Structural racism and its pathways to asthma and atopic dermatitis.
Structural racism and its pathways to asthma and atopic dermatitis.
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DOI：
10.1016/j.jaci.2021.09.020
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发表时间：
2021-11
影响因子：
14.2
通讯作者：
Thakur, Neeta
中科院分区：
文献类型：
--
作者：
Martinez, Adali;de la Rosa, Rosemarie;Mujahid, Mahasin;Thakur, Neeta
美国的黑人、拉丁裔和原住民承受着不成比例的哮喘和特应性皮炎负担。对这些疾病差异的研究主要集中在最近的社会环境暴露和生物力学上，包括遗传、种族和族裔群体之间的差异。虽然过敏和免疫学领域的生物医学研究将受益于纳入不同的研究人群，但对生物机制的狭隘关注忽视了生物和结构因素之间相互作用的复杂性，包括结构性种族主义的影响。结构性种族主义是社会通过政府和机构批准的有意政策和做法创建和强化不平等制度而助长歧视的方式的总和。它植根于经济、教育、医疗保健和司法系统等多个层面，表现为物质和社会环境的不平等。在这篇综述中，我们提出了一个概念框架，并借鉴文献来证明结构性种族主义如何成为特应性疾病差异的根本原因，通过居住隔离、社会经济地位和大规模监禁，可能导致先天性和适应性免疫反应的异常以及生理应激反应的增强，从而导致种族和族裔人口承受不成比例的疾病负担。
Black, Latinx and Indigenous people in the United States experience a disproportionate burden of asthma and atopic dermatitis. The study of these disease disparities has focused on proximal socioenvironmental exposures and on the biomechanistic, including genetic, differences between racial and ethnic groups. While biomedical research in allergy and immunology stands to benefit from the inclusion of diverse study populations, the narrow focus on biologic mechanisms disregards the complexity of interactions across biological and structural factors, including the effects of structural racism. Structural racism is the totality of ways in which society fosters discrimination by creating and reinforcing inequitable systems through intentional policies and practices sanctioned by government and institutions. It is embedded across multiple levels, including the economic, educational, health care and judicial systems, which manifest in inequity in the physical and social environment. In this review, we present a conceptual framework and pull from the literature to demonstrate how structural racism is a root cause of atopic disease disparities, by way of residential segregation, socioeconomic position, and mass incarceration that may lead to aberrations in the innate and adaptive immune response and the augmentation of physiological stress responses, contributing to a disproportionate disease burden for racial and ethnic populations.
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