotheses from the emerging Identity Pathology (IP) framework, we assessed race-gender differences in the effects of reporting experiences of racial and gender discrimination simultaneously compared with racial or gender discrimination alone, or no discrimination, on future cardiovascular health (CVH). Data were from a sample of 3758 black or white adults in CARDIA, a community-based cohort recruited in Birmingham, AL; Chicago, IL; Minneapolis, MN, and Oakland, CA in 1985-6 (year 0). Racial and gender discrimination were assessed using the Experiences of Discrimination scale. CVH was evaluated using a 12-point composite outcome modified from the Life's Simple 7, with higher scores indicating better health. Multivariable linear regressions were used to evaluate the associations between different perceptions of discrimination and CVH scores two decades later by race and gender simultaneously. Reporting racial and gender discrimination in ≥2 settings were 48% of black women, 42% of black men, 10% of white women, and 5% of white men. Year 30 CVH scores (mean, SD) were 7.9(1.4), 8.1(1.6), 8.8(1.6), and 8.7(1.3), respectively. Compared with those of their race-gender groups reporting no discrimination, white women reporting only gender-based discrimination saw an adjusted score difference of +0.3 (95% CI: 0.0,0.6), whereas white men reporting only racial discrimination had on average a 0.4 (95% CI: 0.1,0.8) higher score, and scores among white men reporting both racial and gender discrimination were on average 0.6 (95% CI: 1.1,-0.1) lower than those of their group reporting no discrimination. Consistent with predictions of the IP model, the associations of reported racial and gender discrimination with future CVH were different for different racially-defined gender groups. More research is needed to understand why reported racial and gender discrimination might better predict deterioration in CVH for whites than blacks, and what additional factors associated with gender and race contribute variability to CVH among these groups.
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Affiliation(s)
- G.S. Bey
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr. Chapel Hill, NC, 27599, USA
| | - B. Jesdale
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA, 01655, USA
| | - S. Forrester
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA, 01655, USA
| | - S.D. Person
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA, 01655, USA
| | - C. Kiefe
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA, 01655, USA
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Panza GA, Puhl RM, Taylor BA, Zaleski AL, Livingston J, Pescatello LS. Links between discrimination and cardiovascular health among socially stigmatized groups: A systematic review. PLoS One 2019; 14:e0217623. [PMID: 31181102 PMCID: PMC6557496 DOI: 10.1371/journal.pone.0217623] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 05/15/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND There is a high prevalence of cardiovascular disease across diverse groups in the U.S. population, and increasing research has identified stigma as a potential barrier to cardiovascular disease prevention and treatment. This systematic review examines evidence linking discrimination and cardiovascular health among socially stigmatized groups. STUDY DESIGN Six databases were systematically reviewed from inception through February 2018 for studies with adult subjects, focusing on cardiovascular health indicators among social groups stigmatized because of their gender, race/ethnicity, age, body weight/obesity, or sexual orientation. The Newcastle-Ottawa Scale was used to evaluate the methodological quality and risk of bias for nonrandomized studies, and the Cochrane Collaboration 7-item domain for randomized controlled and experimental trials. RESULTS The search identified 84 eligible studies published between 1984 and 2017. Studies retrieved were categorized according to demonstrated links between stigma and cardiovascular disease risk factors including blood pressure (n = 45), heart rate variability (n = 6), blood/saliva cardiovascular biomarkers (n = 18), as well as other indicators of cardiovascular health (n = 15). Based on the findings from included studies, 86% concluded that there was a significant relationship among stigma or discrimination and cardiovascular health indicators among socially stigmatized groups. However, there were varying degrees of evidence supporting these relationships, depending on the type of discrimination and cardiovascular health indicator. The current evidence implies an association between perceived discrimination and cardiovascular health. However, a majority of these studies are cross-sectional (73%) and focus on racial discrimination (79%), while using a wide variety of measurements to assess social discrimination and cardiovascular health. CONCLUSIONS Future research should include longitudinal and randomized controlled trial designs, with larger and more diverse samples of individuals with stigmatized identities, using consistent measurement approaches to assess social discrimination and its relationship with cardiovascular health.
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Affiliation(s)
- Gregory A. Panza
- Department of Kinesiology, University of Connecticut, Storrs, CT, United States of America
- Department of Cardiology, Hartford Hospital, Hartford, CT, United States of America
- * E-mail:
| | - Rebecca M. Puhl
- Rudd Center for Food Policy & Obesity, University of Connecticut, Hartford, CT, United States of America
- Department of Human Development & Family Studies, University of Connecticut, Storrs, CT, United States of America
| | - Beth A. Taylor
- Department of Kinesiology, University of Connecticut, Storrs, CT, United States of America
- Department of Cardiology, Hartford Hospital, Hartford, CT, United States of America
| | - Amanda L. Zaleski
- Department of Kinesiology, University of Connecticut, Storrs, CT, United States of America
- Department of Cardiology, Hartford Hospital, Hartford, CT, United States of America
| | - Jill Livingston
- Department of Research Services, University of Connecticut, Storrs, CT, United States of America
| | - Linda S. Pescatello
- Department of Kinesiology, University of Connecticut, Storrs, CT, United States of America
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Schoenthaler A, Fei K, Ramos MA, Richardson LD, Ogedegbe G, Horowitz CR. Comprehensive examination of the multilevel adverse risk and protective factors for cardiovascular disease among hypertensive African Americans. J Clin Hypertens (Greenwich) 2019; 21:794-803. [PMID: 31125186 DOI: 10.1111/jch.13560] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/24/2019] [Accepted: 05/05/2019] [Indexed: 12/25/2022]
Abstract
This paper describes the multilevel factors that contribute to hypertension disparities in 2052 hypertensive African Americans (mean age 52.9 ± 9.9 years; 66.3% female) who participated in a clinical trial. At the family level, participants reported average levels of life chaos and high social support. However, at the individual level, participants exhibited several adverse clinical and behavioral factors including poor blood pressure control (45% of population), obesity (61%), medication non-adherence (48%), smoking (32%), physical inactivity (45%), and poor diet (71%). While participants rated their provider as trustworthy, they reported high levels of discrimination in the health care system. Finally, community-level data indicate that participants reside in areas characterized by poor socio-economic and neighborhood conditions (eg, segregation). In the context of our trial, hypertensive African Americans exhibited several adverse risks and protective factors at multiple levels of influence. Future research should evaluate the impact of these factors on cardiovascular outcomes using a longitudinal design.
