Under the Skin: Understanding the Role of Stress and Immune Function in Health Di

描述(由申请人提供)：社会经济地位(SES)和健康之间的关系在许多健康结果和许多情况下都得到了很好的确立。尽管研究对健康不平等给予了关注，但将SES与健康联系起来的物理机制却知之甚少。终身接触感染和炎症已被认为是死亡率的一个重要决定因素。人们对美国人群中多种慢性感染或免疫功能的社会模式以及这些因素如何导致健康差距知之甚少。心理社会压力也被认为是一种潜在的途径，在这种途径中，较低的SES可能会损害一个人的健康。有大量研究描述了心理社会压力和感染易感性之间的一致联系，以及对现有感染的免疫控制减弱。然而，SES可能通过其对心理社会压力的影响而在免疫功能中发挥的作用尚不清楚。该项目将利用几个不同强度的数据集，推进目前关于感染、免疫和压力在健康差异中的潜在作用的研究。使用国家健康和营养检查调查(NHANES)III(包括保密的死亡率数据)、萨克拉门托地区拉丁裔老龄化研究(SALSA)、芝加哥社区成人健康调查(CCAHS)和健康和退休调查(HRS)的数据，我们将首先评估SES的衡量标准是否与美国人口中慢性感染和免疫反应的负担有关。接下来，我们将研究感染负担和免疫反应是否在美国SES和死亡率等健康结果之间的关系中起中介作用。最后，我们将评估SES和免疫功能之间的关系是否由心理社会和经济应激源的标记物调节。我们相信，这项工作将填补在理解压力和免疫系统在社会和生物风险相互作用中可能发挥的作用方面的重要空白，这些风险在生命过程中演变为疾病和死亡率的差异。这项研究的结果可能确定针对生物风险因素的新干预措施，例如需要有针对性的疫苗接种或常见慢性感染的早期治疗。公共卫生相关性：这项研究建议探索压力和免疫功能对美国人口健康差距的贡献。利用几项人口水平调查的经济和生物数据，我们将检验社会经济地位(SES)与慢性感染负担以及对感染的免疫反应之间的关系。我们将测试这些免疫和感染标记物是否与心理社会和经济应激源有关，以及它们是否调节SES和包括死亡率在内的健康结果之间的关系。

DESCRIPTION (provided by applicant): The relationship between socioeconomic status (SES) and health is well established for many health outcomes and in many contexts. Despite the research attention being paid to health inequalities, the physical mechanisms linking SES and health are poorly understood. Lifelong exposure to infections and inflammation has been proposed as an important determinant of mortality. Little is known about the social patterning of multiple chronic infections or immune function in the U.S. population and how these factors may contribute to health disparities. Psychosocial stress has also been proposed as a potential pathway whereby lower SES can harm one's health. There is a large body of research describing a consistent link between psychosocial stress and susceptibility to infection, as well as reduced immune control over existing infections. However, the role that SES may play in immune function via its effects on psychosocial stress is unknown. This project will advance current research on the potential role of infection, immunity and stress in health disparities using several datasets with different strengths. Using data from the National Health and Nutrition Examination Survey (NHANES) III (including confidential mortality data), the Sacramento Area Latino Study of Aging (SALSA), the Chicago Community Adult Health Survey (CCAHS), and the Health and Retirement Survey (HRS), we will first assess whether measures of SES are associated with the burden of chronic infection and immune response in the U.S population. Next, we will examine whether infectious burden and immune response mediate the relationship between SES and health outcomes such as mortality in the U.S. Finally, we will assess whether any relationships between SES and immune function are mediated by markers of psychosocial and economic stressors. We believe this work will fill important gaps in understanding the role that stress and the immune system might play in the interplay of social and biological risks that evolve over the life course to create disparities in disease and mortality. The results from this study may identify novel interventions for biological risk factors, such as the need for targeted vaccination or early treatment of common chronic infections. PUBLIC HEALTH RELEVANCE: This study proposes to explore the contribution of stress and immune function to health disparities in the U.S. population. Using several population level surveys with both economic and biological data, we will test relationships between socioeconomic status (SES) and the burden of chronic infection, as well as immune response to infection. We will test whether these immune and infection markers are related to psychosocial and economic stressors and whether they mediate the relationship between SES and health outcomes including mortality.