1
|
Yang Q, Zhang J, Fan Z. Causal association between telomere length and female reproductive endocrine diseases: a univariable and multivariable Mendelian randomization analysis. J Ovarian Res 2024; 17:146. [PMID: 39010148 PMCID: PMC11247788 DOI: 10.1186/s13048-024-01466-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 06/28/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND The relationship between leukocyte telomere length (LTL) and female reproductive endocrine diseases has gained significant attention and research interest in recent years. However, there is still limited understanding of the exact impacts of LTL on these diseases. Therefore, the primary objective of this study was to investigate the genetic causal association between LTL and female reproductive endocrine diseases by employing Mendelian randomization (MR) analysis. METHODS Instruments for assessing genetic variation associated with exposure and outcome were derived from summary data of published genome-wide association studies (GWAS). Inverse-variance weighted (IVW) was utilized as the main analysis method to investigate the causal relationship between LTL and female reproductive endocrine diseases. The exposure data were obtained from the UK Biobanks GWAS dataset, comprising 472,174 participants of European ancestry. The outcome data were acquired from the FinnGen consortium, including abnormal uterine bleeding (menorrhagia and oligomenorrhea), endometriosis (ovarian endometrioma and adenomyosis), infertility, polycystic ovary syndrome (PCOS), premature ovarian insufficiency (POI) and premenstrual syndrome (PMS). Furthermore, to account for potential confounding factors such as smoking, alcohol consumption, insomnia, body mass index (BMI) and a history of pelvic inflammatory disease (PID), multivariable MR (MVMR) analysis was also conducted. Lastly, a series of pleiotropy tests and sensitivity analyses were performed to ensure the reliability and robustness of our findings. P < 0.0063 was considered to indicate statistically significant causality following Bonferroni correction. RESULTS Our univariable MR analysis demonstrated that longer LTL was causally associated with an increased risk of menorrhagia (IVW: odds ratio [OR]: 1.1803; 95% confidence interval [CI]: 1.0880-1.2804; P = 0.0001) and ovarian endometrioma (IVW: OR: 1.2946; 95%CI: 1.0970-1.5278; P = 0.0022) at the Bonferroni significance level. However, no significant correlation was observed between LTL and oligomenorrhea (IVW: OR: 1.0124; 95%CI: 0.7350-1.3946; P = 0.9398), adenomyosis (IVW: OR: 1.1978; 95%CI: 0.9983-1.4372; P = 0.0522), infertility (IVW: OR: 1.0735; 95%CI: 0.9671-1.1915; P = 0.1828), PCOS (IVW: OR: 1.0633; 95%CI: 0.7919-1.4278; P = 0.6829), POI (IVW: OR: 0.8971; 95%CI: 0.5644-1.4257; P = 0.6459) or PMS (IVW: OR: 0.7749; 95%CI: 0.4137-1.4513; P = 0.4256). Reverse MR analysis indicated that female reproductive endocrine diseases have no causal effect on LTL. MVMR analysis suggested that the causal effect of LTL on menorrhagia and ovarian endometrioma remained significant after accounting for smoking, alcohol consumption, insomnia, BMI and a history of PID. Pleiotropic and sensitivity analyses also showed robustness of our results. CONCLUSION The results of our bidirectional two-sample MR analysis revealed that genetically predicted longer LTL significantly increased the risk of menorrhagia and ovarian endometrioma, which is consistent with the findings from MVMR studies. However, we did not notice any significant effects of LTL on oligomenorrhea, adenomyosis, infertility, PCOS, POI or PMS. Additionally, reproductive endocrine disorders were found to have no impact on LTL. To enhance our understanding of the effect and underlying mechanism of LTL on female reproductive endocrine diseases, further large-scale studies are warranted in the future.
Collapse
Affiliation(s)
- QiaoRui Yang
- Department of Gynecology, Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - JinFu Zhang
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Department of Gynecology, Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, China
| | - ZhenLiang Fan
- Nephrology Department, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Zhejiang, China.
- Academy of Chinese Medical Science, Zhejiang Chinese Medical University, Zhejiang, China.
| |
Collapse
|
2
|
Kitchens K, Graaf G. Piloting a Measure of Segregation at the Census Tract Level: Associations with Place and Racial/Ethnic Disparities in Life Expectancy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:613. [PMID: 38791827 PMCID: PMC11121047 DOI: 10.3390/ijerph21050613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 05/04/2024] [Accepted: 05/09/2024] [Indexed: 05/26/2024]
Abstract
This study considers residential segregation as a critical driver of racial/ethnic health disparities and introduces a proxy measure of segregation that estimates the degree of segregation at the census tract level with a metric capturing the overrepresentation of a racialized/ethnic group in a census tract in relation to that group's representation at the city level. Using Dallas, Texas as a pilot city, the measure is used to investigate mean life expectancy at birth for relatively overrepresented Hispanic, non-Hispanic white, non-Hispanic Black, and Asian census tracts and examine for significant differences between mean life expectancy in relatively overrepresented census tracts and that group's mean life expectancy at the state level. Multivariable linear regression analysis was utilized to assess how segregation measured at the census tract level associates with life expectancy across different racialized/ethnic groups, controlling for socioeconomic disparities. This study aimed to expose the need to consider the possibility of neighborhood mechanisms beyond socioeconomic characteristics as an important determinant of health and draw attention to the importance of critically engaging the experience of place in examinations of racial and ethnic health disparities. Multivariable linear regression modeling resulted in significant findings for non-Hispanic Black, non-Hispanic white, and Asian groups, indicating increased census tract-level life expectancy for Black and white residents in highly segregated census tracts and decreased life expectancy for residents of tracts in which the Asian community is overrepresented when compared to state means. Unadjusted models demonstrated socioeconomic inequities between first and fourth quartile census tracts and pointed to the importance of mixed methods in health disparities research and the importance of including the voice of community members to account for places of daily lived experience and people's relationships with them.
Collapse
Affiliation(s)
- Katherine Kitchens
- School of Social Work, University of Texas at Arlington, 501 W. Mitchell Street, Arlington, TX 76019, USA;
| | | |
Collapse
|
3
|
Lange-Maia BS, James BD, Capuano AW, Grodstein F, Chen Y, Barnes LL. Everyday Discrimination Is Associated With Higher Odds of Hospitalizations Among Older African Americans. J Gerontol A Biol Sci Med Sci 2024; 79:glae089. [PMID: 38549555 PMCID: PMC11046980 DOI: 10.1093/gerona/glae089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Everyday discrimination-experiences of being treated unfairly based on background characteristics like race-is linked to poor physical and mental health throughout the lifespan. Whether more experiences of discrimination are associated with higher odds of being hospitalized in older African Americans has not been explored. METHODS Community-dwelling participants from 3 longitudinal cohort studies (N = 446, age 65+ years) with discrimination scores and ≥12 months of linked Medicare claims were included. Hospitalizations were identified using Medicare fee-for-service claims, available for an average of 6.2 (SD: 3.7) years of follow-up after baseline. RESULTS In mixed-effects ordinal logistic regression models (outcomes of 0, 1, or 2+ hospitalizations per year) adjusted for age, sex, education, and income, higher discrimination was associated with higher odds of total annual hospitalizations (odds ratio [OR] per point higher = 1.09, 95% confidence intervals [95% CI]: 1.02-1.17). Results were similar when accounting for depressive symptoms. CONCLUSIONS Higher exposure to everyday discrimination is associated with higher odds of hospitalization among older African Americans. Mechanisms underlying associations should be explored further to understand how hospitalizations may be reduced in older African Americans.
Collapse
Affiliation(s)
- Brittney S Lange-Maia
- Department of Family and Preventive Medicine, Rush Medical College, Chicago, Illinois, USA
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Bryan D James
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, USA
- Department of Internal Medicine, Rush Medical College, Chicago, Illinois, USA
| | - Ana W Capuano
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, USA
- Department of Neurological Sciences, Rush Medical College, Chicago, Illinois, USA
| | - Francine Grodstein
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, USA
- Department of Internal Medicine, Rush Medical College, Chicago, Illinois, USA
| | - Yi Chen
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Lisa L Barnes
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, USA
- Department of Neurological Sciences, Rush Medical College, Chicago, Illinois, USA
| |
Collapse
|
4
|
Agbonlahor O, DeJarnett N, Hart JL, Bhatnagar A, McLeish AC, Walker KL. Racial/Ethnic Discrimination and Cardiometabolic Diseases: A Systematic Review. J Racial Ethn Health Disparities 2024; 11:783-807. [PMID: 36976513 PMCID: PMC10044132 DOI: 10.1007/s40615-023-01561-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/23/2023] [Accepted: 03/01/2023] [Indexed: 03/29/2023]
Abstract
INTRODUCTION Racial discrimination has been identified as a risk factor for cardiometabolic diseases, the leading cause of morbidity and mortality among racial/ethnic minority groups; however, there is no synthesis of current knowledge on the association between discrimination and cardiometabolic diseases. The objective of this systematic review was to summarize evidence linking racial/ethnic discrimination and cardiometabolic diseases. METHODS The review was conducted based on studies identified via electronic searches of 5 databases (PubMed, Google Scholar, WorldWideScience.org, ResearchGate and Microsoft Academic) using terms related to discrimination and cardiometabolic disease. RESULTS Of the 123 eligible studies included in the review, 87 were cross-sectional, 25 longitudinal, 8 quasi-experimental, 2 randomized controlled trials and 1 case-control. Cardiometabolic disease outcomes discussed were hypertension (n = 46), cardiovascular disease (n = 40), obesity (n = 12), diabetes (n = 11), metabolic syndrome (n = 9), and chronic kidney disease (n = 5). Although a variety of discrimination measures was employed across the studies, the Everyday Discrimination Scale was used most often (32.5%). African Americans/Blacks were the most frequently studied racial/ethnic group (53.1%), and American Indians the least (0.02%). Significant associations between racial/ethnic discrimination and cardiometabolic disease were found in 73.2% of the studies. DISCUSSION Racial/ethnic discrimination is positively associated with increased risk of cardiometabolic disease and higher levels of cardiometabolic biomarkers. Identifying racial/ethnic discrimination as a potential key contributor to the health inequities associated with cardiometabolic diseases is important for addressing the significant burden borne by racial/ethnic minorities.
Collapse
Affiliation(s)
- Osayande Agbonlahor
- Department of Communication, University of Louisville, Louisville, KY USA
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, KY USA
| | - Natasha DeJarnett
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, KY USA
- Division of Environmental Medicine, School of Medicine, University of Louisville, Louisville, KY USA
| | - Joy L. Hart
- Department of Communication, University of Louisville, Louisville, KY USA
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, KY USA
- American Heart Association Tobacco Center for Regulatory Science, Dallas, TX USA
| | - Aruni Bhatnagar
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, KY USA
- Division of Environmental Medicine, School of Medicine, University of Louisville, Louisville, KY USA
- American Heart Association Tobacco Center for Regulatory Science, Dallas, TX USA
| | - Alison C. McLeish
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, KY USA
- American Heart Association Tobacco Center for Regulatory Science, Dallas, TX USA
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY USA
| | - Kandi L. Walker
- Department of Communication, University of Louisville, Louisville, KY USA
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, KY USA
- American Heart Association Tobacco Center for Regulatory Science, Dallas, TX USA
| |
Collapse
|
5
|
Gilgoff R, Mengelkoch S, Elbers J, Kotz K, Radin A, Pasumarthi I, Murthy R, Sindher S, Harris NB, Slavich GM. The Stress Phenotyping Framework: A multidisciplinary biobehavioral approach for assessing and therapeutically targeting maladaptive stress physiology. Stress 2024; 27:2327333. [PMID: 38711299 PMCID: PMC11219250 DOI: 10.1080/10253890.2024.2327333] [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: 10/23/2023] [Accepted: 03/02/2024] [Indexed: 05/08/2024] Open
Abstract
Although dysregulated stress biology is becoming increasingly recognized as a key driver of lifelong disparities in chronic disease, we presently have no validated biomarkers of toxic stress physiology; no biological, behavioral, or cognitive treatments specifically focused on normalizing toxic stress processes; and no agreed-upon guidelines for treating stress in the clinic or evaluating the efficacy of interventions that seek to reduce toxic stress and improve human functioning. We address these critical issues by (a) systematically describing key systems and mechanisms that are dysregulated by stress; (b) summarizing indicators, biomarkers, and instruments for assessing stress response systems; and (c) highlighting therapeutic approaches that can be used to normalize stress-related biopsychosocial functioning. We also present a novel multidisciplinary Stress Phenotyping Framework that can bring stress researchers and clinicians one step closer to realizing the goal of using precision medicine-based approaches to prevent and treat stress-associated health problems.