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Affiliation(s)
- Antoinette Schoenthaler
- Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine, New York, New York
| | - Kezhen Fei
- Department of Population Health Sciences and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.,Center for Health Equity and Community Engaged Research, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Michelle A Ramos
- Department of Population Health Sciences and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.,Center for Health Equity and Community Engaged Research, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Lynne D Richardson
- Department of Population Health Sciences and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.,Center for Health Equity and Community Engaged Research, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Gbenga Ogedegbe
- Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine, New York, New York
| | - Carol R Horowitz
- Department of Population Health Sciences and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.,Center for Health Equity and Community Engaged Research, Icahn School of Medicine at Mount Sinai, New York, New York
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Nystedt TA, Rosvall M, Lindström M. The association of self-reported discrimination to all-cause mortality: A population-based prospective cohort study. SSM Popul Health 2019; 7:100360. [PMID: 30766909 PMCID: PMC6360602 DOI: 10.1016/j.ssmph.2019.100360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 01/13/2019] [Accepted: 01/17/2019] [Indexed: 11/25/2022] Open
Abstract
Discrimination has is an important social determinant of health and though some research has been carried out on this it is mostly from the United States, which may not be generalisable to Europe and Sweden. This study investigated the association between self-reported experiences of repeated discrimination and all-cause mortality in Scania, Sweden. The Scania Public Health survey was sent out in 2008 with a follow-up in 2013 through the Swedish national cause of death register (N=28,062). The exposure variable under investigation was self-reported discrimination and the outcome variable was all-cause mortality. Additional variables included demographics (age, sex, marital status, immigrant status), health behaviours (smoking, alcohol consumption, physical exercise), BMI, social participation, economic stress, and mental health. Time was measured as total number of days. Statistical analysis included association of the different variables to discrimination (ORs) and to all-cause mortality (HRs) adjusting for different covariates. Effect modification was tested for social participation, economic stress and mental health. The odds of discrimination was higher among the most vulnerable groups in society. All-cause mortality was strongly associated to age and sex, with a much higher risk among men than women. The association of repeated discrimination to all-cause mortality remained significant after adjusting for demographic variables, health behaviours and either social participation or economic stress, but not both. The association was non-significant after adjusting for demographic variables and mental health. Social participation was found to be an effect modifier with low participation strengthening the effect of the association of repeated discrimination to all-cause mortality. Repeated discrimination clearly has a strong impact on mental health but also on economic stress and social participation which in turn have a strong impact on mortality.
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Affiliation(s)
- Tanya Andersson Nystedt
- Social Medicine and Health Policy, Department of Clinical Sciences in Malmö, Lund University, S-205 02 Malmö, Sweden
| | - Maria Rosvall
- Social Medicine and Health Policy, Department of Clinical Sciences in Malmö, Lund University, S-205 02 Malmö, Sweden
- Department of Community Medicine and Public Health, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Martin Lindström
- Social Medicine and Health Policy, Department of Clinical Sciences in Malmö, Lund University, S-205 02 Malmö, Sweden
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Meng LB, Shan MJ, Yu ZM, Lv J, Qi RM, Guo P, Zhang YM, Gong T. Chronic stress: a crucial promoter of cell apoptosis in atherosclerosis. J Int Med Res 2019; 48:300060518814606. [PMID: 30700193 PMCID: PMC7140195 DOI: 10.1177/0300060518814606] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objective Chronic stress may lead to augmented incidence rates of coronary and
cerebrovascular diseases associated with atherosclerosis. However, few
studies have focused on the effect of chronic stress on atherosclerosis
plaque formation. Therefore, this study was designed to directly evaluate
how chronic stress affects atherosclerosis. Methods Thirty rabbits were divided into three groups: the control group,
balloon-injury operation + high-fat diet model group, and chronic
stress + balloon-injury operation + high-fat diet model group. Physical and
social stress were induced, and proteomic methods were applied to identify
specific markers. Results After protein determination, the chronic stress + balloon-injury
operation + high-fat diet model group exhibited significant upregulation of
the following apoptosis-related proteins: UBE2K, caspase 3, caspase 9, BAX,
P53, and FAS. In particular, real-time polymerase chain reaction showed that
the protein expression of caspase 9 was significantly downregulated in the
stress group compared with the non-stress groups. However, the other
proteins showed significantly increased expression in the stress group. Conclusion Chronic stress may promote cell apoptosis in the physiopathologic process of
atherosclerosis.
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Affiliation(s)
- Ling-Bing Meng
- Neurology Department, Beijing Hospital, National Center of Gerontology, Dong Dan, Beijing, China
| | - Meng-Jie Shan
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ze-Mou Yu
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Jian Lv
- Second Department of Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Ruo-Mei Qi
- The MOH Key Laboratory of Geriatrics, Beijing Hospital, National Center of Gerontology, Dong Dan, Beijing, China
| | - Peng Guo
- Department of Orthopedics, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Yuan-Meng Zhang
- Internal Medicine Department, Jinzhou Medical University, Liaoning, China
| | - Tao Gong
- Neurology Department, Beijing Hospital, National Center of Gerontology, Dong Dan, Beijing, China
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Zahodne LB, Kraal AZ, Sharifian N, Zaheed AB, Sol K. Inflammatory mechanisms underlying the effects of everyday discrimination on age-related memory decline. Brain Behav Immun 2019; 75:149-154. [PMID: 30367930 PMCID: PMC6279484 DOI: 10.1016/j.bbi.2018.10.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 09/04/2018] [Accepted: 10/23/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND/OBJECTIVES Previous research suggests that everyday discrimination is associated with worse episodic memory and partially mediates Black-White disparities in memory aging. The biological mechanisms underlying the link between everyday discrimination and memory are unclear but may involve inflammatory processes. This study aimed to determine whether systemic inflammation, indexed by blood levels of C-reactive protein (CRP), mediates associations between everyday discrimination and episodic memory over 6 years. DESIGN A longitudinal mediation model quantified associations between baseline everyday discrimination, 4-year change in CRP, and 6-year change in episodic memory. SETTING The Health and Retirement Study (HRS). PARTICIPANTS 12,624 HRS participants aged 51 and older. MEASUREMENTS Everyday Discrimination Scale, high-sensitivity CRP assays of dried blood spots, composite scores of immediate and delayed recall of a word list. RESULTS Black participants reported greater everyday discrimination. Greater discrimination was associated with lower baseline memory and faster memory decline. Higher CRP at baseline partially mediated the negative association between discrimination and baseline memory, but CRP change did not mediate the association between discrimination and memory decline. CONCLUSION This U.S.-representative longitudinal study provides evidence for deleterious effects of discrimination on subsequent episodic memory. The fact that elevated CRP only partially explained the concurrent association between discrimination and memory highlights the need for more comprehensive investigations of biological mechanisms underlying the link between social stress and age-related memory decline in order to better characterize potential intervention targets to reduce racial inequalities in memory aging.
