Intersectional effects of racial and gender discrimination on cardiovascular health vary among black and white women and men in the CARDIA study
Intersectional effects of racial and gender discrimination on cardiovascular health vary among black and white women and men in the CARDIA study
复制标题
DOI：
10.1016/j.ssmph.2019.100446
复制
发表时间：
2019-08-01
影响因子：
4.7
通讯作者：
Kiefe, C.
中科院分区：
文献类型：
--
作者：
Bey, G. S.;Jesdale, B.;Kiefe, C.
从新兴的身份病理学（IP）的框架测试假设，我们评估种族和性别歧视的影响，同时报告的经验相比，种族或性别歧视，或没有歧视，对未来的心血管健康（CVH）的种族性别差异。数据来自CARDIA的3758名黑人或白色成年人样本，CARDIA是一个以社区为基础的队列，于1985-6年（0年）在阿拉巴马州伯明翰、伊利诺伊州芝加哥、明尼苏达州明尼阿波利斯和加利福尼亚州奥克兰招募。种族和性别歧视进行了评估，使用的歧视规模的经验。CVH使用12分复合结果进行评估，该结果由Life's Simple 7修改而来，分数越高表示健康状况越好。多变量线性回归被用来评估不同的歧视和CVH分数的种族和性别同时在二十年后的协会。在≥ 2种环境中报告种族和性别歧视的黑人女性为48%，黑人男性为42%，白色女性为10%，白色男性为5%。第30年CVH评分（平均值，SD）分别为7.9（1.4）、8.1（1.6）、8.8（1.6）和8.7（1.3）。与那些没有报告歧视的种族性别组相比，只报告基于性别的歧视的白色妇女的调整后得分差异为+0.3（95%CI：0.0，0.6），而仅报告种族歧视的白色男性平均有0.4（95% CI：0.1，0.8）得分较高，报告种族和性别歧视的白色男性的得分平均为0.6（95%CI：1.1，-0.1）低于他们的组报告没有歧视。与IP模型的预测一致，不同种族定义的性别群体报告的种族和性别歧视与未来CVH的关联是不同的。需要更多的研究来了解为什么报告的种族和性别歧视可能更好地预测白人比黑人CVH的恶化，以及与性别和种族相关的其他因素对这些群体中CVH的变异性有什么影响。
Testing hypotheses from the emerging Identity Pathology (IP) framework, we assessed race-gender differences in the effects of reporting experiences of racial and gender discrimination simultaneously compared with racial or gender discrimination alone, or no discrimination, on future cardiovascular health (CVH). Data were from a sample of 3758 black or white adults in CARDIA, a community-based cohort recruited in Birmingham, AL; Chicago, IL; Minneapolis, MN, and Oakland, CA in 1985-6 (year 0). Racial and gender discrimination were assessed using the Experiences of Discrimination scale. CVH was evaluated using a 12-point composite outcome modified from the Life's Simple 7, with higher scores indicating better health. Multivariable linear regressions were used to evaluate the associations between different perceptions of discrimination and CVH scores two decades later by race and gender simultaneously. Reporting racial and gender discrimination in >= 2 settings were 48% of black women, 42% of black men, 10% of white women, and 5% of white men. Year 30 CVH scores (mean, SD) were 7.9(1.4), 8.1(1.6), 8.8(1.6), and 8.7(1.3), respectively. Compared with those of their race-gender groups reporting no discrimination, white women reporting only gender-based discrimination saw an adjusted score difference of +0.3 (95% CI: 0.0,0.6), whereas white men reporting only racial discrimination had on average a 0.4 (95% CI: 0.1,0.8) higher score, and scores among white men reporting both racial and gender discrimination were on average 0.6 (95% CI: 1.1,-0.1) lower than those of their group reporting no discrimination. Consistent with predictions of the IP model, the associations of reported racial and gender discrimination with future CVH were different for different racially-defined gender groups. More research is needed to understand why reported racial and gender discrimination might better predict deterioration in CVH for whites than blacks, and what additional factors associated with gender and race contribute variability to CVH among these groups.