Collapse
Affiliation(s)
- Rachel Gilgoff
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Palo Alto, CA, USA
| | - Summer Mengelkoch
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Jorina Elbers
- Trauma recovery Program, HeartMath Institute, Boulder Creek, CA, USA
| | | | | | - Isha Pasumarthi
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Palo Alto, CA, USA
| | - Reanna Murthy
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Palo Alto, CA, USA
| | - Sayantani Sindher
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Palo Alto, CA, USA
| | | | - George M. Slavich
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| |
Collapse
|
6
|
Brady SS, Arguedas A, Huling JD, Hellemann G, Lewis CE, Fok CS, Van Den Eeden SK, Markland AD. Discrimination and bladder health among women in the CARDIA cohort study: Life course and intersectionality perspectives. Soc Sci Med 2024; 341:116547. [PMID: 38159485 PMCID: PMC10840419 DOI: 10.1016/j.socscimed.2023.116547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 09/10/2023] [Accepted: 12/20/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE This study examines whether discriminatory experiences are associated with lower urinary tract symptoms (LUTS) and their impact among 972 women in the Coronary Artery Risk Development in Young Adults (CARDIA) cohort study, which recruited participants from 4 cities in the United States. METHOD Exposure to discrimination was assessed 3 times (1992-93, 2000-01, 2010-11) and averaged across assessments. Participants separately reported whether they experienced discrimination on the basis of their gender, race or color, and socioeconomic position or social class. For each social identity, discrimination was assessed in 6-7 settings (e.g., when getting a job, medical care, or housing). At different time points, women who reported discriminatory experiences for a given social identity were asked how frequently the discrimination occurred and how stressful experience(s) were. Following the 2010-11 assessment, data on LUTS and their impact were collected. Women were classified into bladder health versus mild, moderate, or severe symptoms/impact clusters. RESULTS More Black than White women reported discriminatory experiences across all social identities and most settings. Perceived stress of discriminatory experiences did not differ between Black and White women. In analyses stratified by race and social identity, White women reported LUTS/impact with discriminatory experiences in more settings, more frequent discriminatory experiences across settings, and each additional social identity for which discrimination was experienced. Black women reported LUTS/impact with more frequent discriminatory experiences across settings. For Black women, greater perceived stress of both gender and race discrimination were associated with LUTS/impact. For White women, only greater perceived stress of race discrimination was associated with LUTS/impact. CONCLUSIONS This is one of the first studies to examine discrimination in relation to LUTS/impact. Additional research is needed to better understand differences in how discriminatory experiences based on potentially intersecting identities may be related to bladder health among women.
Collapse
Affiliation(s)
- Sonya S Brady
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Program in Health Disparities Research, 717 Delaware Street SE, Suite 166, Minneapolis, MN, 55414, USA.
| | - Andrés Arguedas
- Division of Biostatistics, University of Minnesota School of Public Health, University Office Plaza 2221 University Ave SE, Suite 200, Minneapolis, MN, 55414, USA.
| | - Jared D Huling
- Division of Biostatistics, University of Minnesota School of Public Health, University Office Plaza 2221 University Ave SE, Suite 200, Minneapolis, MN, 55414, USA.
| | - Gerhard Hellemann
- Department of Biostatistics, University of Alabama at Birmingham School of Public Health, Ryals Public Health Building (RPHB), 1665 University Boulevard, Birmingham, AL, 35233, USA.
| | - Cora E Lewis
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Ryals Public Health Building (RPHB), 1665 University Boulevard, Birmingham, AL, 35233, USA.
| | - Cynthia S Fok
- Department of Urology, University of Minnesota Medical School, Mayo Building 420 Delaware St. Se. MMC 394, Minneapolis, MN, 55454, USA.
| | - Stephen K Van Den Eeden
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway Oakland, CA, 94612, USA; Department of Urology, University of California, San Francisco, 400 Parnassus Ave, San Francisco, CA, 94143, USA.
| | - Alayne D Markland
- Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham School of Medicine, 933 19th Street South, CH19 201 Birmingham, AL, 35294, USA; Birmingham VA Medical Center, 700 19th St S, Birmingham, AL, 35233, USA.
| |
Collapse
|
7
|
Ogletree SS, Huang JH, Reif D, Yang L, Dunstan C, Osakwe N, Oh JI, Hipp JA. The relationship between greenspace exposure and telomere length in the National Health and Nutrition Examination Survey. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 905:167452. [PMID: 37777139 DOI: 10.1016/j.scitotenv.2023.167452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 10/02/2023]
Abstract
The exposome, reflecting the range of environmental exposures individuals encounter throughout their life, can influence a variety of health outcomes and can play a role in how the environment impacts our genes. Telomeres, genetic structures regulating cell growth and senescence, are one pathway through which the exposome may impact health. Greenspace exposure, representing the amount of green areas in one's neighborhood, is one component of the exposome and has been associated with multiple health benefits. To investigate the potential link between greenspace exposure and telomere length, we analyzed data from the 1999-2001 National Health and Nutrition Examination Survey (NHANES) sample. Our study examined individual, risk, and contextual factors. We found that greater greenspace exposure in one's neighborhood was associated with longer telomere lengths when considering individual and risk factors, suggesting a positive effect of living in greener neighborhoods. However, this relationship became non-significant when contextual factors, such as air pollution and deprivation, were included in the analysis. These findings highlight a complex relationship between greenspace and telomere length, warranting further research to explore contextual factors in detail.
Collapse
Affiliation(s)
- S Scott Ogletree
- Edinburgh School of Architecture and Landscape Architecture, OPENspace Research Centre, University of Edinburgh, United Kingdom; Center for Geospatial Analytics, North Carolina State University, United States of America.
| | - Jing-Huei Huang
- Center for Geospatial Analytics, North Carolina State University, United States of America; Montgomery County Parks Department, Maryland-National Capital Park and Planning Commission, United States of America
| | - David Reif
- Division of Translational Toxicology, National Institute of Environmental Health Sciences, United States of America
| | - Lin Yang
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Canada; Departments of Oncology and Community Health Sciences, University of Calgary, Canada
| | - Christopher Dunstan
- Center for Geospatial Analytics, North Carolina State University, United States of America
| | - Nnamdi Osakwe
- Bioinformatics Research Center, North Carolina State University, United States of America
| | - Jae In Oh
- Department of Parks, Recreation, and Tourism Management, North Carolina State University, United States of America
| | - J Aaron Hipp
- Center for Geospatial Analytics, North Carolina State University, United States of America; Department of Parks, Recreation, and Tourism Management, North Carolina State University, United States of America
| |
Collapse
|
8
|
Waziry R, Gu Y, Boehme AK, Williams OA. Measures of Aging Biology in Saliva and Blood as Novel Biomarkers for Stroke and Heart Disease in Older Adults. Neurology 2023; 101:e2355-e2363. [PMID: 37848333 PMCID: PMC10752636 DOI: 10.1212/wnl.0000000000207909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 08/24/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The role of aging biology as a novel risk factor and biomarker for vascular outcomes in different accessible body tissues such as saliva and blood remain unclear. We aimed to (1) assess the role of aging biology as a risk factor of stroke and heart disease among individuals of same chronologic age and sex and (2) compare aging biology biomarkers measured in different accessible body tissues as novel biomarkers for stroke and heart disease in older adults. METHODS This study included individuals who consented for blood and saliva draw in the Venous Blood Substudy and Telomere Length Study of the Health and Retirement Study (HRS). The HRS is a population-based, nationally representative longitudinal survey of individuals aged 50 years and older in the United States. Saliva-based measures included telomere length. Blood-based measures included DNA methylation and physiology biomarkers. Propensity scores-matched analyses and Cox regression models were conducted. RESULTS This study included individuals aged 50 years and older, who consented for blood (N = 9,934) and saliva (N = 5,808) draw in the HRS. Blood-based biomarkers of aging biology showed strong associations with incident stroke as follows: compared with the lowest tertile of blood-based biomarkers of aging, biologically older individuals had significantly higher risk of stroke based on DNA methylation Grim Age clock (adjusted hazard ratio [aHR] = 2.64, 95% CI 1.90-3.66, p < 0.001) and Physiology-based Phenotypic Age clock (aHR = 1.75, 95% CI 1.27-2.42, p < 0.001). In secondary analysis, biologically older individuals had increased risk of heart disease as follows: DNA methylation Grim Age clock (aHR = 1.77, 95% CI 1.49-2.11, p < 0.001) and Physiology-based Phenotypic Age clock (aHR = 1.61, 95% CI 1.36-1.90, p < 0.001). DISCUSSION Compared with saliva-based telomere length, blood-based aging physiology and some DNA methylation biomarkers are strongly associated with vascular disorders including stroke and are more precise and sensitive biomarkers of aging. Saliva-based telomere length and blood-based DNA methylation and physiology biomarkers likely represent different aspects of biological aging and accordingly vary in their precision as novel biomarkers for optimal vascular health.
Collapse
Affiliation(s)
- Reem Waziry
- From the Department of Neurology (R.W., Y.G., A.K.B., O.A.W.) and G.H. Sergievsky Center (Y.G.), Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center; Department of Epidemiology (Y.G.), Joseph P. Mailman School of Public Health, and the Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Columbia University, New York.
| | - Yian Gu
- From the Department of Neurology (R.W., Y.G., A.K.B., O.A.W.) and G.H. Sergievsky Center (Y.G.), Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center; Department of Epidemiology (Y.G.), Joseph P. Mailman School of Public Health, and the Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Columbia University, New York
| | - Amelia K Boehme
- From the Department of Neurology (R.W., Y.G., A.K.B., O.A.W.) and G.H. Sergievsky Center (Y.G.), Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center; Department of Epidemiology (Y.G.), Joseph P. Mailman School of Public Health, and the Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Columbia University, New York
| | - Olajide A Williams
- From the Department of Neurology (R.W., Y.G., A.K.B., O.A.W.) and G.H. Sergievsky Center (Y.G.), Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center; Department of Epidemiology (Y.G.), Joseph P. Mailman School of Public Health, and the Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Columbia University, New York
| |
Collapse
|
9
|
Ackerman-Barger K, Barksdale D, Draughon Moret JE. Call to Action: Academic Nursing's Role in Redesigning Health Care to Reduce the Human and Financial Cost of Health Inequities. Creat Nurs 2023; 29:360-366. [PMID: 38043929 DOI: 10.1177/10784535231216466] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Health equity is an aspirational goal for health outcomes that can be achieved when systemic inequalities are addressed. The human cost of health inequities is without number; we can and must ameliorate health inequities. This essay summarizes the impact of continued health disparities and inequities in the United States and outlines the ways in which increasing diversity in the nursing workforce and graduating equity-minded nurses can promote innovation and problem-solving to address these disparities and inequities. We then present multiple pathways for nurses in academia to advance health equity.
Collapse
Affiliation(s)
| | - Debra Barksdale
- University of North Carolina Greensboro, Greensboro, NC, USA
| | | |
Collapse
|
10
|
MICHAELS ELIK, LAM‐HINE TRACY, NGUYEN THUT, GEE GILBERTC, ALLEN AMANIM. The Water Surrounding the Iceberg: Cultural Racism and Health Inequities. Milbank Q 2023; 101:768-814. [PMID: 37435779 PMCID: PMC10509530 DOI: 10.1111/1468-0009.12662] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 04/03/2023] [Accepted: 05/08/2023] [Indexed: 07/13/2023] Open
Abstract
Policy Points Cultural racism-or the widespread values that privilege and protect Whiteness and White social and economic power-permeates all levels of society, uplifts other dimensions of racism, and contributes to health inequities. Overt forms of racism, such as racial hate crimes, represent only the "tip of the iceberg," whereas structural and institutional racism represent its base. This paper advances cultural racism as the "water surrounding the iceberg," allowing it to float while obscuring its base. Considering the fundamental role of cultural racism is needed to advance health equity. CONTEXT Cultural racism is a pervasive social toxin that surrounds all other dimensions of racism to produce and maintain racial health inequities. Yet, cultural racism has received relatively little attention in the public health literature. The purpose of this paper is to 1) provide public health researchers and policymakers with a clearer understanding of what cultural racism is, 2) provide an understanding of how it operates in conjunction with the other dimensions of racism to produce health inequities, and 3) offer directions for future research and interventions on cultural racism. METHODS We conducted a nonsystematic, multidisciplinary review of theory and empirical evidence that conceptualizes, measures, and documents the consequences of cultural racism for social and health inequities. FINDINGS Cultural racism can be defined as a culture of White supremacy, which values, protects, and normalizes Whiteness and White social and economic power. This ideological system operates at the level of our shared social consciousness and is expressed in the language, symbols, and media representations of dominant society. Cultural racism surrounds and bolsters structural, institutional, personally mediated, and internalized racism, undermining health through material, cognitive/affective, biologic, and behavioral mechanisms across the life course. CONCLUSIONS More time, research, and funding is needed to advance measurement, elucidate mechanisms, and develop evidence-based policy interventions to reduce cultural racism and promote health equity.
Collapse
Affiliation(s)
- ELI K. MICHAELS
- Division of Epidemiology, School of Public HealthUniversity of California
| | - TRACY LAM‐HINE
- Division of Epidemiology & Population HealthStanford University School of Medicine
| | | | - GILBERT C. GEE
- Jonathan and Karin Fielding School of Public HealthUniversity of California
| | - AMANI M. ALLEN
- Division of Epidemiology, School of Public HealthUniversity of California
- Division of Community Health Sciences, School of Public HealthUniversity of California
| |
Collapse
|
11
|
Brown RL, Epel EE, Lin J, Dubal DB, Prather AA. Associations between klotho and telomere biology in high stress caregivers. Aging (Albany NY) 2023; 15:7381-7396. [PMID: 37580799 PMCID: PMC10457041 DOI: 10.18632/aging.204961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 07/06/2023] [Indexed: 08/16/2023]
Abstract
Aging biomarkers may be related to each other through direct co-regulation and/or through being regulated by common processes associated with chronological aging or stress. Klotho is an aging regulator that acts as a circulating hormone with critical involvement in regulating insulin signaling, phosphate homeostasis, oxidative stress, and age-related inflammatory functioning. Both klotho and telomere length are biomarkers of biological aging and decrease with age; however, the relationship between them is not well understood. Here we test the association between klotho levels and the telomere length of specific sorted immune cells among a healthy sample of mothers caregiving for a child with autism spectrum disorder (ASD; i.e., experiencing higher caregiving stress) or a child without ASD, covarying age and body mass index, in order to understand if high stress associated with caregiving for a child with an ASD may be involved in any association between these aging biomarkers. In 178 caregiving women (n = 90 high-stress mothers of children with ASD, n = 88 low-stress mothers of neurotypical children), we found that klotho levels were positively associated with telomere length in PBMCs (an effect driven by CD4+ and CD8+CD28- T cells) among high-stress mothers of children with an ASD but not among low-stress mothers of neurotypical children. There were no significant associations between klotho and telomerase activity in either group, across cell types assessed here. Our results suggest that klotho levels and telomere length may be associated through a coordinated downregulation of longevity factors occurring under higher stress caregiving conditions.