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70
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LoSchiavo C, Halkitis PN, Kapadia F. Sexual Orientation and Gender Identity Victimization Among Young Adults in the New York City Metropolitan Area: The P18 Cohort Study. PSYCHOLOGY OF SEXUAL ORIENTATION AND GENDER DIVERSITY 2019; 6:399-407. [PMID: 32864389 DOI: 10.1037/sgd0000336] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Sexual and gender minority populations are significantly more likely to experience verbal and physical victimization in young adulthood. These analyses examine the types, contexts, and sources of lifetime sexual orientation and gender identity victimization (SGV) in a diverse sample of sexual minority men (SMM) and transgender women as well as the extent to which experiences of SGV vary between subgroups of the population. Cross-sectional data were collected as part of a study of sexual health, mental health, and HIV examined through the lens of syndemic production in young SMM. Measures assessed sociodemographic characteristics as well as the types, sources, and contexts of physical assault and verbal harassment due to actual or perceived gender or sexuality. Verbal harassment was more prevalent in the sample than physical assault (44.5% vs. 11.6%). Schools or sports teams and neighborhoods were the most common contexts for verbal and physical SGV. Strangers were the most frequent perpetrators of SGV, followed by family and peers. Bivariate analyses showed significant differences in SGV based on race, education, perceived familial SES, sexual identity, and borough of residence. In multivariate analyses, race, SES, sexual identity, and borough of residence were significant predictors of verbal SGV. Findings suggest that SGV experiences are not uniform in sexual minority young adults, and thus prevention and care must be targeted. Understanding the multiple identities of sexual minority young adults who experience greater levels of victimization can allow for policy and interventions to best support those at risk.
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71
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Fuller-Rowell TE, Curtis DS, Chae DH, Ryff CD. Longitudinal health consequences of socioeconomic disadvantage: Examining perceived discrimination as a mediator. Health Psychol 2018; 37:491-500. [PMID: 29698020 DOI: 10.1037/hea0000616] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Foundational theoretical perspectives suggest that socioeconomic disadvantage (SED) increases an individual's risk of being exposed to unfair treatment or discrimination. However, little empirical attention has been given to the role of perceived discrimination in the SED-health gradient. Addressing this knowledge gap, the current study examined the mediating role of discrimination in the longitudinal association between SED and self-rated health. METHOD Participants in the Midlife in the United States (MIDUS) study were followed over 3 waves covering a 17- to 19-year period (N = 6,286; 53% female; 91% White; mean age at baseline = 47 years, SD = 13). SED was assessed from education, occupational prestige, income, and assets; self-rated health was measured at baseline and follow-up assessments. Two measures of discrimination-perceived inequality in work and everyday discrimination-were considered as mediators. RESULTS Both measures of discrimination emerged as important explanatory variables in the link between SED and health. SED at the baseline assessment was associated with changes in self-rated health over the 17- to 19-year period (B = -.15, p < .001). Measures of discrimination partially mediated this longitudinal association, explaining 22% of the total effect. Exposure to discrimination and its health consequences were also more pronounced at younger ages. CONCLUSION Additional research is needed to replicate the findings of this study using objective health measures and to examine possible interventions. Challenging the ideologies and practices that underlie social class-related discrimination, or mitigating its harmful consequences, will both be important approaches to consider. (PsycINFO Database Record
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Affiliation(s)
| | - David S Curtis
- Department of Human Development and Family Studies, Auburn University
| | - David H Chae
- Department of Human Development and Family Studies, Auburn University
| | - Carol D Ryff
- Department of Psychology, University of Wisconsin-Madison
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Multiple forms of discrimination, social status, and telomere length: Interactions within race. Psychoneuroendocrinology 2018; 98:119-126. [PMID: 30138832 PMCID: PMC6359723 DOI: 10.1016/j.psyneuen.2018.08.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 08/07/2018] [Accepted: 08/07/2018] [Indexed: 12/14/2022]
Abstract
Previous research has demonstrated inverse associations between experiences of interpersonal discrimination and telomere length, a marker of cellular aging. Here, we investigate within-race interactions between multiple indices of interpersonal discrimination and sociodemographic characteristics in relation to telomere length in African American and White adults. Participants were from the Healthy Aging in Neighborhoods of Diversity across the Life Span study (Baltimore, Maryland). Ages ranged from 30 to 64 years old and all self-identified as either African American (n = 176) or White (n = 165). Using linear regression, three patterns were observed within African Americans: (1) women reporting greater lifetime burden of discrimination (p = .02), racial (p = .03), or gender (p = .01) discrimination; (2) those with higher socioeconomic status reporting greater lifetime burden (p = .03) or racial discrimination (p = .02); and (3) younger adults reporting greater exposure to multiple sources of discrimination (p = .03) had shorter telomere length. Among Whites, younger and older men reporting greater racial discrimination had shorter and longer telomeres, respectively (p = .02). Findings demonstrate within-race patterns of interpersonal discrimination and cellular aging, which may contribute to racial health disparities.
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Beatty Moody DL, Taylor AD, Leibel DK, Al-Najjar E, Katzel LI, Davatzikos C, Gullapalli RP, Seliger SL, Kouo T, Erus G, Rosenberger WF, Evans MK, Zonderman AB, Waldstein SR. Lifetime discrimination burden, racial discrimination, and subclinical cerebrovascular disease among African Americans. Health Psychol 2018; 38:63-74. [PMID: 30474995 DOI: 10.1037/hea0000638] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Explore interactive relations of lifetime discrimination burden and racial discrimination-chronic stressors among African Americans (AAs)-and age with MRI-assessed white matter lesion volume (WMLV), a prognostic indicator of poor clinical brain health outcomes. METHOD AAs (N = 71; 60.6% female, mean age = 50) participating in the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) SCAN study underwent quantitative magnetic resonance imaging coded for WMLV. Participants self-reported lifetime discrimination burden and racial discrimination approximately 5 years earlier. Multivariable regression models assessed interactions of linear and quadratic effects of discrimination and age with WMLV adjusted for sex and socioeconomic status. RESULTS Findings revealed significant interactive relations of age and (a) quadratic, lifetime discrimination burden, B = .05, p = .014, ηpartial2 = .092, and (b) quadratic, racial discrimination, B = .03, p = .001, ηpartial2 = .155, with WMLV. Among older AA, increases in lifetime discrimination burden and racial discrimination were associated with increases in WMLV (ps < .03); in younger AA, decreasing levels of racial discrimination were related to increases in WMLV (p = .006). CONCLUSIONS Among older AA, as lifetime discrimination burden and racial discrimination increased, so did WMLV. However, in younger AA, decreases in racial discrimination were associated with increased WMLV. Elucidation of complex mechanistic underpinnings, including potentially differential impacts of the acknowledgment versus suppression or underreporting of discriminatory experiences, among AA of different age cohorts, is critical to understanding the present pattern of findings. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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Affiliation(s)
| | - Antione D Taylor
- Department of Psychology, University of Maryland, Baltimore County
| | - Daniel K Leibel
- Department of Psychology, University of Maryland, Baltimore County
| | - Elias Al-Najjar
- Department of Mathematics and Statistics, University of Maryland, Baltimore County
| | - Leslie I Katzel
- Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Maryland School of Medicine
| | | | - Rao P Gullapalli
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine
| | - Stephen L Seliger
- Division of Nephrology, Department of Medicine, University of Maryland School of Medicine
| | - Theresa Kouo
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine
| | - Guray Erus
- Department of Radiology, University of Pennsylvania
| | | | - Michele K Evans
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging
| | - Alan B Zonderman
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging
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Lockwood KG, Marsland AL, Matthews KA, Gianaros PJ. Perceived discrimination and cardiovascular health disparities: a multisystem review and health neuroscience perspective. Ann N Y Acad Sci 2018; 1428:170-207. [PMID: 30088665 DOI: 10.1111/nyas.13939] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 07/03/2018] [Accepted: 07/09/2018] [Indexed: 12/19/2022]
Abstract
There are distinct racial disparities in cardiovascular disease (CVD) risk, with Black individuals at much greater risk than White individuals. Although many factors contribute to these disparities, recent attention has focused on the role of discrimination as a stress-related factor that contributes to racial disparities in CVD. As such, it is important to understand the mechanisms by which discrimination might affect CVD. Recent studies have examined these mechanisms by focusing on neurobiological mediators of CVD risk. Given this increase in studies, a systematic review of perceived discrimination and neurobiological mediators of CVD risk is warranted. Our review uses a multisystem approach to review studies on the relationship between perceived discrimination and (1) cardiovascular responses to stress, (2) hypothalamic-pituitary-adrenocortical axis function, and (3) the immune system, as well as (4) the brain systems thought to regulate these parameters of peripheral physiology. In addition to summarizing existing evidence, our review integrates these findings into a conceptual model describing multidirectional pathways linking perceived discrimination with a CVD risk.
