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

心脏病康复中的种族差异：压力和耻辱的作用

基本信息

批准号：
8102893
负责人：
BECCA R LEVY
金额：
$ 59.89万
依托单位：
YALE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2008
资助国家：
美国
起止时间：
2008-07-01 至 2014-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8102893
关键词：
Acute Acute myocardial infarction Address Admission activity Affect African American Age Ageism Autonomic nervous system Belief Blood Pressure Cardiovascular system Categories Chronic Clinical Data Depressed mood Dimensions Discrimination Disease Progression Elderly Equilibrium Event Exposure to Functional disorder Future Glossary Goals Health Health Services Accessibility Heart Heart Rate Hospitals Hour Individual Intervention Label Laboratories Laboratory Finding Lead Literature Measures Mediating Mediator of activation protein Mental Depression Methods Minority Modeling Myocardial Infarction National Heart, Lung, and Blood Institute Nervous system structure Outcome Participant Pathway interactions Performance Persons Physiological Procedures Process Psychological Factors Public Health Race Recovery Recovery of Function Reporting Research Resources Risk Role Sampling Severities Socioeconomic Status Speed Stereotyping Stigmata Stress Time Translating United States National Institutes of Health Variant Walking age group aged base biological adaptation to stress clinical application cognitive function coping cost effective experience health disparity heart rate variability improved longitudinal design member mortality prospective psychologic psychosocial public health relevance racial difference racism response secondary outcome social social stigma stressor theories

项目摘要

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.

描述（由申请人提供）：在急性心肌梗塞（AMI）后，老年非裔美国人的功能恢复往往比同龄白人明显较差，死亡率也更高。在调整了传统上用来解释这种差异的因素（例如社会经济地位和获得医疗保健的机会）后，老年人心血管结局的种族差异仍然存在。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部分是由年龄耻辱和种族耻辱的综合影响来解释的，这两者都会产生压力。根据我们的试点数据、耻辱文献和鲁特的累积风险理论，我们将首次检验以下假设：（1）年龄耻辱感较大的非裔美国人和白人的功能恢复较差；（2）年龄耻辱对非裔美国人功能恢复的有害影响会比白人更大；（3）在非裔美国人中，（a）年龄耻辱和种族耻辱较大的人功能恢复较差，（b）年龄耻辱和种族耻辱会协同作用使功能恢复恶化；（4）自主神经系统（ANS）功能障碍将介导以下过程：（a）年龄耻辱影响非裔美国人和白人的功能恢复，以及（b）种族耻辱影响非裔美国人的功能恢复。拟议研究的次要目的是确定帮助从 AMI 中恢复的老年人应对年龄耻辱和种族耻辱的方法。我们将重点关注可能适合未来干预的应对策略。我们的跨学科团队将采用前瞻性纵向设计，在 AMI 入院后一周内对 200 名年龄在 50 岁及以上的非洲裔美国人和 200 名白人进行评估，并在一个月、四个月、八个月和十二个月后再次评估。功能恢复将通过一段时间内的身体表现进行评估。中介者 ANS 功能障碍将通过 24 小时心率变异性和对实验室压力源的急性反应来测量。次要结局包括抑郁、认知功能和不良心血管事件。相关协变量将包含在分析中，例如年龄、AMI 严重程度和抑郁症。本研究响应 PA-05-029，《健康的社会和文化维度》，因为我们将研究耻辱感的社会结构如何影响 AMI 恢复。此外，该研究符合 NHLBI 解决健康差异的战略，其中包括确定导致对少数群体影响尤为严重的疾病进展的社会心理机制。拟议的研究可能会阐明一种未经探索的机制，使耻辱恶化健康状况。此外，它还可以为未来的干预措施奠定基础，以改善一般老年人，特别是非裔美国老年人的 AMI 康复体验。公共卫生相关性：老年非裔美国人心脏病发作后恢复较差一直是一个持续存在的公共卫生问题。我们希望展示以前未探索过的心理因素与身体因素相结合如何导致非裔美国人和白人康复之间的差异。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，以改善一般老年人，特别是非裔美国老年人的心脏病发作康复。