Collapse
Affiliation(s)
- Ryan L. Brown
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA 94107, USA
| | - Elissa E. Epel
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA 94107, USA
| | - Jue Lin
- Department of Biochemistry and Biophysics, University of California, San Francisco, CA 94107, USA
| | - Dena B. Dubal
- Department of Neurology and Weill Institute of Neurosciences, University of California, San Francisco, CA 94107, USA
| | - Aric A. Prather
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA 94107, USA
| |
Collapse
|
12
|
Miller-Kleinhenz JM, Moubadder L, Beyer KM, Zhou Y, Gaglioti AH, Collin LJ, Gohar J, Do W, Conneely K, Krishnamurti U, Gogineni K, Gabram-Mendola S, D’Angelo O, Henry K, Torres M, McCullough LE. Redlining-associated methylation in breast tumors: the impact of contemporary structural racism on the tumor epigenome. Front Oncol 2023; 13:1154554. [PMID: 37621676 PMCID: PMC10446968 DOI: 10.3389/fonc.2023.1154554] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 07/17/2023] [Indexed: 08/26/2023] Open
Abstract
Purpose Place-based measures of structural racism have been associated with breast cancer mortality, which may be driven, in part, by epigenetic perturbations. We examined the association between contemporary redlining, a measure of structural racism at the neighborhood level, and DNA methylation in breast tumor tissue. Methods We identified 80 Black and White women diagnosed and treated for a first-primary breast cancer at Emory University Hospitals (2008-2017). Contemporary redlining was derived for census tracts using the Home Mortgage Disclosure Act database. Linear regression models were used to calculate the association between contemporary redlining and methylation in breast tumor tissue. We also examined epigenetic age acceleration for two different metrics, regressing β values for each cytosine-phosphate-guanine dinucleotide (CpG) site on redlining while adjusting for covariates. We employed multivariable Cox-proportional hazards models and 95% confidence intervals (CI) to estimate the association between aberrant methylation and mortality. Results Contemporary redlining was associated with 5 CpG sites after adjustment for multiple comparisons (FDR<0.10). All genes were implicated in breast carcinogenesis, including genes related to inflammation, immune function and stress response (ANGPT1, PRG4 and PRG4). Further exploration of the top 25 CpG sites, identified interaction of 2 sites (MRPS28 and cg11092048) by ER status and 1 site (GDP1) was associated with all-cause mortality. Contemporary redlining was associated with epigenetic age acceleration by the Hannum metric (β=5.35; CI 95%=0.30,10.4) and showed positive but non-significant correlation with the other clock. Conclusion We identified novel associations between neighborhood contemporary redlining and the breast tumor DNA methylome, suggesting that racist policies leading to inequitable social and environmental exposures, may impact the breast tumor epigenome. Additional research on the potential implications for prognosis is needed.
Collapse
Affiliation(s)
| | - Leah Moubadder
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, United States
| | - Kirsten M. Beyer
- Division of Epidemiology, Institute for Health & Society, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Yuhong Zhou
- Division of Epidemiology, Institute for Health & Society, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Anne H. Gaglioti
- National Center for Primary Care, Department of Family Medicine, Morehouse School of Medicine, Atlanta, GA, United States
- Center for Health Integration, Population Health Research Institute at The MetroHealth System, Case Western Reserve University, Cleveland, OH, United States
| | - Lindsay J. Collin
- Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States
| | - Jazib Gohar
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, United States
| | - Whitney Do
- Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA, United States
- Nutrition and Health Sciences Program, Laney Graduate School, Atlanta, GA, United States
| | - Karen Conneely
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, United States
| | - Uma Krishnamurti
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Keerthi Gogineni
- Department of Medical Oncology, Emory University School of Medicine, Atlanta, GA, United States
| | | | - Olivia D’Angelo
- Department of Surgery, Jackson Memorial Hospital/University of Miami Miller School of Medicine, Miami, FL, United States
| | - Kashari Henry
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, United States
| | - Mylin Torres
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA, United States
| | - Lauren E. McCullough
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, United States
| |
Collapse
|
13
|
Martz CD, Wang Y, Chung KW, Jiakponnah NN, I Danila M, Webb-Detiege T, Allen AM, Chae DH. Incident racial discrimination predicts elevated C-Reactive protein in the Black Women's experiences Living with Lupus (BeWELL) study. Brain Behav Immun 2023; 112:77-84. [PMID: 37286173 PMCID: PMC10919347 DOI: 10.1016/j.bbi.2023.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 04/21/2023] [Accepted: 06/03/2023] [Indexed: 06/09/2023] Open
Abstract
INTRODUCTION Racial discrimination is a distinct health threat that increases disease risk among Black Americans. Psychosocial stress may compromise health through inflammatory mechanisms. This study examines incident experiences of racial discrimination and changes in the inflammatory biomarker C-reactive protein (CRP) over a two-year period among Black women with systemic lupus erythematosus (SLE)-an inflammatory autoimmune disease sensitive to psychosocial stress and characterized by stark racial inequities in outcomes. METHODS Data are from the Black Women's Experiences Living with Lupus (BeWELL) Study. Participants (n = 380) from metropolitan Atlanta, Georgia were enrolled from April 2015 to May 2017. Incident racial discrimination was assessed bi-annually via self-report using the Experiences of Discrimination measure. CRP was assessed annually over a two-year period. Latent change score analyses modeled longitudinal within-person associations between incident racial discrimination and change in log-transformed CRP from baseline to Year 2. RESULTS Incident experiences of racial discrimination were associated with elevated log-CRP across the two-year study period (b = 0.039, SE = 0.017, 95% CI: 0.006, 0.071). For each domain of incident racial discrimination experienced, CRP increased 3.98%. CONCLUSION This study contributes to growing evidence on the biological consequences of racism and is the first to document an association between incident racial discrimination and changes in inflammation among Black women with SLE. Racial inequities in SLE outcomes and other diseases driven by inflammatory pathways may be explained in part through experiences of racial discrimination.
Collapse
Affiliation(s)
- Connor D Martz
- Population Research Center, The University of Texas at Austin, 305 E. 23(rd) Street, Stop G1800, RLP 2.602, Austin, TX 78712, United States.
| | - Yijie Wang
- Department of Human Development and Family Studies, Michigan State University, 552 W. Circle Drive, Human Ecology, 13C, East Lansing, MI 48824, United States
| | - Kara W Chung
- Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2210, New Orleans, LA 70112, United States
| | - Nwanyieze N Jiakponnah
- Tulane Center for Aging, Tulane University School of Medicine, 1430 Tulane Avenue, Suite 8513, New Orleans, LA 70112, United States
| | - Maria I Danila
- Division of Clinical Immunology and Rheumatology, Department of Medicine, The University of Alabama at Birmingham, 510 20(th) Street South #834, Birmingham, AL 35294, United States
| | - Tamika Webb-Detiege
- Department of Rheumatology, Ochsner Health, 1514 Jefferson Highway, New Orleans, LA 70121, United States; The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA 70121, United States
| | - Amani M Allen
- Divisions of Community Health Sciences and Epidemiology, University of California Berkeley School of Public Health, 2121 Berkeley Way, Berkeley, CA 94720, United States
| | - David H Chae
- Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2210, New Orleans, LA 70112, United States
| |
Collapse
|
14
|
Etti M, Yuan M, Bump JB. Sun, skin and the deadly politics of medical racism. BMJ Glob Health 2023; 8:e013616. [PMID: 37652568 PMCID: PMC10476135 DOI: 10.1136/bmjgh-2023-013616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 08/06/2023] [Indexed: 09/02/2023] Open
Affiliation(s)
- Melanie Etti
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - MyMai Yuan
- Department of Health Policy and Management, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Jesse B Bump
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
- Bergen Center for Ethics and Priority Setting, University of Bergen, Bergen, Norway
| |
Collapse
|
15
|
Montoya M, Uchino BN. Social support and telomere length: a meta-analysis. J Behav Med 2023; 46:556-565. [PMID: 36617609 DOI: 10.1007/s10865-022-00389-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 12/26/2022] [Indexed: 01/10/2023]
Abstract
Previous studies have shown that lower social support is associated with higher all-cause mortality (Holt-Lunstad et al. in PLoS ONE Medicine 7:e1000316, 2010). While social support has been associated with system-specific biological measures (e.g., cardiovascular), there is the need to elucidate more general biological mechanisms linking social support to health risk across a number of diseases. In this meta-analytic review, the link between social support and telomere length (Cawthon et al. in Lancet 361:393-395, 2003) was conducted based on the updated PRISMA guidelines (Page et al., 2021). Across 17 studies, higher social support was not significantly related to longer telomere length (Zr = 0.010, 95% CI [- 0.028, 0.047], p > 0.05). The confidence interval indicated that the bulk of plausible values were small to null associations. Little evidence for bias was found as shown by funnel plots and Kendall's Tau. Moderator analyses focusing on the measure of support, health of sample, age, type of assay specimen, and gender were not significant. In conclusion, this review showed no significant relationship between social support and telomere length and highlights important future directions.
Collapse
Affiliation(s)
- Mariah Montoya
- Department of Psychology, University of Utah, Salt Lake City, USA
| | - Bert N Uchino
- Department of Psychology and Health Psychology Program, University of Utah, Salt Lake City, USA.
| |
Collapse
|
16
|
Kwon E, Fisher S, Lin HC, Kogan SM. Racial discrimination, childhood adversity, and depression among Black men: Tests of stress sensitization hypotheses. Psychiatry Res 2023; 325:115257. [PMID: 37257250 DOI: 10.1016/j.psychres.2023.115257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 04/29/2023] [Accepted: 05/18/2023] [Indexed: 06/02/2023]
Abstract
Racial discrimination has been linked to depression among Black American men. Racial discrimination, however, does not uniformly confer risk for depression. According to the stress sensitization theory, racial discrimination can be particularly harmful for those with histories of adversity in childhood. Existing research on stress sensitization is limited in that it has conceptualized childhood adversity as a unidimensional construct composed of a broad range of stressful experiences. To fill this gap in the literature, the current study investigated stress sensitization hypotheses, focusing on how different dimensions of adverse childhood experiences moderate the association between racial discrimination and depression. Study sample was 504 young Black men (mean age at baseline = 20.3, SD = 1.08) living in rural counties in South Georgia where childhood adversity is disproportionately high. The association between racial discrimination and increased risk for depressive symptoms varied by the degree of childhood experience of deprivation, but not threat. Our findings suggest that no or low levels of childhood deprivation, which is commonly regarded as a protective factor, can elevate the negative effects of discrimination on depression. This finding emphasizes that clinicians should consider developmental risk and protective factors that are unique to Black American men.
Collapse
Affiliation(s)
- Elizabeth Kwon
- Department of Public Health, Baylor University, Waco, TX, United States.
| | - Sycarah Fisher
- Department of Educational Psychology, University of Georgia, Athens, GA, United States
| | - Hsien-Chang Lin
- School of Public Health, Indiana University, Bloomington, IN, United States
| | - Steven M Kogan
- Department of Human Development and Family Science, University of Georgia, Athens, GA, United States
| |
Collapse
|
17
|
Mandelblatt JS, Ruterbusch JJ, Thompson HS, Zhou X, Bethea TN, Adams-Campbell L, Purrington K, Schwartz AG. Association between major discrimination and deficit accumulation in African American cancer survivors: The Detroit Research on Cancer Survivors Study. Cancer 2023; 129:1557-1568. [PMID: 36935617 PMCID: PMC10568940 DOI: 10.1002/cncr.34673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/25/2022] [Accepted: 12/16/2022] [Indexed: 03/21/2023]
Abstract
BACKGROUND Discrimination can adversely affect health and accelerate aging, but little is known about these relationships in cancer survivors. This study examines associations of discrimination and aging among self-identified African American survivors. METHODS A population-based sample of 2232 survivors 20-79 years old at diagnosis were enrolled within 5 years of breast (n = 787), colorectal (n = 227), lung (n = 223), or prostate (n = 995) cancer between 2017 and 2022. Surveys were completed post-active therapy. A deficit accumulation index measured aging-related disease and function (score range, 0-1, where <0.20 is robust, 0.20 to <0.35 is pre-frail, and 0.35+ is frail; 0.06 is a large clinically meaningful difference). The discrimination scale assessed ever experiencing major discrimination and seven types of events (score, 0-7). Linear regression tested the association of discrimination and deficit accumulation, controlling for age, time from diagnosis, cancer type, stage and therapy, and sociodemographic variables. RESULTS Survivors were an average of 62 years old (SD, 9.6), 63.2% reported ever experiencing major discrimination, with an average of 2.4 (SD, 1.7) types of discrimination events. Only 24.4% had deficit accumulation scores considered robust (mean score, 0.30 [SD, 0.13]). Among those who reported ever experiencing major discrimination, survivors with four to seven types of discrimination events (vs. 0-1) had a large, clinically meaningful increase in adjusted deficits (0.062, p < .001) and this pattern was consistent across cancer types. CONCLUSION African American cancer survivors have high deficit accumulated index scores, and experiences of major discrimination were positively associated with these deficits. Future studies are needed to understand the intersectionality between aging, discrimination, and cancer survivorship among diverse populations.