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Affiliation(s)
- Kimberly G Lockwood
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Anna L Marsland
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Karen A Matthews
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Peter J Gianaros
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania
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Stewart AL, Kathawalla UK, Wolfe AG, Everson-Rose SA. Women's heart health at mid-life: what is the role of psychosocial stress? Womens Midlife Health 2018; 4:11. [PMID: 30766721 PMCID: PMC6297972 DOI: 10.1186/s40695-018-0041-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 07/02/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Women in mid-life experience unique stressors, including transitions within their family roles, informal caregiving, job stress, and perceived discrimination. The impact of these stressors on cardiovascular health in women during mid-life is of growing interest in both the popular and scientific literature. The objective of this review is to summarize the recent literature on stress and cardiovascular health in mid-life women. We focus on stressors that are relevant to mid-life women, including social stress and discrimination, and long-term risk of CVD events and subclinical CVD measures. METHODS We systematically reviewed the literature published between January 2012 and April 2018 for studies examining stress in mid-life and either CVD endpoints or subclinical CVD outcomes. Eligible studies included at least one psychosocial stress exposure, a CVD or subclinical CVD outcome, and either included only female participants, reported sex-stratified analyses or tested for a sex*stress interaction. RESULTS We identified 37 studies published since 2012 that met our criteria and included women between the ages of 40 and 65, including 3 case-control studies, 15 cross-sectional studies, and 19 prospective cohort studies. Because clinical CVD events typically occur after age 65 in women, only 22 studies were available that evaluated stress and hard CVD events in samples with mid-life women. Results from these studies suggested an increased and significant risk of CVD due to stress. Of the 15 studies that included subclinical CVD outcomes, the majority showed that mid-life women experiencing greater levels of stress had more subclinical CVD, as indicated by carotid intima-media thickness, flow-mediated dilation and arterial stiffness; however, several studies reported null associations. CONCLUSIONS General life stress, including perceived stress and life events, in mid-life was significantly related to later-life CVD risk and mid-life subclinical CVD in the majority of studies published in the past six years. Job stress was inconsistently related to CVD risk in women, and fewer studies examined characteristics of other social roles, such as marriage, motherhood or caregiving. Perceived discrimination also was associated with CVD events and subclinical CVD in some samples of mid-life women. Further investigation into specific stressors relevant to women in mid-life, including caregiving and marital stress, are needed to understand the full extent to which life stress impacts CVD risk in mid-life women.
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Affiliation(s)
- Andrea L. Stewart
- Department of Epidemiology, University of Pittsburgh, 4420 Bayard Street, Suite 600, Pittsburgh, PA 15260 USA
| | - Ummul-Kiram Kathawalla
- Department of Psychology, University of Minnesota, 75 E River Parkway, Minneapolis, MN 55414 USA
| | - Alexandra G. Wolfe
- Department of Medicine, University of Minnesota, 717 Delaware St SE, Suite 166, Minneapolis, MN 55414 USA
| | - Susan A. Everson-Rose
- Department of Medicine, University of Minnesota, 717 Delaware St SE, Suite 166, Minneapolis, MN 55414 USA
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Datu JAD. Everyday discrimination, negative emotions, and academic achievement in Filipino secondary school students: Cross-sectional and cross-lagged panel investigations. J Sch Psychol 2018; 68:195-205. [PMID: 29861029 DOI: 10.1016/j.jsp.2018.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 09/18/2017] [Accepted: 04/11/2018] [Indexed: 10/17/2022]
Abstract
Different forms of overt discrimination have been consistently linked to maladaptive psychological, physical health, and educational outcomes. However, limited research has been carried out to assess the link of subtle forms of discrimination like everyday discrimination on academic functioning in the school context. The current study addressed this research gap through examining the association of everyday discrimination with negative emotions and academic achievement among Filipino high school students. A cross-sectional study (Study 1) showed that everyday discrimination was positively associated with negative emotions and negatively linked to perceived academic achievement. Furthermore, everyday discrimination had indirect effects on academic achievement through the intermediate variable negative emotions. Then, a two-wave cross-lagged panel investigation (Study 2) demonstrated that Time 1 everyday discrimination was linked to higher Time 2 negative emotions. Reciprocal associations were also found among the constructs because Time 1 academic achievement was linked to lower levels Time 2 negative emotions and Time 2 everyday discrimination. The theoretical and practical implications of the research are elucidated.
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Affiliation(s)
- Jesus Alfonso D Datu
- Department of Special Education and Counselling, Hong Kong, SAR China; Integrated Centre for Well-Being (I-WELL), The Education University of Hong Kong, Hong Kong, SAR China.
