Racial Disparities in Heart Attack Recovery: Role of Stress and Stigma

描述（由申请人提供）：急性心肌梗死（AMI）后，老年非裔美国人的功能恢复明显较差，死亡率高于同龄白人。在调整传统上用于解释这种差异的因素后，老年人心血管结局的种族差异仍然存在，例如社会经济地位和获得医疗保健的机会。我们的总体目标是研究老年人AMI恢复结果中的种族差异是否可以部分解释为年龄耻辱和种族耻辱的综合影响，这两者都可以产生压力。 基于我们的试点数据、污名文献和Rutter的累积风险理论，我们将首次检验以下假设：（1）具有更大年龄污名的非裔美国人和白人的功能恢复更差;（2）年龄污名对非裔美国人功能恢复的有害影响比白人更大;（3）在非裔美国人中，（a）年龄污名和种族污名越大，功能恢复越差，（B）年龄污名和种族污名会协同作用，恶化功能恢复;（4）自主神经系统（ANS）功能障碍将介导（a）年龄污名影响非裔美国人和白人的功能恢复和（B）种族污名影响非裔美国人的功能恢复的过程。 拟议研究的第二个目的是确定方法，以帮助老年人从急性心肌梗死恢复科普年龄歧视和种族歧视。我们将侧重于可能适合未来干预措施的应对战略。 采用前瞻性纵向设计，我们的跨学科团队将评估200名非裔美国人和200名白人，年龄在50岁及以上，在AMI后入院一周内，并在一个月，四个月，八个月和十二个月后再次评估他们。功能恢复将通过随时间推移的身体表现进行评估。将通过24小时心率变异性和对实验室应激源的急性反应来测量介导剂ANS功能障碍。次要结局包括抑郁、认知功能和不良心血管事件。相关协变量将纳入分析，如年龄、AMI严重程度和抑郁。 本研究响应PA-05-029，健康的社会和文化维度，因为我们将研究污名的社会结构如何影响AMI的恢复。此外，该研究符合NHLBI解决健康差距的战略，其中包括确定有助于不成比例地影响少数群体的疾病进展的心理社会机制。这项拟议中的研究可以阐明一种未被探索的机制，使耻辱恶化健康。此外，它可以为今后的干预措施奠定基础，以改善一般老年人，特别是非洲裔美国老年人的急性心肌梗死康复经验。 公共卫生相关性：老年非裔美国人在心脏病发作后恢复较差一直是一个持续的公共卫生问题。我们希望展示一个以前未被探索的心理因素，结合身体因素，有助于非洲裔美国人和白色恢复之间的差距。此外，我们的研究可以为未来具有成本效益的程序奠定基础，以改善老年人，特别是非洲裔美国老年人的心脏病发作恢复。

DESCRIPTION (provided by applicant): Following an acute myocardial infarction (AMI), older African Americans tend to have significantly worse functional recovery and higher mortality rates than same-aged Whites. Race differences in older individuals' cardiovascular outcomes remain after adjusting for factors that traditionally have been used to explain this disparity, such as socioeconomic status and access to health care. Our overall goal is to examine whether this racial disparity in older individuals' AMI-recovery outcomes is partially explained by the combined influence of age stigma and race stigma, both of which can generate stress. Based on our pilot data, the stigma literature, and Rutter's theory of cumulative risk, we will examine the following hypotheses for the first time: (1) African Americans and Whites with greater age stigma will have worse functional recovery; (2) Age stigma's deleterious influence on functional recovery will be greater among African Americans than Whites; (3) Among African Americans, (a) those with greater age stigma and race stigma will have worse functional recovery, and (b) age stigma and race stigma will act in a synergistic way to worsen functional recovery; and (4) Autonomic nervous system (ANS) dysfunction will mediate the process by which (a) age stigma impacts the functional recovery of African Americans and Whites, and (b) race stigma impacts the functional recovery of African Americans. The secondary aim of the proposed study is to identify methods to help older persons recovering from an AMI cope with age stigma and race stigma. We will focus on coping strategies that may be amenable to future interventions. Using a prospective, longitudinal design, our interdisciplinary team will assess 200 African Americans and 200 Whites, aged 50 and over, within a week of hospital admission following an AMI, and assess them again one month, four months, eight months, and twelve months later. Functional recovery will be assessed by physical performance over time. The mediator, ANS dysfunction, will be measured by 24-hour heart-rate variability and acute response to laboratory stressors. Secondary outcomes consist of depression, cognitive functioning, and adverse cardiovascular events. Relevant covariates will be included in analyses, such as age, AMI severity, and depression. This study is responsive to PA-05-029, Societal and Cultural Dimensions of Health, because we will examine how the societal construct of stigma influences AMI recovery. Additionally, the study fits the NHLBI Strategy for Addressing Health Disparities which includes identifying psychosocial mechanisms that contribute to the progression of diseases that disproportionately affect minorities. The proposed research could illuminate an unexplored mechanism that enable stigmas to worsen health. In addition, it could lay the groundwork for future interventions to improve the AMI-recovery experience of older persons in general and African American older persons in particular. Public Health Relevance: The worse recovery of older African Americans following a heart attack has been a persistent public-health problem. We expect to show how a previously unexplored psychological factor, in combination with a physical factor, contributes to the disparity between African American and White recovery. Further, our research could lay the groundwork for future cost-effective procedures to improve heart attack recovery of older persons in general and African American older persons in particular.