Collapse
Affiliation(s)
- Jeanne S. Mandelblatt
- Department of Oncology, Cancer Prevention and Control Program, Georgetown Lombardi Comprehensive Cancer Center, Washington, District of Columbia, USA
- Georgetown Lombardi Institute for Cancer and Aging Research, Georgetown University, Washington, District of Columbia, USA
| | - Julie J. Ruterbusch
- Department of Oncology, Wayne State University, Detroit, Michigan, USA
- Karmanos Cancer Institute, Detroit, Michigan, USA
| | - Hayley S. Thompson
- Department of Oncology, Wayne State University, Detroit, Michigan, USA
- Karmanos Cancer Institute, Detroit, Michigan, USA
| | - Xingtao Zhou
- Department of Oncology, Cancer Prevention and Control Program, Georgetown Lombardi Comprehensive Cancer Center, Washington, District of Columbia, USA
- Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia, USA
- Office of Minority Health and Health Disparities Research, Georgetown University, Washington, District of Columbia, USA
| | - Traci N. Bethea
- Department of Oncology, Cancer Prevention and Control Program, Georgetown Lombardi Comprehensive Cancer Center, Washington, District of Columbia, USA
| | - Lucile Adams-Campbell
- Department of Oncology, Cancer Prevention and Control Program, Georgetown Lombardi Comprehensive Cancer Center, Washington, District of Columbia, USA
| | - Kristen Purrington
- Department of Oncology, Wayne State University, Detroit, Michigan, USA
- Karmanos Cancer Institute, Detroit, Michigan, USA
| | - Ann G. Schwartz
- Department of Oncology, Wayne State University, Detroit, Michigan, USA
- Karmanos Cancer Institute, Detroit, Michigan, USA
| |
Collapse
|
18
|
Wang C, Malaktaris A, McLean CL, Kelsven S, Chu GM, Ross KS, Endsley M, Minassian A, Liu L, Hong S, Lang AJ. Mitigating the health effects of systemic racism: Evaluation of the Race-Based Stress and Trauma Empowerment intervention. Contemp Clin Trials 2023; 127:107118. [PMID: 36796623 PMCID: PMC10389054 DOI: 10.1016/j.cct.2023.107118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 02/07/2023] [Accepted: 02/10/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND Disparities in physical and mental health among Black, Indigenous, and People of Color (BIPOC) are well-documented and mirrored in the Veteran population. Chronic stress due to racism and discrimination is one possible mechanism driving these negative health outcomes. The Race-Based Stress and Trauma Empowerment (RBSTE) group is a novel, manualized, health promotion intervention designed to address the direct and indirect impacts of racism among Veterans of Color. This paper describes the protocol of the first pilot randomized controlled trial (RCT) of RBSTE. This study will examine the feasibility, acceptability, and appropriateness of RBSTE compared to an active control (an adaptation of Present-Centered Therapy; PCT) in a Veterans Affairs (VA) healthcare setting. A secondary aim is to identify and optimize strategies for holistic evaluation. METHODS Veterans of Color (N = 48) endorsing perceived discrimination and stress will be randomized to RBSTE or PCT; both groups will be delivered in 8 weekly, 90-min virtual group sessions. Outcomes will include measures of psychological distress, discrimination and ethnoracial identity, holistic wellness, and allostatic load. Measures will be administered at baseline and post-intervention. CONCLUSION This study will inform future interventions targeting identity-based stressors and represents an important step in advancing equity for BIPOC in medicine and research. CLINICAL TRIAL REGISTRATION NUMBER NCT05422638.
Collapse
Affiliation(s)
- Clarice Wang
- VA San Diego Healthcare System, 3350 La Jolla Village Dr., San Diego, CA 92161, USA.
| | - Anne Malaktaris
- VA San Diego Healthcare System, 3350 La Jolla Village Dr., San Diego, CA 92161, USA; University of California San Diego, Department of Psychiatry, 9500 Gilman Dr., La Jolla, CA 92093, USA; VA San Diego Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr., San Diego, CA 92161, USA.
| | - Caitlin L McLean
- VA San Diego Healthcare System, 3350 La Jolla Village Dr., San Diego, CA 92161, USA; University of California San Diego, Department of Psychiatry, 9500 Gilman Dr., La Jolla, CA 92093, USA.
| | - Skylar Kelsven
- University of California San Diego, Department of Psychiatry, 9500 Gilman Dr., La Jolla, CA 92093, USA; VA San Diego Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr., San Diego, CA 92161, USA.
| | - Gage M Chu
- VA San Diego Healthcare System, 3350 La Jolla Village Dr., San Diego, CA 92161, USA.
| | - Keisha S Ross
- VA St. Louis Health Care System, 915 N. Grand Blvd, St. Louis, MO 63106, USA.
| | - Maurice Endsley
- VA Northern California Health Care System, 10535 Hospital Way, Mather, CA 95655, USA.
| | - Arpi Minassian
- University of California San Diego, Department of Psychiatry, 9500 Gilman Dr., La Jolla, CA 92093, USA; VA San Diego Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr., San Diego, CA 92161, USA.
| | - Lin Liu
- VA San Diego Healthcare System, 3350 La Jolla Village Dr., San Diego, CA 92161, USA; Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA.
| | - Suzi Hong
- University of California San Diego, Department of Psychiatry, 9500 Gilman Dr., La Jolla, CA 92093, USA; VA San Diego Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr., San Diego, CA 92161, USA; Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA.
| | - Ariel J Lang
- University of California San Diego, Department of Psychiatry, 9500 Gilman Dr., La Jolla, CA 92093, USA; VA San Diego Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr., San Diego, CA 92161, USA; Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA.
| |
Collapse
|
19
|
Sabot D, Lovegrove R, Stapleton P. The association between sleep quality and telomere length: A systematic literature review. Brain Behav Immun Health 2023; 28:100577. [PMID: 36691437 PMCID: PMC9860369 DOI: 10.1016/j.bbih.2022.100577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 12/20/2022] [Indexed: 01/10/2023] Open
Abstract
Several sleep parameters present an elevated risk for processes that contribute to cellular aging. Short sleep duration, sleep apnoea, and insomnia are significantly associated with shorter telomeres, a biological marker of cellular aging. However, there has been no review or analysis of studies that have examined the association between the psychological construct of sleep quality and telomere length. The present study aimed to provide a systematic review of the association between sleep quality and telomere length. A systematic review of English articles was conducted using MEDLINE/PubMed, PsycINFO, Google Scholar, and Web of Science electronic databases, with the final search conducted on 3rd September 2021. Search terms included sleep quality, poor sleep, insomnia, sleep difficulties, sleep issue*, non-restorative sleep, telomere*, cellular aging, and immune cell telomere length. Study eligibility criteria included human participants aged 18 years or older and a reproducible methodology. Study appraisal and synthesis were completed using a systematic search in line with a PICOS approach (P = Patient, problem, or population; I = Intervention, prognostic factor, exposure; C = Comparison, control, or comparator; O = Outcomes; S = Study designs). Twenty-two studies met review inclusion criteria. Qualitative synthesis of the literature indicated insufficient evidence overall to support a significant association between sleep quality and telomere length. Limitations across studies were addressed, such as the assessment of examined constructs. Findings highlight important targets for future research, including the standardised operationalisation of the sleep quality construct and experimental study designs. Research in this area has clinical significance by identifying possible mechanisms that increase the risk for age-related disease and mortality. PROSPERO Registration No.: CRD 42021233139.
Collapse
Affiliation(s)
- Debbie Sabot
- Corresponding author. School of Psychology, Faculty of Society and Design, Bond University, Robina, QLD, 4227, Australia.
| | | | | |
Collapse
|
20
|
Uddin LQ, De Los Reyes A. Developmental Considerations for Understanding Perceptions and Impacts of Identity-Related Differences: Focusing on Adolescence. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2022; 7:1209-1214. [PMID: 35525409 DOI: 10.1016/j.bpsc.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/06/2022] [Accepted: 04/25/2022] [Indexed: 12/24/2022]
Abstract
Biological psychiatry, similar to many other scientific fields, is grappling with the challenge of revising its practices with an eye toward promoting diversity, equity, and inclusivity. One arena in which much of this work will have significant impact is in developmental science generally and the study of adolescence specifically. Adolescence is a critical period during human development during which important social, neural, and cognitive maturation processes take place. It is also a time marked by risky behaviors and the onset of a range of mental disorders. Social and developmental research has provided insight into the cognitive and neural processes by which perceptions of identity-related differences emerge. Clinical research aimed at understanding how individuals from diverse backgrounds navigate the transition period of adolescence is critical for identifying the unique factors underlying risk and resilience in minoritized populations. Taking a developmental perspective, we review processes by which the brain understands group differences and how the developmental timing of this can influence antecedents of psychological distress. We close with a call to action, pointing to important understudied areas within the field of biological psychiatry that are critical for supporting mental health among diverse adolescent populations.
Collapse
Affiliation(s)
- Lucina Q Uddin
- Department of Psychiatry and Biobehavioral Sciences (LQU), University of California, Los Angeles, Los Angeles, California.
| | - Andres De Los Reyes
- Department of Psychology (ADLR), University of Maryland, College Park, Maryland.
| |
Collapse
|
21
|
Carroll JE, Price JE, Brown J, Bamishigbin O, Shalowitz MU, Ramey S, Dunkel Schetter C. Lifetime discrimination in low to middle income mothers and cellular aging: A prospective analysis. Soc Sci Med 2022; 311:115356. [PMID: 36122526 PMCID: PMC10024938 DOI: 10.1016/j.socscimed.2022.115356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 08/15/2022] [Accepted: 09/03/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Experiences of discrimination on the basis of race, ethnicity, and other characteristics are associated with adverse health outcomes, including elevated rates of morbidity in later life and earlier mortality. Acceleration of biological aging is a plausible pathway linking discrimination to disease risk. The objective of this study was to examine the relationship of self-reported lifetime and everyday discrimination to women's telomere length several years after birth of a child in a longitudinal cohort study. METHODS The Community Child Health Network (CCHN) conducted a community-based participatory research project focused on racial, ethnic, and socioeconomic disparities in maternal and child health. Data for the current substudy are from a longitudinal cohort study in 3 of the 5 project sites. This multi-site community-based longitudinal study was conducted in Lake County, IL north of Chicago, Washington, D.C., and rural North Carolina. Participants were low to middle-income mothers (N = 103) with a primary identity of Hispanic/Latina, Black, or non-Hispanic White who rated their experience of everyday and lifetime discrimination during an at-home interview one-month postpartum. Buccal samples were collected to assay buccal cell telomere length several years later when a consecutive child was 3-5 years of age. Telomere length derived from buccal cells was used as a biomarker indicating cellular aging and a risk factor for age-related disease. RESULTS Mothers (18-39 years old) who reported higher lifetime discrimination had shorter telomere length an average of 5.6 years later (B = -0.22 [SE = 0.04], p < 0.001). Mother's reports of everyday discrimination were not significantly related to telomere length (0.01[0.01], p = 0.15). CONCLUSIONS These findings suggest that lifetime exposure to discrimination, but not necessarily current reports of everyday discrimination, may increase biological aging as indicated by shorter buccal cell telomere length, providing evidence of a plausible route through which discrimination contributes to increased risk for earlier onset aging and age-related disease in women.
Collapse
Affiliation(s)
- Judith E Carroll
- University of California, Los Angeles, Cousins Center for Psychoneuroimmunology, Department of Psychiatry & Biobehavioral Science, David Geffen School of Medicine, Jane & Terry Semel Institute for Neuroscience & Human Behavior, United States.
| | - Jonah Eliezer Price
- University of California, Los Angeles, Department of Psychology, United States
| | - Joni Brown
- University of California, Los Angeles, Department of Psychology, United States
| | | | - Madeleine U Shalowitz
- NorthShore University HealthSystem, Department of Pediatrics, Rush University, Department of Psychiatry, United States
| | - Sharon Ramey
- Virginia Tech, Fralin Biomedical Research Institute, Departments of Psychology, Neuroscience, and Human Development, Department of Psychiatry & Behavioral Medicine and Pediatrics, United States
| | - Christine Dunkel Schetter
- University of California, Los Angeles, Cousins Center for Psychoneuroimmunology, Department of Psychiatry & Biobehavioral Science, David Geffen School of Medicine, Jane & Terry Semel Institute for Neuroscience & Human Behavior, United States; University of California, Los Angeles, Department of Psychology, United States
| |
Collapse
|
22
|
Schreiber WB, Robinson-Drummer PA. Opportunities to Discuss Diversity-Related Topics in Neuroscience Courses. JOURNAL OF UNDERGRADUATE NEUROSCIENCE EDUCATION : JUNE : A PUBLICATION OF FUN, FACULTY FOR UNDERGRADUATE NEUROSCIENCE 2022; 20:A361-A375. [PMID: 39036724 PMCID: PMC11256382 DOI: 10.59390/aoin4016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 03/31/2022] [Accepted: 04/04/2022] [Indexed: 07/23/2024]
Abstract
Diversity is a foundational topic in psychology, and APA recommends that diversity is covered across the psychology curriculum. Neuroscience courses face challenges with incorporating diversity-related topics owing to the historical lack of neuroscience research that focuses on diversity and the restricted range of diversity-related topics that neuroscience is typically associated with (i.e., health and disability status). This may limit students' learning of neuroscience's contributions towards understanding diversity. We review some specific examples of diversity-related topics that can be incorporated into neuroscience courses. These examples have been selected to include topics across the three major content domains of neuroscience (cellular/molecular, neuroanatomy/systems, and cognitive/behavioral), as well as across multiple diversity-related topics. Neuroscience instructors can use these examples to incorporate greater coverage of diversity-related topics within their courses and/or as points of inspiration for their own curricular additions. Providing systematic coverage of diversity-related topics in neuroscience courses highlights the ways neuroscience advances our understanding of human diversity and contributes to the educational objectives of psychology and neuroscience programs.