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77
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Chronic discrimination and bodily pain in a multiethnic cohort of midlife women in the Study of Women's Health Across the Nation. Pain 2018; 158:1656-1665. [PMID: 28753588 DOI: 10.1097/j.pain.0000000000000957] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
A growing literature links discrimination to key markers of biobehavioral health. While racial or ethnic differences in pain are seen in experimental and clinical studies, the authors were interested in how chronic discrimination contributes to pain within multiple racial or ethnic groups over time. Participants were 3056 African American, Caucasian, Chinese, Hispanic, and Japanese women from the Study of Women's Health Across the Nation. The Everyday Discrimination Scale was assessed from baseline through 13 follow-up examinations. The bodily pain subscale of the MOS 36-Item Short-Form Health Survey (SF-36) was assessed annually. There were large racial or ethnic differences in reports of discrimination and pain. Discrimination attributions also varied by race or ethnicity. In linear mixed model analyses, initially adjusted for age, education, and pain medications, chronic everyday discrimination was associated with more bodily pain in all ethnic groups (beta = -5.84; P < 0.002 for Japanese; beta = -6.17; P < 0.001 for African American; beta = -8.74; P < 0.001 for Chinese; beta = -10.54; P < 0.001 for Caucasians; beta = -12.82; P < 0.001 for Hispanic). Associations remained significant in all ethnic groups after adjusting for additional covariates in subsequent models until adding depressive symptoms as covariate; in the final fully-adjusted models, discrimination remained a significant predictor of pain for African American (beta = -4.50; P < 0.001), Chinese (beta = -6.62; P < 0.001), and Caucasian (beta = -7.86; P < 0.001) women. In this longitudinal study, experiences of everyday discrimination were strongly linked to reports of bodily pain for the majority of women. Further research is needed to determine if addressing psychosocial stressors, such as discrimination, with patients can enhance clinical management of pain symptoms.
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78
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Lewis TT, Van Dyke ME. Discrimination and the Health of African Americans: The Potential Importance of Intersectionalities. CURRENT DIRECTIONS IN PSYCHOLOGICAL SCIENCE 2018; 27:176-182. [PMID: 30655654 DOI: 10.1177/0963721418770442] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Research examining associations between self-reported experiences of discrimination overall (e.g. potentially due to race, gender, socioeconomic status, age, etc…) and health -particularly among African-Americans - has grown rapidly over the past two decades. Yet recent findings suggest that self-reported experiences of racism alone may be less impactful for the health of African-Americans than previously hypothesized. Thus, an approach that captures a broader range of complexities in the study of discrimination and health among African-Americans may be warranted. This article presents an argument for the importance of examining intersectionalities in studies of discrimination and physical health in African-Americans, and provides an overview of research in this area.
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Affiliation(s)
- Tené T Lewis
- Department of Epidemiology, Rollins School of Public Health, Emory University
| | - Miriam E Van Dyke
- Department of Epidemiology, Rollins School of Public Health, Emory University
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79
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Colen CG, Ramey DM, Cooksey EC, Williams DR. Racial disparities in health among nonpoor African Americans and Hispanics: The role of acute and chronic discrimination. Soc Sci Med 2018; 199:167-180. [PMID: 28571900 PMCID: PMC5673593 DOI: 10.1016/j.socscimed.2017.04.051] [Citation(s) in RCA: 153] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 04/25/2017] [Accepted: 04/27/2017] [Indexed: 02/07/2023]
Abstract
Racial disparities in health tend to be more pronounced at the upper ends of the socioeconomic (SES) spectrum. Despite having access to above average social and economic resources, nonpoor African Americans and Latinos report significantly worse health compared to nonpoor Whites. We combine data from the parents and children of the 1979 National Longitudinal Survey of Youth (NLSY79) to address two specific research aims. First, we generate longitudinal SES trajectories over a 33-year period to estimate the extent to which socioeconomic mobility is associated with exposure to discrimination (acute and chronic) across different racial/ethnic groups (nonHispanic Whites, nonHispanic Blacks, and Hispanics). Then we determine if the disparate relationship between SES and self-rated health across these groups can be accounted for by more frequent exposure to unfair treatment. For Whites, moderate income gains over time result in significantly less exposure to both acute and chronic discrimination. Upwardly mobile African Americans and Hispanics, however, were significantly more likely to experience acute and chronic discrimination, respectively, than their socioeconomically stable counterparts. We also find that differential exposure to unfair treatment explains a substantial proportion of the Black/White, but not the Hispanic/White, gap in self-rated health among this nationally representative sample of upwardly mobile young adults. The current study adds to the debate that the shape of the SES/health gradient differs, in important ways, across race and provides empirical support for the diminishing health returns hypothesis for racial/ethnic minorities.
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Affiliation(s)
- Cynthia G Colen
- Department of Sociology, Ohio State University, United States
| | - David M Ramey
- Department of Sociology & Criminology, Penn State University, United States
| | - Elizabeth C Cooksey
- Department of Sociology, Center for Human Resource Research, Ohio State University, United States
| | - David R Williams
- Florence Sprague Norman & Laura Smart Norman Professor of Public Health, Harvard University, United States
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80
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Okhomina VI, Glover L, Taylor H, Sims M. Dimensions of and Responses to Perceived Discrimination and Subclinical Disease Among African-Americans in the Jackson Heart Study. J Racial Ethn Health Disparities 2018; 5:1084-1092. [PMID: 29313298 DOI: 10.1007/s40615-017-0457-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/21/2017] [Accepted: 12/26/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Although discrimination among African Americans (AAs) has been linked to various health outcomes, few studies have examined associations of multiple measures of discrimination with prevalent subclinical disease in a large sample of AAs. OBJECTIVES To examine the associations of measures of discrimination and coping responses to discrimination with prevalent subclinical disease among AAs in the Jackson Heart Study (JHS); and whether this association is modified by sex. METHODS We examined the associations of everyday, lifetime, and burden of lifetime discrimination with carotid intima-media thickness (cIMT), and left ventricular hypertrophy (LVH) among 3029 AAs in the JHS. Prevalence ratios (PR 95% confidence interval-CI) and odds ratios (OR 95% CI) were estimated for above-median cIMT and LVH, respectfully, adjusting for demographic, behavioral, and clinical risk factors. RESULTS No significant associations were found between everyday and lifetime discrimination and median cIMT and LVH. Participants who reported high (vs. no) burden of lifetime discrimination had a 48% reduced odds of LVH (OR, 0.52; 95% CI, 0.29, 0.94) after full adjustment. There was evidence of effect modification by sex in the association of coping with everyday discrimination and LVH after full adjustment (p value for interaction < 0.01). Women who actively (vs. passively) coped with everyday discrimination had a greater odds of prevalent LVH (OR, 2.49; 95% CI, 1.39, 4.46). CONCLUSIONS This study suggests that the manner by which AA women cope with discriminatory events is associated with subclinical disease.
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Affiliation(s)
- Victoria I Okhomina
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
| | - LáShauntá Glover
- Department of Medicine, University of Mississippi Medical Center, Jackson Heart Study, 350 W. Woodrow Wilson Drive, Jackson, MS, 39213, USA
| | - Herman Taylor
- Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, GA, USA
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson Heart Study, 350 W. Woodrow Wilson Drive, Jackson, MS, 39213, USA.