Collapse
|
23
|
Cost of resilience: Childhood poverty, mental health, and chronic physiological stress. Psychoneuroendocrinology 2022; 144:105872. [PMID: 35879139 DOI: 10.1016/j.psyneuen.2022.105872] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 07/09/2022] [Accepted: 07/18/2022] [Indexed: 12/23/2022]
Abstract
Childhood poverty is associated with elevated internalizing symptoms. Nevertheless, some children exposed to poverty evince remarkable resilience, demonstrating lower than expected levels of psychological distress. However, recent work suggests that coping with adversity can lead to undesirable physical health consequences. Specifically, successful adaptation in the context of early adversity, including socioeconomic disadvantage, appears to be associated with elevated chronic physiological stress and ill health. The current study adds to this emerging literature by examining in a longitudinal context whether low levels of internalizing symptoms in the face of childhood poverty is accompanied by elevated chronic physiological stress (allostatic load) during childhood, as well as over time from childhood to adulthood. Results (n = 341; M=9.2 years, 49 % female; 94 % Caucasian) show that childhood poverty was prospectively associated with higher allostatic load during adolescence, controlling for baseline allostatic load. Furthermore, greater duration of childhood poverty led to steeper, more elevated allostatic load trajectories from childhood to adulthood, for youth with lower levels of internalizing symptoms. Efforts to manage adverse sequelae of early adversity likely yield a complex array of benefits and costs.
Collapse
|
24
|
A systematic review and meta-analysis of the Everyday Discrimination Scale and biomarker outcomes. Psychoneuroendocrinology 2022; 142:105772. [PMID: 35490482 PMCID: PMC9997446 DOI: 10.1016/j.psyneuen.2022.105772] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 03/01/2022] [Accepted: 04/17/2022] [Indexed: 02/08/2023]
Abstract
Discrimination has consistently been associated with multiple adverse health outcomes. Like other psychosocial stressors, discrimination is thought to impact health through stress-related physiologic pathways including hypothalamic-pituitary-adrenal (HPA) axis activation, dysregulation of inflammation responses, and accelerated cellular aging. Given growing attention to research examining the biological pathways through which discrimination becomes embodied, this systematic review and meta-analysis synthesizes empirical evidence examining relationships between self-reported discrimination and four biomarker outcomes (i.e., cortisol, C-reactive protein (CRP), interleukin-6 (IL-6), and telomere length) among studies that have used the Everyday Discrimination Scale. We conducted a systematic review of studies discussing self-reported, everyday, or chronic discrimination in the context of health by searching Medline / PubMed (National Library of Medicine, NCBI), PsycInfo (APA, Ebsco) and Web of Science Core Collection (Clarivate). Twenty-five articles met the criteria for meta-analysis, with several reporting on multiple outcomes. Discrimination was associated with elevated CRP levels (r = 0.11; 95% CI: 0.01, 0.20, k = 10), though not cortisol (r = 0.05; 95% CI: -0.06, 0.16, k = 9), IL-6 (r = 0.05; 95% CI: -0.32, 0.42, k = 5), or telomere length (r = 0.03; 95% CI: -0.01, 0.07, k = 6). We identify several points of consideration for future research including addressing heterogeneity in assessment of biomarker outcomes and the need for longitudinal assessments of relationships between discrimination and biomarker outcomes.
Collapse
|
25
|
How does it all end? Trends and disparities in health at the end of life. PLoS One 2022; 17:e0267551. [PMID: 35895597 PMCID: PMC9328500 DOI: 10.1371/journal.pone.0267551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 04/11/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To consider trends and disparities in end-of-life health in the US. METHODS I use data from the National Health Interview Survey, linked to death records through 2015, for respondents who died at ages 65+ to compare the prevalence of three health outcomes in the last six years of life across time, sex, age, race, and educational attainment. Self-rated health (SRH) is available for respondents interviewed in years 1987-2014, while information on activities of daily living (ADL) and instrumental activities of daily living (IADL) is available for the period 1997-2014. RESULTS By the end of the study period, individuals reported two fewer months of fair/poor health at the end of life than those dying in earlier years. In contrast, time lived with at least one activity limitation at the end of life generally remained comparable. Compared to men, women on average reported an additional year of living with an IADL limitation before death, and an additional eight months with an ADL limitation. Despite sex differences in disability, both sexes reported similar periods of fair/poor SRH before death. Similarly, while individuals who lived to older ages experienced a longer disabled period before death than individuals who died at younger ages, all age groups were equally likely to report fair/poor SRH. Black adults and adults with less formal schooling also spent more time with an end-of-life disability. For men, these racial and socioeconomic disparities lessened as death approached. For women, inequalities persisted until death. DISCUSSION These findings suggest that despite increasing life expectancy, the period of poor health and disability prior to death has not recently been extended. Black women and women with less than a high school degree, require extended support at the end of life.
Collapse
|
26
|
Qian M, Heyman GD, Wu M, Fu G. Individuating multiple (not one) persons reduces implicit racial bias. Front Psychol 2022; 13:939811. [PMID: 35936246 PMCID: PMC9355476 DOI: 10.3389/fpsyg.2022.939811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 06/28/2022] [Indexed: 11/13/2022] Open
Abstract
Individuation training that helps humans see multiple other-race targets as distinct rather than as interchangeable can reduce children’s implicit racial bias in the form of more negative other-race associations than own-race associations. However, little is known about which aspects of these interventions are critical for their effectiveness. The present research examines whether children need to learn to differentiate among multiple other-race individuals for these interventions to reduce their level of implicit racial bias, or whether differentiating a single other-race individual is sufficient. We addressed this question among 4-to-6-year-old Chinese children (N = 66, 31 girls) who engaged in coordinated movement with Black instructors for 2 min. There were two between-subject conditions: in a differentiation condition, there were four different Black instructors, and children had to learn to tell them apart, and in a no-differentiation condition, there was only one Black instructor. Implicit bias was measured using the IRBT, an implicit association test that was developed based on the IAT but is appropriate for young children. We found a reduction in implicit bias against Black people after this interaction in the differentiation condition, but not in the no-differentiation condition. These findings suggest that learning to differentiate among multiple other-race individuals plays a critical role in reducing children’s implicit racial bias.
Collapse
Affiliation(s)
- Miao Qian
- Department of Psychology, University of Detroit Mercy, Detroit, MI, United States
- *Correspondence: Miao Qian,
| | - Gail D. Heyman
- Department of Psychology, University of California, San Diego, San Diego, CA, United States
| | - Mingzhan Wu
- Department of Psychology, Hangzhou Normal University, Hangzhou, China
| | - Genyue Fu
- Department of Psychology, Hangzhou Normal University, Hangzhou, China
- Genyue Fu,
| |
Collapse
|
27
|
Murkey JA, Watkins BX, Vieira D, Boden-Albala B. Disparities in allostatic load, telomere length and chronic stress burden among African American adults: A systematic review. Psychoneuroendocrinology 2022; 140:105730. [PMID: 35338946 DOI: 10.1016/j.psyneuen.2022.105730] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 02/04/2022] [Accepted: 03/14/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND The chronic disease burden among African Americans has continued to rise. Although racial disparities in chronic disease risk are well documented, the role of chronic stress in risk disparities among racial and ethnic minorities is not well understood. This systematic review of studies reporting on the relationship between chronic stress, education, and/or income, and biomarkers of chronic stress (allostatic load and telomere length) longitudinally among African Americans, seeks to contribute to this knowledge gap. OBJECTIVE To use the existing literature to both examine the strength of two objective biomarkers--telomere length and allostatic load--as measures of the overactivation of physiological stress processes in African American adults; and determine if existing studies used these two biomarkers to assess the relationship between chronic stress, income and level of educational attainment among African Americans longitudinally. METHODS In order to identify English-language articles published prior to October 11, 2021, a comprehensive search strategy was developed using five databases: PubMed/Medline, EMBASE, Web of Science Plus, Global Health (Ovid), and PsycINFO. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method was used to record progress on the comprehensive search for studies reporting on allostatic load and/or telomere length biomarkers longitudinally within all bodily fluids and chronic stress among African American adults. RESULTS In total, 7 studies met the search criteria; 902 were excluded. Thus, less than 1% of all studies reporting on biomarkers of chronic stress longitudinally included African Americans. Each of the 7 studies described the relationship between telomere length and/or allostatic load among African Americans and chronic stress, education, and/or income. Higher chronic stress levels and experiences of racial discrimination were associated with telomere shortening while lower income and higher chronic stress levels were associated with an increase in allostatic load among African Americans. DISCUSSION Given the limited number of studies reporting on the association between allostatic load, telomere length, and/or the relationship between both in assessing chronic stress severity longitudinally among African American populations, it is impossible to determine whether one biomarker has greater predictive value than the other. However, based on the literature included in this review, higher chronic stress levels and experiences of racial discrimination were associated with shorter telomere length, while lower income and higher chronic stress levels are associated with an increase in allostatic load among African Americans. CONCLUSION These data illustrate a gap in the literature on the relationship between the biomarkers of telomere length and allostatic load combined as a potential measure for chronic stress among African Americans. To our knowledge, none the current literature describes the relationship between telomere length and allostatic load longitudinally among African American adults. As the field strives to develop a "gold standard" for measuring chronic stress, the combination of these biomarkers needs to be the subject of scientific inquiry and thus, fully examined. Future longitudinal studies among African Americans are needed to better understand which biomarker, or combination of biomarkers will provide the most accurate measure of physiological stress processes.
Collapse
Affiliation(s)
- Jamie A Murkey
- New York University School of Global Public Health, Department of Epidemiology, 708 Broadway, New York, NY 10003, USA.
| | - Beverly-Xaviera Watkins
- New York University School of Global Public Health, Department of Epidemiology, 708 Broadway, New York, NY 10003, USA
| | - Dorice Vieira
- New York University Langone School of Medicine, Health Sciences Library, 550 First Avenue, New York, NY 10016, USA
| | - Bernadette Boden-Albala
- University of California Irvine Department of Population Health, 653 East Peltason Drive, Irvine, CA 92697, USA
| |
Collapse
|
28
|
Vara EL, Langefeld CD, Wolf BJ, Howard TD, Hawkins GA, Quet Q, Moultrie LH, Quinnette King L, Molano ID, Bray SL, Ueberroth LA, Lim SS, Williams EM, Kamen DL, Ramos PS. Social Factors, Epigenomics and Lupus in African American Women (SELA) Study: protocol for an observational mechanistic study examining the interplay of multiple individual and social factors on lupus outcomes in a health disparity population. Lupus Sci Med 2022; 9:9/1/e000698. [PMID: 35768168 PMCID: PMC9244713 DOI: 10.1136/lupus-2022-000698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/14/2022] [Indexed: 11/08/2022]
Abstract
Introduction Despite the disproportional impact of SLE on historically marginalised communities, the individual and sociocultural factors underlying these health disparities remain elusive. We report the design and methods for a study aimed at identifying epigenetic biomarkers associated with racism and resiliency that affect gene function and thereby influence SLE in a health disparity population. Methods and analysis The Social Factors, Epigenomics and Lupus in African American Women (SELA) Study is a cross-sectional, case–control study. A total of 600 self-reported African American women will be invited to participate. All participants will respond to questionnaires that capture detailed sociodemographic and medical history, validated measures of racial discrimination, social support, as well as disease activity and damage for cases. Participants who wish will receive their genetic ancestry estimates and be involved in research. Blood samples are required to provide peripheral blood mononuclear cell counts, DNA and RNA. The primary goals of SELA are to identify variation in DNA methylation (DNAm) associated with self-reported exposure to racial discrimination and social support, to evaluate whether social DNAm sites affect gene expression, to identify the synergistic effects of social factors on DNAm changes on SLE and to develop a social factors-DNAm predictive model for disease outcomes. This study is conducted in cooperation with the Sea Island Families Project Citizen Advisory Committee. Discussion and dissemination SELA will respond to the pressing need to clarify the interplay and regulatory mechanism by which various positive and negative social exposures influence SLE. Results will be published and shared with patients and the community. Knowledge of the biological impact of social exposures on SLE, as informed by the results of this study, can be leveraged by advocacy efforts to develop psychosocial interventions that prevent or mitigate risk exposures, and services or interventions that promote positive exposures. Implementation of such interventions is paramount to the closure of the health disparities gap.