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81
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Carnethon MR, Pu J, Howard G, Albert MA, Anderson CAM, Bertoni AG, Mujahid MS, Palaniappan L, Taylor HA, Willis M, Yancy CW. Cardiovascular Health in African Americans: A Scientific Statement From the American Heart Association. Circulation 2017; 136:e393-e423. [PMID: 29061565 DOI: 10.1161/cir.0000000000000534] [Citation(s) in RCA: 679] [Impact Index Per Article: 97.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE Population-wide reductions in cardiovascular disease incidence and mortality have not been shared equally by African Americans. The burden of cardiovascular disease in the African American community remains high and is a primary cause of disparities in life expectancy between African Americans and whites. The objectives of the present scientific statement are to describe cardiovascular health in African Americans and to highlight unique considerations for disease prevention and management. METHOD The primary sources of information were identified with PubMed/Medline and online sources from the Centers for Disease Control and Prevention. RESULTS The higher prevalence of traditional cardiovascular risk factors (eg, hypertension, diabetes mellitus, obesity, and atherosclerotic cardiovascular risk) underlies the relatively earlier age of onset of cardiovascular diseases among African Americans. Hypertension in particular is highly prevalent among African Americans and contributes directly to the notable disparities in stroke, heart failure, and peripheral artery disease among African Americans. Despite the availability of effective pharmacotherapies and indications for some tailored pharmacotherapies for African Americans (eg, heart failure medications), disease management is less effective among African Americans, yielding higher mortality. Explanations for these persistent disparities in cardiovascular disease are multifactorial and span from the individual level to the social environment. CONCLUSIONS The strategies needed to promote equity in the cardiovascular health of African Americans require input from a broad set of stakeholders, including clinicians and researchers from across multiple disciplines.
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82
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Udo T, Grilo CM. Cardiovascular disease and perceived weight, racial, and gender discrimination in U.S. adults. J Psychosom Res 2017; 100:83-88. [PMID: 28720250 PMCID: PMC5598460 DOI: 10.1016/j.jpsychores.2017.07.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 07/12/2017] [Accepted: 07/13/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To date, most research on perceived discrimination and cardiovascular disease (CVD) has examined racial discrimination although other forms of discrimination may also impact physical and mental health. The current study investigated the relationship between three forms of discrimination (weight, race, and gender) and 3-year incidence of CVD in a large national sample of U.S. adults. METHODS 26,992 adults (55.5% women) who participated in the 2001-2002 and 2004-2005 National Epidemiologic Survey of Alcohol and Related Conditions (NESARC) were included in this study. Multiple logistic regression analyses were used to calculate odds ratios (OR) and 95% confidence intervals (CI) for three forms of perceived discrimination (simultaneously included in equations after adjusting for relevant potential confounds) for predicting CVD incidence at Wave 2. RESULTS Perceived weight and racial discrimination were associated with significantly greater likelihood of reporting myocardial infarction (OR=2.56 [95% CI=1.31-4.98], OR=1.84 [95% CI=1.19-2.84], respectively) and minor heart conditions (OR=1.48 [95% CI=1.11-1.98], OR=1.41 [95% CI=1.18-1.70], respectively). Perceived racial discrimination was also significantly associated with greater likelihood of reporting arteriosclerosis (OR=1.61 [95% CI=1.11-2.34]). Odds ratios for diagnoses of arteriosclerosis, myocardial infarction, and other minor heart disease were largest for individuals reporting multiple forms of discrimination. CONCLUSIONS Adults who experience weight and racial discrimination, and especially multiple forms of discrimination, may be at heightened risk for CVD. Perceived discrimination may be important to consider during assessment of life stressors by health providers. Future research should address the mechanisms that link discrimination and CVD to assist public health and policy efforts to reduce discrimination.
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Affiliation(s)
- Tomoko Udo
- Department of Health Policy, Management, and Behavior, School of Public Health, University at Albany, State University of New York, 12144, USA.
| | - Carlos M. Grilo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510,Department of Psychology, Yale University, New Haven, CT. 06510
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83
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Whitaker KM, Everson-Rose SA, Pankow JS, Rodriguez CJ, Lewis TT, Kershaw KN, Diez Roux AV, Lutsey PL. Experiences of Discrimination and Incident Type 2 Diabetes Mellitus: The Multi-Ethnic Study of Atherosclerosis (MESA). Am J Epidemiol 2017; 186:445-455. [PMID: 28407040 DOI: 10.1093/aje/kwx047] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 10/07/2017] [Indexed: 01/14/2023] Open
Abstract
Experiences of discrimination are associated with increased risk of adverse health outcomes; however, it is unknown whether discrimination is related to incident type 2 diabetes mellitus (diabetes). We investigated the associations of major experiences of discrimination (unfair treatment in 6 situations) and everyday discrimination (frequency of day-to-day experiences of unfair treatment) with incident diabetes among 5,310 participants from the Multi-Ethnic Study of Atherosclerosis, enrolled in 2000-2002. Using Cox proportional hazards models, we estimated hazard ratios and confidence intervals, adjusting for demographic factors, depressive symptoms, stress, smoking, alcohol, physical activity, diet, waist circumference, and body mass index. Over a median follow-up of 9.4 years, 654 diabetes cases were accrued. Major experiences of discrimination were associated with greater risk of incident diabetes when modeled continuously (for each additional experience of discrimination, hazard ratio = 1.09, 95% confidence interval: 1.01, 1.17) or categorically (for ≥2 experiences vs. 0, hazard ratio = 1.34, 95% confidence interval: 1.08, 1.66). Similar patterns were observed when evaluating discrimination attributed to race/ethnicity or to a combination of other sources. Everyday discrimination was not associated with incident diabetes. In conclusion, major experiences of discrimination were associated with increased risk of incident diabetes, independent of obesity or behavioral and psychosocial factors. Future research is needed to explore the mechanisms of the discrimination-diabetes relationship.
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84
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Ziaeian B, Kominski GF, Ong MK, Mays VM, Brook RH, Fonarow GC. National Differences in Trends for Heart Failure Hospitalizations by Sex and Race/Ethnicity. Circ Cardiovasc Qual Outcomes 2017; 10:e003552. [PMID: 28655709 PMCID: PMC5540644 DOI: 10.1161/circoutcomes.116.003552] [Citation(s) in RCA: 140] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 05/15/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND National heart failure (HF) hospitalization rates have not been appropriately age standardized by sex or race/ethnicity. Reporting hospital utilization trends by subgroup is important for monitoring population health and developing interventions to eliminate disparities. METHODS AND RESULTS The National Inpatient Sample (NIS) was used to estimate the crude and age-standardized rates of HF hospitalization between 2002 and 2013 by sex and race/ethnicity. Direct standardization was used to age-standardize rates to the 2000 US standard population. Relative differences between subgroups were reported. The national age-adjusted HF hospitalization rate decreased 30.8% from 526.86 to 364.66 per 100 000 between 2002 and 2013. Although hospitalizations decreased for all subgroups, the ratio of the age-standardized rate for men compared with women increased from 20% greater to 39% (P trend=0.002) between 2002 and 2013. Black men had a rate that was 229% (P trend=0.141) and black women, 240% (P trend=0.725) with reference to whites in 2013 with no significant change between 2002 and 2013. Hispanic men had a rate that was 32% greater in 2002 and the difference narrowed to 4% (P trend=0.047) greater in 2013 relative to whites. For Hispanic women, the rate was 55% greater in 2002 and narrowed to 8% greater (P trend=0.004) in 2013 relative to whites. Asian/Pacific Islander men had a 27% lower rate in 2002 that improved to 43% (P trend=0.040) lower in 2013 relative to whites. For Asian/Pacific Islander women, the hospitalization rate was 24% lower in 2002 and improved to 43% (P trend=0.021) lower in 2013 relative to whites. CONCLUSIONS National HF hospitalization rates have decreased steadily during the recent decade. Disparities in HF burden and hospital utilization by sex and race/ethnicity persist. Significant population health interventions are needed to reduce the HF hospitalization burden among blacks. An evaluation of factors explaining the improvements in the HF hospitalization rates among Hispanics and Asian/Pacific Islanders is needed.
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Affiliation(s)
- Boback Ziaeian
- From the Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA (B.Z., G.F.K., V.M.M., R.H.B.); Division of Cardiology (B.Z.) and Department of Internal Medicine (M.K.O.), Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA; Division of General Internal Medicine and Health Services Research (M.K.O., R.H.B.) and Division of Cardiology (B.Z., G.C.F.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Psychology, University of California, Los Angeles (V.M.M.); and Ahmanson-UCLA Cardiomyopathy Center, UCLA Medical Center, Los Angeles, CA (G.C.F.)
| | - Gerald F Kominski
- From the Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA (B.Z., G.F.K., V.M.M., R.H.B.); Division of Cardiology (B.Z.) and Department of Internal Medicine (M.K.O.), Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA; Division of General Internal Medicine and Health Services Research (M.K.O., R.H.B.) and Division of Cardiology (B.Z., G.C.F.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Psychology, University of California, Los Angeles (V.M.M.); and Ahmanson-UCLA Cardiomyopathy Center, UCLA Medical Center, Los Angeles, CA (G.C.F.)
| | - Michael K Ong
- From the Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA (B.Z., G.F.K., V.M.M., R.H.B.); Division of Cardiology (B.Z.) and Department of Internal Medicine (M.K.O.), Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA; Division of General Internal Medicine and Health Services Research (M.K.O., R.H.B.) and Division of Cardiology (B.Z., G.C.F.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Psychology, University of California, Los Angeles (V.M.M.); and Ahmanson-UCLA Cardiomyopathy Center, UCLA Medical Center, Los Angeles, CA (G.C.F.)
| | - Vickie M Mays
- From the Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA (B.Z., G.F.K., V.M.M., R.H.B.); Division of Cardiology (B.Z.) and Department of Internal Medicine (M.K.O.), Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA; Division of General Internal Medicine and Health Services Research (M.K.O., R.H.B.) and Division of Cardiology (B.Z., G.C.F.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Psychology, University of California, Los Angeles (V.M.M.); and Ahmanson-UCLA Cardiomyopathy Center, UCLA Medical Center, Los Angeles, CA (G.C.F.)
| | - Robert H Brook
- From the Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA (B.Z., G.F.K., V.M.M., R.H.B.); Division of Cardiology (B.Z.) and Department of Internal Medicine (M.K.O.), Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA; Division of General Internal Medicine and Health Services Research (M.K.O., R.H.B.) and Division of Cardiology (B.Z., G.C.F.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Psychology, University of California, Los Angeles (V.M.M.); and Ahmanson-UCLA Cardiomyopathy Center, UCLA Medical Center, Los Angeles, CA (G.C.F.)
| | - Gregg C Fonarow
- From the Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA (B.Z., G.F.K., V.M.M., R.H.B.); Division of Cardiology (B.Z.) and Department of Internal Medicine (M.K.O.), Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA; Division of General Internal Medicine and Health Services Research (M.K.O., R.H.B.) and Division of Cardiology (B.Z., G.C.F.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Psychology, University of California, Los Angeles (V.M.M.); and Ahmanson-UCLA Cardiomyopathy Center, UCLA Medical Center, Los Angeles, CA (G.C.F.).
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85
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Ferraro KF, Kemp BR, Williams MM. Diverse Aging and Health Inequality by Race and Ethnicity. Innov Aging 2017; 1:igx002. [PMID: 29795805 PMCID: PMC5954610 DOI: 10.1093/geroni/igx002] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 03/09/2017] [Indexed: 12/14/2022] Open
Abstract
Although gerontologists have long embraced the concept of heterogeneity in theories and models of aging, recent research reveals the importance of racial and ethnic diversity on life course processes leading to health inequality. This article examines research on health inequality by race and ethnicity and identifies theoretical and methodological innovations that are transforming the study of health disparities. Drawing from cumulative inequality theory, we propose greater use of life course analysis, more attention to variability within racial and ethnic groups, and better integration of environmental context into the study of accumulation processes leading to health disparities.