Collapse
Affiliation(s)
- Emily L Vara
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Carl D Langefeld
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.,Center for Precision Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Bethany J Wolf
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Timothy D Howard
- Center for Precision Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.,Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Gregory A Hawkins
- Center for Precision Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.,Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Queen Quet
- Gullah/Geechee Nation, St Helena Island, South Carolina, USA
| | - Lee H Moultrie
- Lee H Moultrie & Associates, North Charleston, South Carolina, USA
| | - L Quinnette King
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ivan D Molano
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Stephanie L Bray
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Lori Ann Ueberroth
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - S Sam Lim
- Department of Medicine, Emory University, Atlanta, Georgia, USA.,Department of Epidemiology, Emory University, Atlanta, Georgia, USA
| | - Edith M Williams
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.,Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Diane L Kamen
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Paula S Ramos
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA .,Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| |
Collapse
|
29
|
Collins M. Black and Waiting: Bioethics and Care during the Covid-19 Pandemic. Hastings Cent Rep 2022; 52 Suppl 1:S63-S65. [PMID: 35470890 PMCID: PMC9087399 DOI: 10.1002/hast.1374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In this essay, a Black scholar of the cultural histories of Black women's reproductive lives launches a discussion of generations of racism, health inequities, and violence against Black bodies by looking at Black poet and essayist Dionne Brand's critique of the notion of returning to “the normal” after the Covid‐19 pandemic. To what, the essay asks, is everyone so eager to return? The intergenerational wait for Black people's moment of racial reckoning is its own unique biomedical warfare, which cannot end with the end of a pandemic. This warfare undercuts Black people's daily health with anxiety and depression, altering the very chromosomes passed down to their children. To health care providers, bioethicists, and those who practice antiracist health work the author poses these questions: How will you confront anti‐Black racism within every formulation of “treatment”—diagnosis, care, medication distribution, physical therapy? How long will the violence against Black lives be dissolved into talking points about our bodies? How can one listen, ethically, to Black people? These, she asserts, are questions of practice, of politics, and of care.
Collapse
|
30
|
Phillippe M. Telomeres, oxidative stress, and timing for spontaneous term and preterm labor. Am J Obstet Gynecol 2022; 227:148-162. [PMID: 35460626 DOI: 10.1016/j.ajog.2022.04.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 04/03/2022] [Accepted: 04/12/2022] [Indexed: 11/26/2022]
Abstract
Telomeres are nucleoprotein complexes located at the distal ends of chromosomes. In adults, progressive telomere shortening occurs throughout the lifetime and is thought to contribute to progressive aging, physiological senescence, multiorgan dysfunction, and ultimately, death. As discussed in this review, multiple lines of evidence provide support for the biological plausibility that a telomere-based clock mechanism also determines the length of gestation, leading to the onset of labor (parturition). After telomere expansion at the beginning of pregnancy, the telomere lengths in the gestational tissues (ie, the placenta and fetal membranes) progressively shorten throughout the remainder of pregnancy. The rate of telomere shortening can be accelerated by conditions that affect the mother and result in oxidative stress. Preterm births in the United States are associated with multiple risk factors that are linked with increased oxidative stress. Antioxidant vitamins (ie, vitamins E and C) mitigate the effects of oxidative stress and delay or prevent telomere shortening. Clinical trials with vitamins E and C and with multivitamins started during the periconception period have been associated with reduced rates of preterm births. In the United States, African-American women have a 2-3-fold higher rate of preterm birth. African-American women have multiple risk factors for premature birth, all of which are distinct and potentially additive with regard to epigenetic telomere shortening. The "weathering effect" is the hypothesis to explain the increased rates of chronic illness, disabilities, and early death observed in African-Americans. With regard to pregnancy, accelerated weathering with the associated telomere shortening in the gestational tissues would not only explain the preterm birth disparity but could also explain why highly educated, affluent African-American women continue to have an increased rate of preterm birth. These studies suggest that the racial disparities in preterm birth are potentially mediated by telomere shortening produced by lifetime or even generational exposure to the effects of systemic racism and socioeconomic marginalization. In conclusion, this review presents multiple lines of evidence supporting a novel hypothesis regarding the biological clock mechanism that determines the length of pregnancy, and it opens the possibility of new approaches to prevent or reduce the rate of spontaneous preterm birth.
Collapse
|
31
|
Abstract
PURPOSE OF REVIEW This paper reviews the literature on the prevalence, risk factors, and effects of traumatic experiences on the mental health outcomes of minority youth in the USA. RECENT FINDINGS The USA has an increasing number of children and youth from minority backgrounds. Research reveals that traumatic experiences disproportionately affect minority youth. These experiences include historical/generational trauma, immigration and acculturation stressors, natural and manmade disasters, experiences of discrimination, family violence, and community violence. The COVID-19 pandemic has also disproportionately affected minority youth resulting in illness and hospitalizations. Despite the higher incidence of trauma exposure, minority youth are less likely to access medical and mental health care. These disparities are resulting in increasing rates of depression, anxiety, post-traumatic stress, substance use disorders, and suicide in minority youth. Recognizing and understanding the impact of trauma is critical to the healthy development and successful functioning of minority youth, and to the success of our nation.
Collapse
Affiliation(s)
- Andres J Pumariega
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of Florida College of Medicine, Gainesville, FL, USA
| | - Youngsuhk Jo
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of Florida College of Medicine, Gainesville, FL, USA
| | - Brent Beck
- Department of Psychiatry, University of Florida College of Medicine, Gainesville, FL, USA
| | - Mariam Rahmani
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of Florida College of Medicine, Gainesville, FL, USA.
| |
Collapse
|
32
|
Camelo LV, Machado AV, Chor D, Griep RH, Mill JG, Brant LCC, Barreto SM. Racial discrimination is associated with greater arterial stiffness and carotid intima-media thickness: The ELSA-Brasil study. Ann Epidemiol 2022; 72:40-47. [DOI: 10.1016/j.annepidem.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 03/14/2022] [Accepted: 03/18/2022] [Indexed: 11/01/2022]
|
33
|
Incollingo Rodriguez AC, Polcari JJ, Nephew BC, Harris R, Zhang C, Murgatroyd C, Santos HP. Acculturative stress, telomere length, and postpartum depression in Latinx mothers. J Psychiatr Res 2022; 147:301-306. [PMID: 35123339 PMCID: PMC8882151 DOI: 10.1016/j.jpsychires.2022.01.063] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 01/05/2022] [Accepted: 01/26/2022] [Indexed: 02/06/2023]
Abstract
Latinx mothers in the United States are highly vulnerable to psychosocial stressors, including discrimination and acculturative stress, which increase maternal health risks. Previous work in Latinx mothers indicates that prenatal discrimination influences epigenetic immune markers that may increase risk for postpartum depression. Discrimination and acculturative stress have also been linked to cellular aging, including telomere degradation, in Hispanic populations broadly, but not in this particularly vulnerable population. The present work addressed this gap in a sample of 150 Latinx mothers living in the United States (mean age 27.6 years). Psychosocial measures (including discrimination, stress, and mental health) and blood were collected at 24-32 weeks gestation. Psychosocial measures were re-evaluated at 4-6 weeks postpartum. First, we examined the relationship between maternal prenatal cultural stress (i.e., discrimination and acculturative stress) and telomere length (TL). Second, we tested whether TL predicted postpartum depression. Acculturative stress - but not discrimination - predicted shorter TL, especially among participants with high methylation of the FOXP3 promoter region. Further, shorter telomere measures during pregnancy predicted greater postpartum depression symptom severity. TL was not related to any sociodemographic characteristics such as age, income, country of origin, or years in the United States. These results highlight the uniquely impactful role of acculturative stress on Latinx maternal health and the potential interactive role of telomere length and epigenetic immune alterations in risk for maternal mental health concerns.
Collapse
Affiliation(s)
| | - Justin J Polcari
- Department of Biology & Biotechnology, Worcester Polytechnic Institute, 100 Institute Road, Worcester, MA, 01609, USA
| | - Benjamin C Nephew
- Department of Biology & Biotechnology, Worcester Polytechnic Institute, 100 Institute Road, Worcester, MA, 01609, USA
| | - Rebeca Harris
- Univeristy of North Carolina School of Nursing, 120 N. Medical Drive, Chapel Hill, NC, 27599, USA
| | - Chongben Zhang
- Biobehavioral Lab, University of North Carolina School of Nursing, Carrington Hall, #7460, Chapel Hill, NC, 27599, USA
| | - Chris Murgatroyd
- Department of Life Sciences, Manchester Metropolitan University, E202 John Dalton Building, Manchester, M15 6BH, UK
| | - Hudson P Santos
- Biobehavioral Lab, University of North Carolina School of Nursing, Carrington Hall, #7460, Chapel Hill, NC, 27599, USA
| |
Collapse
|
34
|
Luo J, Hendryx M, Wang F. Mortality disparities between Black and White Americans mediated by income and health behaviors. SSM Popul Health 2022; 17:101019. [PMID: 35036515 PMCID: PMC8752946 DOI: 10.1016/j.ssmph.2021.101019] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 12/22/2021] [Accepted: 12/27/2021] [Indexed: 11/16/2022] Open
Abstract
Background Race disparities in health outcomes including mortality risk are well known, but mediating mechanisms that link race to mortality risk have rarely been formally tested. Methods We analyzed public NHANES III data from 1988 to 1994 linked to mortality outcomes prospectively through 2015. Participants included 10,460 non-Hispanic Black (40.5%, n = 4233) and non-Hispanic White (59.5%, n = 6227) adults. Proportional hazards regression models examined mortality risk in association with race, demographics, income, and an index of risky health behaviors including smoking, poor diet and low physical activity. A mediation approach under the counterfactual framework was used to test effects of income and risky health behaviors as mediators between race and mortality risk. Results Considering only race, age and sex, Black participants had significantly higher mortality risk than Whites (HR = 1.46, 95% CI 1.35–1.58). When income and education were added, the race effect was lower but remained significant (HR = 1.15, 95% CI 1.02–1.30). In the subsequent model that also included risky behaviors the association between race and mortality was no longer significant (HR = 1.05, 95% CI 0.92–1.20); both higher income and healthier behaviors contributed to lower mortality risk. There was a significant indirect effect of race on mortality mediated through income, and the direct effect of race on mortality was not significant when the mediating effect of income was considered. Likewise, the risky behavior score significantly mediated the association between race with mortality, and the direct effect of race was not significant. In the separate models, income mediated 62% of the association between race and mortality and lifestyle mediated 61% of the relationship. Conclusions Efforts to reduce race-based mortality disparities may focus on policies to reduce income-based disparities and promote positive health behaviors that consider variations in socioeconomic resources and personal preferences. Racial mortality disparities are mediated by lower income and poorer health behaviors. Direct race effects are not present when formally accounting for mediators. Interventions to reduce disparities may focus on income policies and behavior change.
Collapse
Affiliation(s)
- Juhua Luo
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University Bloomington, USA
| | - Michael Hendryx
- Department of Environmental and Occupational Health, School of Public Health, Indiana University Bloomington, 1025 E 7th St., Bloomington, IN, 47405, USA
| | - Fengge Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University Bloomington, USA
| |
Collapse
|
35
|
Thomas MD, Mendez RM, Zhang Y, Wang Y, Sohail S, Chae DH, Márquez-Magaña L, Sellers R, Woods-Giscombé CL, Allen AM. OUP accepted manuscript. THE GERONTOLOGIST 2022; 62:762-772. [PMID: 35084030 PMCID: PMC9154235 DOI: 10.1093/geront/gnac005] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Indexed: 11/30/2022] Open
Abstract
Background and Objectives African American women experience faster telomere shortening (i.e., cellular aging) compared with other racial–gender groups. Prior research demonstrates that race and gender interact to influence culturally specific norms for responding to socially-relevant stress and other stress-coping processes, which may affect healthy aging. Research Design and Methods Data are from African American Women’s Heart & Health Study participants who consented to DNA extraction (n = 140). Superwoman Schema (SWS) was measured using 5 validated subscales: presenting strength, emotion suppression, resisting vulnerability, motivation to succeed, and obligation to help others. Racial identity was measured using 3 subscales from the Multidimensional Inventory of Black Identity: racial centrality, private regard, and public regard. Relative telomere length (rTL) was measured using DNA extracted from blood samples. Path analysis tested associations and interactions between SWS and racial identity dimensions with rTL. Results For SWS, higher resistance to being vulnerable predicted longer telomeres. For racial identity, high private regard predicted longer telomeres while high public regard predicted shorter telomeres. Interactions were found between public regard and 2 SWS dimensions: among women with high public regard, emotion suppression (β = 0.20, p < .05) and motivation to succeed (β = 0.18, p < .05) were associated with longer rTL. The interaction between high centrality and emotion suppression predicted shorter rTL (β = −0.17, p < .05). Discussion and Implications Culturally specific responses to gendered racism and racial identity, developed early in life and shaped over the life course, are important psychosocial determinants of cellular aging among African American women.
Collapse
Affiliation(s)
- Marilyn D Thomas
- Departments of Epidemiology & Biostatistics and Psychiatry & Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
- Address correspondence to: Marilyn D. Thomas, PhD, MPH, Departments of Epidemiology & Biostatistics and Psychiatry & Behavioral Sciences, University of California, San Francisco, 1001 Potrero Avenue, Box 0852, San Francisco, CA 94110, USA. E-mail:
| | - Rebecca M Mendez
- Department of Biology, San Francisco State University, San Francisco, California, USA
| | - Youchuan Zhang
- Department of Human Development and Family Studies, Michigan State University, East Lansing, Michigan, USA
| | - Yijie Wang
- Department of Human Development and Family Studies, Michigan State University, East Lansing, Michigan, USA
| | - Saba Sohail
- Department of Biology, San Francisco State University, San Francisco, California, USA
| | - David H Chae
- Department of Global Community Health and Behavioral Sciences, Tulane University, School of Public Health & Tropical Medicine, New Orleans, Louisiana, USA
| | | | - Rob Sellers
- Office of Diversity, Equity & Inclusion, University of Michigan, Ann Arbor, Michigan, USA
| | - Cheryl L Woods-Giscombé
- School of Nursing, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina, USA
| | - Amani M Allen
- School of Public Health, Divisions of Community Health Sciences and Epidemiology, University of California, Berkeley, Berkeley, California, USA
| |
Collapse
|
36
|
Montiel Ishino FA, McNab P, Villalobos K, Cohen JH, Nápoles AM, Williams F. Hispanic/Latino Acculturation Profiles and Telomere Length: Latent Class Analysis on a Nationally Representative Sample. Front Public Health 2021; 9:640226. [PMID: 34988044 PMCID: PMC8722469 DOI: 10.3389/fpubh.2021.640226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 11/29/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Acculturation profiles and their impact on telomere length among foreign-born Hispanics/Latinos living in the United States (US) are relatively unknown. The limited research available has linked acculturation with shortened telomere length. Objectives: To identify acculturation profiles among a US representative sample of Hispanics/Latinos and to then examine telomere length differences between profiles. Methods: We conducted a latent class analysis among a non-institutionalized US-representative sample of Hispanics/Latinos using the 1999-2002 National Health and Nutrition Examination Survey (N = 2,292). The latent variable of acculturation was assessed by length of time in the US and language used as a child, read and spoken, usually spoken at home, used to think, and used with friends (i.e., Spanish and/or English). Telomere length assessed from leukocytes was used as the distal continuous outcome. Results: We identified five profiles: (1) low acculturated [33.2% of sample]; (2) partially integrated [18.6% of sample]; (3) integrated [19.4% of sample]; (4) partially assimilated [15.1% of sample]; and (5) assimilated [13.7% of sample]. Acculturation profiles revealed nuanced differences in conditional probabilities with language use despite the length of time spent in the US. While telomere length did vary, there were no significant differences between profiles. Conclusion: Profiles identified revealed that possible life-course and generational effects may be at play in the partially assimilated and assimilated profiles. Our findings expand public health research using complex survey data to identify and assess the dynamic relationship of acculturation profiles and health biomarkers, while being among the first to examine this context using a person-centered approach.
Collapse
Affiliation(s)
- Francisco Alejandro Montiel Ishino
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, United States
| | - Philip McNab
- Department of Environmental Health & Engineering, Center for a Livable Future, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Kevin Villalobos
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, United States
| | - Jeffrey H. Cohen
- Department of Anthropology, The Ohio State University, Columbus, OH, United States
| | - Anna M. Nápoles
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, United States
| | - Faustine Williams
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, United States
| |
Collapse
|
37
|
Logan AC, Berman BM, Prescott SL. Earth Dreams: Reimagining ARPA for Health of People, Places and Planet. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12788. [PMID: 34886514 PMCID: PMC8657388 DOI: 10.3390/ijerph182312788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/29/2021] [Accepted: 12/02/2021] [Indexed: 12/28/2022]
Abstract
Bold new approaches are urgently needed to overcome global health challenges. The proposed Advanced Research Projects Agency for Health (ARPA-H) is intended to provide rapid health breakthroughs. While new technologies for earlier disease detection and more effective treatment are critical, we urge equal attention be given to the wider (physical, emotional, social, political, and economic) environmental ecosystems driving the non-communicable disease (NCD) crisis in the first place. This requires an integrated, cross-sectoral vision that spans the interwoven connections affecting health across the scales of people, places, and planet. This wider "exposome" perspective considers biopsychosocial factors that promote resilience and reduce vulnerabilities of individuals and communities over time-the many variables driving health disparities. Since life course health is strongly determined by early life environments, early interventions should be prioritized as a matter of effectiveness and social justice. Here, we explore the origins of the Advanced Research Project Agency and point to its potential to build integrated solutions, with wisdom and ethical value systems as a compass. Since the planned ARPA-H is anticipated to spawn international collaborations, the imagined concept is of relevance to a broad audience of researchers. With appropriate input, the quest for health equity through personalized, precision medicine while deconstructing unacceptable structural inequities may be accelerated.
Collapse
Affiliation(s)
- Alan C. Logan
- Nova Institute for Health of People, Places and Planet, 1407 Fleet Street, Baltimore, MD 21231, USA; (A.C.L.); (B.M.B.)
| | - Brian M. Berman
- Nova Institute for Health of People, Places and Planet, 1407 Fleet Street, Baltimore, MD 21231, USA; (A.C.L.); (B.M.B.)
- Center for Integrative Medicine, Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Susan L. Prescott
- Nova Institute for Health of People, Places and Planet, 1407 Fleet Street, Baltimore, MD 21231, USA; (A.C.L.); (B.M.B.)
- Center for Integrative Medicine, Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
- inVIVO Planetary Health, Worldwide Universities Network (WUN), Baltimore, MD 21231, USA
- ORIGINS Project, Telethon Kids Institute, Perth Children’s Hospital, University of Western Australia, 15 Hospital Avenue, Nedlands, WE 6009, Australia
| |
Collapse
|
38
|
Teixeira MZ. Telomere and Telomerase: Biological Markers of Organic Vital Force State and Homeopathic Treatment Effectiveness. HOMEOPATHY 2021; 110:283-291. [PMID: 34000743 PMCID: PMC8575553 DOI: 10.1055/s-0041-1726008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 12/03/2020] [Indexed: 10/28/2022]
Abstract
BACKGROUND Philosophical-scientific correlations described in previous studies suggest that the genome can be the biological representation of the vital force, whilst the disease-promoting epigenetic alterations would be the biological representation of the chronic miasmas. In this study, we expand the functional correlation between vital force and chromosomes, describing the mechanism of action of the telomere-telomerase complex in the context of physiological balance. AIMS The aim of the work is to study the role of the telomere-telomerase complex in cell vitality, biological aging, and the health-disease process, with the goal of proposing the use of telomere length as a biomarker of the vital force state and the effectiveness of homeopathic treatment. RESULTS Similar to the vital force, telomere length and telomerase enzyme activity play an important role in maintaining cellular vitality, biological longevity, and physiological homeostasis. Telomere shortening functions as a biomarker of vital imbalance and is associated with numerous diseases and health disorders. On the other hand, health-promotion practices neutralize the pathological shortening of the telomeres, acting therapeutically in diseases or age-dependent health disorders. CONCLUSIONS As a hypothetical biomarker of the vital force state, an intra-individual analysis of the mean leukocyte telomere length before, during, and after homeopathic treatment can be used as a biomarker of therapeutic effectiveness.
Collapse
|
39
|
Njoroge WFM, Forkpa M, Bath E. Impact of Racial Discrimination on the Mental Health of Minoritized Youth. Curr Psychiatry Rep 2021; 23:81. [PMID: 34648076 DOI: 10.1007/s11920-021-01297-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/12/2021] [Indexed: 12/29/2022]
Abstract
PURPOSE OF REVIEW The impacts of racism and discrimination on developing minoritized youth are increasingly shown as having the potential to create long-lasting adverse outcomes on children's developmental trajectories. RECENT FINDINGS From the quality of the schools they attend, to the level and amount of toxicants in the air they breathe, to equitable access to health care, and within interpersonal relationships and experiences with their peers, multiple forms of racism, systemic/structural, interpersonal/personally mediated, and internalized shape the health status of Black, Indigenous, and people of color (BIPoC) youth. Accordingly, it is exceedingly important to use a developmental lens to distinguish the various outcomes these multiple forms of racism have on the health of minoritized youth. Critically, the time is now for rapid identification of these harms in all of the mediums and spaces in which they present followed by prevention and intervention strategies that are effective in equitably ensuring the healthy development for all of America's children.
Collapse
Affiliation(s)
- Wanjikũ F M Njoroge
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Department of Child and Adolescent Psychiatry, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Markolline Forkpa
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Eraka Bath
- Department of Psychiatry, David Geffen School of Medicine, UCLA Neuropsychiatric Institute, Los Angeles, CA, USA
| |
Collapse
|
40
|
Seedat S. Commentary on the special issue on disproportionate exposure to trauma: Trauma, stress, and adversities and health disparities among disenfranchised groups globally during the COVID pandemic. J Trauma Stress 2021; 34:1061-1067. [PMID: 34642999 PMCID: PMC8662206 DOI: 10.1002/jts.22746] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 09/14/2021] [Indexed: 11/11/2022]
Abstract
The papers in this Journal of Traumatic Stress special issue on disproportionate adversity cover the gamut of discrimination traumas and stressors, including microaggressions, a more insidious forms of discrimination, and their often-devastating and wide-ranging mental health sequelae, in disproportionately affected disenfranchised groups. Discrimination based on race, ethnicity, gender, and sexual orientation commonly confers cumulative and chronic effects. In the field of traumatic stress studies, several types of identity-linked traumatic events have been identified and empirically investigated as posttraumatic stress disorder (PTSD)-producing experiences. Collectively, the 13 papers included in this special issue raise questions about the definition, conceptualization, and categorization of various forms of explicit and implicit identity-linked trauma. These papers highlight the need for acceptance of a shared nomenclature and better differentiation of both causal and correlational associations with acute and chronic PTSD, depression, suicide risk, alcohol misuse, and other mental health outcomes. In this commentary, the discussion is extended to COVID-19, a disease that has been globally devastating for many. On multiple levels (i.e., physical, mental, emotional, economic, and social), COVID-19 has magnified the prepandemic fault lines of race, ethnicity, gender, gender identity, and sexual orientation. Applying a syndemic framework to the health impact of COVID-19 and, arguably, the most pervasive identity linked epidemic worldwide-systemic racism-brings perspective to the biological and social forces that are likely to be driving the convergence of COVID-19, systemic racism, and chronic health inequities, and may be informative in guiding evidence-based strategies for managing racial trauma in the context of COVID-19.
Collapse
Affiliation(s)
- Soraya Seedat
- Department of PsychiatryFaculty of Medicine and Health SciencesStellenbosch UniversityCape TownSouth Africa
| |
Collapse
|
41
|
Gwanyalla NK, Asker S, Abazaid N, Aromolaran K, Jackson T, Okpere H. "Say their names:" Thoughts on residency leadership response to police brutality and social injustices. AEM EDUCATION AND TRAINING 2021; 5:S149-S151. [PMID: 34616991 PMCID: PMC8480498 DOI: 10.1002/aet2.10665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/31/2021] [Accepted: 06/07/2021] [Indexed: 06/13/2023]
|
42
|
Teixeira MZ. Telomere length: biological marker of cellular vitality, aging, and health-disease process. Rev Assoc Med Bras (1992) 2021; 67:173-177. [PMID: 34406239 DOI: 10.1590/1806-9282.67.02.20200655] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 08/19/2020] [Indexed: 12/16/2022] Open
Abstract
The aging process occurs due to the decline of vital physiological functions and adaptability of the body, being influenced by genetics and lifestyle. With advances in genetics, biological aging can be calculated by telomere length. Telomeres are regions at the ends of chromosomes that play a role in the maintenance and integrity of DNA. With biological aging, telomere shortening occurs, causing cellular senescence. Several studies show that shorter telomeres are associated with acute and chronic diseases, stress, addictions, and intoxications. Even in the current COVID-19 pandemic, telomere shortening is proposed as a marker of severity in individuals infected by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). On the other hand, healthy lifestyle habits increase telomere length and balance of various cellular functions, preventing diseases.
Collapse
Affiliation(s)
- Marcus Zulian Teixeira
- Instituto de Psiquiatria, Hospital das Clinicas, Faculdade de Medicina - Universidade de São Paulo (SP), Brazil
| |
Collapse
|
43
|
Kritsotakis G, Gkorezis P, Andreadaki E, Theodoropoulou M, Grigoriou G, Alvizou A, Kostagiolas P, Ratsika N. Nursing practice environment and employee silence about patient safety: The mediating role of professional discrimination experienced by nurses. J Adv Nurs 2021; 78:434-445. [PMID: 34337760 DOI: 10.1111/jan.14994] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 05/18/2021] [Accepted: 07/20/2021] [Indexed: 12/29/2022]
Abstract
AIMS To examine the associations between nurse work environment with nurses' silence about patient safety and the mediating effects of professional discrimination experienced by nurses. DESIGN Multicentre cross-sectional study. METHODS Between January and April 2019, 607 nurses and nursing assistants from seven hospitals in Greece assessed their clinical environment using the 'Practice Environment Scale of the Nursing Work Index Revised-PES-NWIR', and the silence about patient safety. The 'Experiences of Discrimination Index' was adapted to specifically address experienced discrimination based on the nursing profession. The PROCESS macros for SPSS were used to examine the above associations. FINDINGS Better nurse practice environment, with the exception of 'staffing and resource adequacy' dimension, was directly associated with less experienced professional discrimination, and directly and indirectly associated with less silence about patient safety, through the mediating role of professional discrimination experienced by nurses. CONCLUSIONS Silence about patient safety is dependent on the clinical work environment and may be a response of nurses to discrimination in the work context. Both an improvement in the nurse work environment and a decrease in professional discrimination would minimize silence about patient safety. IMPACT On many occasions, nurses are directly or indirectly discouraged from voicing their concerns about patient safety or are ignored when they do, leading to employee silence and decreasing the standard of care (Alingh et al., BMJ Quality & Safety, 2019, 28, 39; Pope, Journal of Change Management, 2019, 19, 45). Nurses' work-related determinants for silence are not clearly understood in the patient safety context. A favourably evaluated nurse practice environment is associated with less experienced professional discrimination and less silence about patient safety. To minimize silence about patient safety, both the nurse work environment and the experienced professional discrimination should be taken into consideration by nurse and healthcare managers.