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Affiliation(s)
- Kenneth F Ferraro
- Department of Sociology, Purdue University, West Lafayette, Indiana.,Center on Aging and the Life Course, Purdue University, West Lafayette, Indiana
| | - Blakelee R Kemp
- Department of Sociology, Purdue University, West Lafayette, Indiana.,Center on Aging and the Life Course, Purdue University, West Lafayette, Indiana
| | - Monica M Williams
- Department of Sociology, Purdue University, West Lafayette, Indiana.,Center on Aging and the Life Course, Purdue University, West Lafayette, Indiana
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86
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Ferdinand KC, Nasser SA. Disparate Cardiovascular Disease Rates in African Americans: The Role of Stress Related to Self-Reported Racial Discrimination. Mayo Clin Proc 2017; 92:689-692. [PMID: 28473033 DOI: 10.1016/j.mayocp.2017.03.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 03/27/2017] [Indexed: 11/22/2022]
Affiliation(s)
| | - Samar A Nasser
- Department of Clinical Research & Leadership, School of Medicine and Health Sciences, The George Washington University, Washington, DC
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87
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Dunlay SM, Lippmann SJ, Greiner MA, O'Brien EC, Chamberlain AM, Mentz RJ, Sims M. Perceived Discrimination and Cardiovascular Outcomes in Older African Americans: Insights From the Jackson Heart Study. Mayo Clin Proc 2017; 92:699-709. [PMID: 28473034 PMCID: PMC5527992 DOI: 10.1016/j.mayocp.2017.01.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 01/17/2017] [Accepted: 01/19/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To assess the associations of perceived discrimination and cardiovascular (CV) outcomes in African Americans (AAs) in the Jackson Heart Study. PATIENTS AND METHODS In 5085 AAs free of clinical CV disease at baseline enrolled in the Jackson Heart Study from September 26, 2000, through March 31, 2004, and followed through 2012, associations of everyday discrimination (frequency of occurrences of perceived unfair treatment) and lifetime discrimination (perceived unfair treatment in 9 life domains) with CV outcomes (all-cause mortality, incident coronary heart disease [CHD], incident stroke, and heart failure [HF] hospitalization) were examined using Cox proportional hazards regression models. RESULTS Higher levels of everyday and lifetime discrimination were more common in participants who were younger and male and had higher education and income, lower perceived standing in the community, worse perceived health care access, and fewer comorbidities. Before adjustment, higher levels of everyday and lifetime discrimination were associated with a lower risk of all-cause mortality, incident CHD, stroke, and HF hospitalization. After adjustment for potential confounders, we found no association of everyday and lifetime discrimination with incident CHD, incident stroke, or HF hospitalization; however, a decrease in all-cause mortality with progressively higher levels of everyday discrimination persisted (hazard ratio per point increase in discrimination measure, 0.90; 95% CI, 0.82-0.99; P=.02). The unexpected association of everyday discrimination and all-cause mortality was partially mediated by perceived stress. CONCLUSION We found no independent association of perceived discrimination with risk of incident CV disease or HF hospitalization in this AA population. An observed paradoxical negative association of everyday discrimination and all-cause mortality was partially mediated by perceived stress.
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Affiliation(s)
| | | | | | | | | | | | - Mario Sims
- University of Mississippi Medical Center, Jackson
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88
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Abstract
A significant body of evidence suggests that poor dietary intake is associated with reduced cognitive function. However, few studies have examined this relation in poor urban settings. Our brief review suggests that (a) higher overall diet quality may play a particularly important role in cognitive function among the poorest; and (b) greater vitamin E intake is related to better cognitive performance, at least in part, via fewer depressive symptoms. The broader recent literature strongly suggests the beneficial role of diet for learning and memory, and potentially synergistic influences on other cognitive domains. However, adherence to healthful diet among urban poor may be limited by factors such as cost and access. Here, we propose several potential moderators and mediators of diet-cognition relations among urban poor. Future studies should focus on the complex interplay among factors that influence the role of diet in cognitive function among poor, urban-dwelling persons.
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89
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Udo T, Purcell K, Grilo CM. Perceived weight discrimination and chronic medical conditions in adults with overweight and obesity. Int J Clin Pract 2016; 70:1003-1011. [PMID: 28032427 PMCID: PMC5215793 DOI: 10.1111/ijcp.12902] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 10/02/2016] [Indexed: 11/30/2022] Open
Abstract
AIM This study investigated whether perceived weight discrimination is associated with increased risk for major chronic medical conditions and whether the associations persist after adjusting for other stressful life events in addition to BMI, physical activity and sociodemographic variables. METHODS The study included 21 357 overweight/obese adults (52.9% women) from the 2001 to 2002 and 2004 to 2005 National Survey of Alcohol and Related Conditions. RESULTS Perceived weight discrimination was significantly associated with risk for arteriosclerosis, diabetes, high cholesterol, myocardial infarction, minor heart conditions and stomach ulcers. Perceived weight discrimination was associated with reporting more stressful life events. After adjusting additionally for stressful life events in the final multiple logistic regression, associations with arteriosclerosis, diabetes and minor cardiac conditions remained significant. Gender-stratified analyses revealed that perceived weight discrimination was associated with different medical conditions in women than men, and many associations became non-significant when adjusting for stressful life events, particularly for women. CONCLUSIONS Among overweight/obese adults, perceived weight discrimination is associated with significantly increased risk for obesity-related chronic medical conditions even after adjusting for BMI, physical activity and sociodemographic variables. Accounting for other acute stressful life events may also be important in understanding the health effects of perceived weight discrimination. Such added health risk of overweight/obesity posed by perceived weight discrimination warrants public health and policy interventions against weight discrimination to reduce the socioeconomic burden of obesity.
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Affiliation(s)
- Tomoko Udo
- Department of Health Policy, Management, and Behavior, School of Public Health, University at Albany, State University of New York, 12144, USA
| | - Katherine Purcell
- Department of Health Policy, Management, and Behavior, School of Public Health, University at Albany, State University of New York, 12144, USA
| | - Carlos M. Grilo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510
- National Center on Addiction and Substance Abuse (at Yale), New Haven, CT. 06510
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Everson-Rose SA, Lutsey PL, Roetker NS, Lewis TT, Kershaw KN, Alonso A, Diez Roux AV. Perceived Discrimination and Incident Cardiovascular Events: The Multi-Ethnic Study of Atherosclerosis. Am J Epidemiol 2015; 182:225-34. [PMID: 26085044 DOI: 10.1093/aje/kwv035] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 01/29/2015] [Indexed: 11/14/2022] Open
Abstract
Perceived discrimination is positively related to cardiovascular disease (CVD) risk factors; its relationship with incident CVD is unknown. Using data from the Multi-Ethnic Study of Atherosclerosis, a population-based multiethnic cohort study of 6,508 adults aged 45-84 years who were initially free of clinical CVD, we examined lifetime discrimination (experiences of unfair treatment in 6 life domains) and everyday discrimination (frequency of day-to-day occurrences of perceived unfair treatment) in relation to incident CVD. During a median 10.1 years of follow-up (2000-2011), 604 incident events occurred. Persons reporting lifetime discrimination in ≥2 domains (versus none) had increased CVD risk, after adjustment for race/ethnicity and sociodemographic factors, behaviors, and traditional CVD risk factors (hazard ratio (HR) = 1.36, 95% confidence interval (CI): 1.09, 1.70) and after control for chronic stress and depressive symptoms (HR = 1.28, 95% CI: 1.01, 1.60). Reported discrimination in 1 domain was unrelated to CVD (HR = 1.05, 95% CI: 0.86, 1.30). There were no differences by race/ethnicity, age, or sex. In contrast, everyday discrimination interacted with sex (P = 0.03). Stratified models showed increased risk only among men (for each 1-standard deviation increase in score, adjusted HR = 1.14, 95% CI: 1.03, 1.27); controlling for chronic stress and depressive symptoms slightly reduced this association (HR = 1.11, 95% CI: 0.99, 1.25). This study suggests that perceived discrimination is adversely related to CVD risk in middle-aged and older adults.
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