Collapse
Affiliation(s)
- George Kritsotakis
- Department of Bussiness Administration & Tourism, Hellenic Mediterranean University, Crete, Greece.,School of Social Sciences, Hellenic Open University, Patras, Greece
| | - Panagiotis Gkorezis
- School of Social Sciences, Hellenic Open University, Patras, Greece.,Faculty of Economics and Political Sciences, Aristotle University of Thessaloniki, Thesaloniki, Greece
| | - Eirini Andreadaki
- School of Social Sciences, Hellenic Open University, Patras, Greece.,Aghios Nikolaos General Hospital, Crete, Greece
| | | | | | | | - Petros Kostagiolas
- School of Social Sciences, Hellenic Open University, Patras, Greece.,Department of Archives, Library Science and Museology, School of Information Science and Informatics, Ionian University, Kerkyra, Greece
| | - Nikoleta Ratsika
- Department of Social Work, Hellenic Mediterranean University, Crete, Greece
| |
Collapse
|
44
|
Hailu EM, Lewis TT, Needham BL, Lin J, Seeman TE, Mujahid MS. Longitudinal Associations between Discrimination, Neighborhood Social Cohesion, and Telomere Length: The Multi-Ethnic Study of Atherosclerosis (MESA). J Gerontol A Biol Sci Med Sci 2021; 77:glab193. [PMID: 34282826 PMCID: PMC8824602 DOI: 10.1093/gerona/glab193] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We aimed to examine if neighborhood social cohesion moderated longitudinal associations between baseline reports of discrimination and 10-year changes in Leukocyte Telomere Length (LTL). METHODS Data are from the Multi-Ethnic Study of Atherosclerosis (MESA; N=1,064; age range 45-84 years). Baseline discrimination was measured using the Major Experiences of Discrimination Scale (MDS; none, 1 domain, ≥2 domains) and the Experiences of Discrimination Scale (EDS; none, moderate, high). Neighborhood social cohesion at baseline was assessed via a community survey within census tract defined neighborhoods. 10-year change in LTL was defined as Regression to the Mean corrected 10-year difference in the ratio of telomeric DNA to a single copy gene (T/S). RESULTS In linear mixed effects models, we found that neighborhood social cohesion modified the effect of baseline reports of MDS on 10-year changes in LTL, independent of sociodemographic characteristics, health behaviors, and health conditions (p(χ 2)=0.01). Among those residing in neighborhoods with low social cohesion, experiencing major discrimination in ≥2 domains was associated with faster LTL attrition over 10-years, compared to reporting no discrimination (β=-0.03; 95% CI: -0.06, -0.003). We found no main associations for either discrimination measure and no interaction between EDS and neighborhood social cohesion. CONCLUSIONS Results indicate that neighborhood social cohesion is an important dimension of the neighborhood context that may moderate the impact of major experiences of discrimination on telomere length attrition. These findings help advance our understanding of the integral role that neighborhood environments play in attenuating the effect of discrimination on accelerated cell aging.
Collapse
Affiliation(s)
- Elleni M Hailu
- Division of Epidemiology, School of Public Health, University of California Berkeley, USA
| | - Tené T Lewis
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Belinda L Needham
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, USA
| | - Jue Lin
- Department of Biochemistry and Biophysics, University of California San Francisco, USA
| | - Teresa E Seeman
- Department of Geriatrics, David Geffen School of Medicine, University of California Los Angeles, USA
| | - Mahasin S Mujahid
- Division of Epidemiology, School of Public Health, University of California Berkeley, USA
| |
Collapse
|
45
|
Lloyd-Jones DM, Lewis CE, Schreiner PJ, Shikany JM, Sidney S, Reis JP. The Coronary Artery Risk Development In Young Adults (CARDIA) Study: JACC Focus Seminar 8/8. J Am Coll Cardiol 2021; 78:260-277. [PMID: 34266580 PMCID: PMC8285563 DOI: 10.1016/j.jacc.2021.05.022] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 05/23/2021] [Accepted: 05/25/2021] [Indexed: 12/15/2022]
Abstract
The CARDIA (Coronary Artery Risk Development in Young Adults) study began in 1985 to 1986 with enrollment of 5,115 Black or White men and women ages 18 to 30 years from 4 US communities. Over 35 years, CARDIA has contributed fundamentally to our understanding of the contemporary epidemiology and life course of cardiovascular health and disease, as well as pulmonary, renal, neurological, and other manifestations of aging. CARDIA has established associations between the neighborhood environment and the evolution of lifestyle behaviors with biological risk factors, subclinical disease, and early clinical events. CARDIA has also identified the nature and major determinants of Black-White differences in the development of cardiovascular risk. CARDIA will continue to be a unique resource for understanding determinants, mechanisms, and outcomes of cardiovascular health and disease across the life course, leveraging ongoing pan-omics work from genomics to metabolomics that will define mechanistic pathways involved in cardiometabolic aging.
Collapse
Affiliation(s)
- Donald M Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
| | - Cora E Lewis
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, USA
| | - Pamela J Schreiner
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - James M Shikany
- Division of Preventive Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Stephen Sidney
- Kaiser Permanente Northern California Division of Research, Oakland, California, USA
| | - Jared P Reis
- National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| |
Collapse
|
46
|
Simckes M, Willits D, McFarland M, McFarland C, Rowhani-Rahbar A, Hajat A. The adverse effects of policing on population health: A conceptual model. Soc Sci Med 2021; 281:114103. [PMID: 34120085 DOI: 10.1016/j.socscimed.2021.114103] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/21/2021] [Accepted: 06/01/2021] [Indexed: 01/02/2023]
Abstract
While negative encounters between police and the community are not a new trend, recent high profile deaths of unarmed people of color have gained widespread national attention and ignited new movements demanding reform, accountability, and progress. Increasingly over the past few decades, researchers have examined the most extreme cases of lethal use of force, describing the context of these violent encounters, situational and personal characteristics, and underlying risk factors. More recent research has aimed to define the broader and more nuanced adverse effects that policing can have on population health. We propose a holistic and multidisciplinary model for the relationship between policing and population health in the U.S. that incorporates contextual, situational, and individual-level factors while also recognizing the direct and vicarious mechanisms by which policing exposures can negatively affect population health. The model captures the short and long term health effects of policing and the cyclic nature by which those effects at the individual, community, and systemic levels can influence each other. We consider the unique qualities of different communities that may influence these pathways, the historical trends of the criminal justice and policing systems, and recommend applications of the model in policing agencies, medicine, and research.
Collapse
Affiliation(s)
- Maayan Simckes
- Washington State Department of Health, Tumwater, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA.
| | - Dale Willits
- Department of Criminal Justice and Criminology, Washington State University, Pullman, WA, USA
| | - Michael McFarland
- Department of Sociology, Florida State University, Tallahassee, FL, USA; Center for Demography and Population Health, Florida State University, Tallahassee, FL, USA
| | - Cheryl McFarland
- Central Jersey Family Health Consortium, North Brunswick, NJ, USA
| | - Ali Rowhani-Rahbar
- Department of Epidemiology, University of Washington, Seattle, WA, USA; Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA
| | - Anjum Hajat
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| |
Collapse
|
47
|
Miller WD, Han X, Peek ME, Charan Ashana D, Parker WF. Accuracy of the Sequential Organ Failure Assessment Score for In-Hospital Mortality by Race and Relevance to Crisis Standards of Care. JAMA Netw Open 2021; 4:e2113891. [PMID: 34143190 PMCID: PMC8214156 DOI: 10.1001/jamanetworkopen.2021.13891] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
IMPORTANCE Crisis Standards of Care (CSC) are guidelines for rationing health care resources during public health emergencies. The CSC adopted by US states ration intensive care unit (ICU) admission using the Sequential Organ Failure Assessment (SOFA) score, which is used to compare expected in-hospital mortality among eligible patients. However, it is unknown if Black and White patients with equivalent SOFA scores have equivalent in-hospital mortality. OBJECTIVE To investigate whether reliance on SOFA is associated with bias against Black patients in CSC. DESIGN, SETTING, AND PARTICIPANTS This cohort study was conducted using data from the eICU Collaborative Research Database of patients admitted to 233 US ICUs in 2014 to 2015. Included individuals were Black and White adult patients in the ICU, who were followed up to hospital discharge. Data were analyzed from May 2020 through April 2021. EXPOSURE SOFA scores at ICU admission. MAIN OUTCOMES AND MEASURES Hierarchical logistic regression with hospital fixed effects was used to measure the interaction between race and SOFA as a factor associated with in-hospital mortality, as well as the odds of death among Black and White patients with equivalent priority for resource allocation according to the SOFA-based ranking rules of 3 statewide CSC (denoted A, B, and C) under shortage conditions that were severe (ie, only patients with the highest priority would be eligible for allocation), intermediate (ie, patients in the highest 2 tiers would be eligible for allocation), or low (ie, only patients with the lowest priority would be at risk of exclusion). RESULTS Among 111 885 ICU encounters representing 95 549 patients, there were 16 688 encounters with Black patients (14.9%) and 51 464 (46.0%) encounters with women and the mean (SD) age was 63.3 (16.9) years. The median (interquartile range) SOFA score was not statistically significantly different between Black and White patients (4 [2-6] for both groups; P = .19), but mortality was lower among Black individuals compared with White individuals with equivalent SOFA scores (odds ratio [OR], 0.98; 95% CI, 0.97-0.99; P < .001). This was associated with lower mortality among Black patients compared with White patients prioritized for resource allocation in 3 CSC under shortage conditions that were severe (system A: OR, 0.65; 95% CI, 0.58-0.74; P < .001; system B: OR, 0.70; 95% CI, 0.64-0.78; P < .001; system C: OR, 0.73; 95% CI, 0.67-0.80; P < .001), intermediate (system A: OR, 0.73; 95% CI, 0.67-0.80; P < .001; system B: OR, 0.83; 95% CI, 0.77-0.89; P < .001; system C: OR, 0.82; 95% CI, 0.77-0.89; P < .001), and low (system A: OR, 0.83; 95% CI, 0.77-0.89; P < .001; system C: OR, 0.86; 95% CI, 0.81-0.92; P < .001; not applicable for system B, which had fewer tiers). When SOFA-based ranking rules were adjusted for Black patients to simulate equitable allocation based on observed mortality, the proportion upgraded to higher priority ranged from 379 Black patient encounters (2.3%) in low shortage conditions to 2601 Black patient encounters (15.6%) in severe shortage conditions. CONCLUSIONS AND RELEVANCE This study found that SOFA scores were associated with overestimated mortality among Black patients compared with White patients, and this was associated with a structural disadvantage for Black patients in CSC allocation systems. These findings suggest that guidelines should be revised to correct this inequity and alternative methods should be developed for more equitable triage.
Collapse
Affiliation(s)
- William Dwight Miller
- Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, Illinois
| | - Xuan Han
- Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, Illinois
| | - Monica E. Peek
- Section of General Internal Medicine, University of Chicago, Chicago, Illinois
- MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, Illinois
- Center for the Study of Race, Politics, and Culture, University of Chicago, Chicago, Illinois
| | - Deepshikha Charan Ashana
- Division of Pulmonary, Allergy and Critical Care Medicine, Duke University, Durham, North Carolina
| | - William F. Parker
- Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, Illinois
- MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, Illinois
| |
Collapse
|
48
|
Abstract
PURPOSE OF REVIEW The Coronavirus Disease 2019 (COVID-19) pandemic has exposed preexisting racial disparities in the healthcare system. This review discusses racial-ethnic differences in COVID-19 related outcomes with an emphasis on the social determinants of health that are responsible for these disparities. RECENT FINDINGS Higher hospitalizations and deaths have been reported amongst minority individuals after a COVID-19 infection. Cardiovascular disease and its risk factors are also more common in minority populations and negatively impact clinical outcomes after a COVID-19 illness. The racial disparities seen after COVID-19 infections appear to be driven by multiple preexisting comorbidities, adverse socioeconomic conditions, and lack of access to healthcare. These disadvantages were present before the COVID-19 pandemic. To effectively reduce disparities in outcomes of COVID-19 and the impact of the virus on minority communities, a multifaceted approach will be needed. SUMMARY Government-backed policies that foster health equity and promote easily accessible testing and fair distribution of COVID-19 therapies and vaccines are necessary to successfully combat racial disparities in COVID-19 outcomes.
Collapse
Affiliation(s)
| | - Duke Appiah
- CA Department of Public Health, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Imo A Ebong
- Division of Cardiology, University of California Davis, Sacramento, California, USA
| |
Collapse
|
49
|
Yip T, Smith P, Tynes M, Mirpuri S, Weems A, Cheon YM. Discrimination and hair cortisol concentration among asian, latinx and white young adults. COMPREHENSIVE PSYCHONEUROENDOCRINOLOGY 2021; 6:100047. [PMID: 35757364 PMCID: PMC9216324 DOI: 10.1016/j.cpnec.2021.100047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/05/2021] [Accepted: 03/05/2021] [Indexed: 11/17/2022] Open
Abstract
Discrimination is a form of chronic stress and hair cortisol concentration is an emerging biomarker of chronic stress. In a sample of 83 first-year college students (age x⋅⋅−=17.65, SD=48, 69% female, 84% United States-born, 24% Asian, 21% Latinx, and 55% White), the current study investigates associations between hair cortisol concentration with discrimination stress assessed across two timeframes: past year and past two weeks. Significant associations were observed for past year discrimination and hair cortisol concentration levels, but not for discrimination over the past two weeks. The current study contributes to a growing body of evidence linking discrimination stress exposure to neuroendocrine functioning. Analyzes hair cortisol concentration (HCC) to measure chronic discrimination. HCC was significantly associated with discrimination over the past year. HCC was not associated with discrimination over the past 2 weeks. Highlights HCC as a neuroendocrine biomarker of discrimination.
Collapse
|
50
|
Sekimitsu S, Zebardast N. Glaucoma and Machine Learning: A Call for Increased Diversity in Data. Ophthalmol Glaucoma 2021; 4:339-342. [PMID: 33879422 DOI: 10.1016/j.ogla.2021.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 02/25/2021] [Accepted: 03/01/2021] [Indexed: 02/07/2023]
|