The impact of structural racism and discrimination on chronic pain in Black or African American older adults: Biopsychosocial mechanisms

项目总结/摘要 在美国，黑人是受人际歧视和结构影响最大的群体。 种族主义和老年黑人成年人经历慢性疼痛和相关残疾的不成比例的负担。 越来越多的证据表明，人际歧视和结构性种族主义可能会增加这样的情况- 发展慢性疼痛和恶化慢性疼痛结果的可能性。心理社会学和神经生物学 结构性种族主义和歧视对与慢性疼痛有关的外 来，这些途径是否彼此不同，以及哪些因素可以防止这些删除， 的影响，在很大程度上仍然未知。了解这些机制对于识别可改变的因素至关重要。 可以作为可操作的干预目标。我们的中心假设是，结构性种族主义（种族歧视） 居住隔离和邻里社会经济劣势）和人际歧视（迪- rect和替代）将通过不同的心理和神经生物学对慢性疼痛相关的结果产生不利影响， 逻辑路径这个项目的理由是，结构性种族主义和歧视直接影响到重新安置， ciprocally相互作用的生物和心理社会过程，促进肌肉骨骼的更快发展， 在黑人或非裔美国老年人中埃塔尔和疼痛相关的残疾。核心假设将 通过三个具体目标进行检验：1）描述结构性种族主义的独立和综合影响 和歧视慢性疼痛相关的结果; 2）测试假设的途径，心理和生物- 结构性种族主义和歧视影响慢性疼痛相关结果的逻辑中介;以及3） 查明可防止结构性种族主义和歧视不利影响的复原力因素 减少种族主义/歧视对心理社会压力源的影响， 逻辑机制，或两者兼而有之。在第一个目标下，结构性种族主义将使用种族住宅指数来衡量。 隔离（社区一级Getis-Ord Gi* 统计）和社区社会经济劣势（地区 延迟索引）。歧视的经历将包括感知到的个人歧视和歧视。 残忍的种族主义本申请中提出的研究具有创新性，因为它调查了个人 以及结构性种族主义和歧视的综合影响，审查了多种生物心理社会机制， 并衡量个人和社区的复原力。这项研究意义重大，因为它是前- 预计将增进对结构性种族主义和歧视影响社会的机制的了解， 患有慢性疼痛的ginalized人。最终，这些知识有可能为多层次的干预提供信息， 改善种族化和服务不足人群的疼痛结果。

PROJECT SUMMARY/ABSTRACT In the United States, Black individuals are the group most affected by interpersonal discrimination and struc- tural racism and older Black adults experience a disproportionate burden of chronic-pain and related disability. Accumulating evidence suggests both interpersonal discrimination and structural racism may increase the like- lihood of developing chronic pain and worsen chronic pain outcomes. The psychosocial and neurobiological mechanisms through which structural racism and discrimination adversely affect chronic pain-related out- comes, whether these pathways differ from one another, and what factors may protect against these deleteri- ous effects, remain largely unknown. Understanding these mechanisms is critical to identifying modifiable fac- tors that may serve as actionable intervention targets. Our central hypothesis is that structural racism (racial residential segregation and neighborhood socioeconomic disadvantage) and interpersonal discrimination (di- rect and vicarious) will adversely impact chronic pain-related outcomes via different psychosocial and neurobi- ological pathways. The rationale for this project is that structural racism and discrimination directly impact re- ciprocally interactive biological and psychosocial processes, promoting more rapid progression of musculoskel- etal pain and pain-related disability among Black or African American older adults. The central hypothesis will be tested by three specific aims: 1) Characterize the independent and combined impact of structural racism and discrimination on chronic pain-related outcomes; 2) Test hypothesized pathways of psychosocial and bio- logical mediators whereby structural racism and discrimination influence chronic pain-related outcomes; and 3) Identify resilience factors that may protect against the adverse effects of structural racism and discrimination on pain-related outcomes by either reducing the effects of racism/discrimination on psychosocial stressors, bio- logical mechanisms, or both. Under the first aim, structural racism will be measured using racial residential segregation (neighborhood-level Getis-Ord Gi* statistic) and neighborhood socioeconomic disadvantage (Area Deprivation Index). Experiences of discrimination will include both perceived individual discrimination and vi- carious racism. The research proposed in this application is innovative, because it investigates the individual and combined effects of structural racism and discrimination, examines multiple biopsychosocial mechanisms, and measures individual and community resilience. The proposed research is significant because it is ex- pected to improve understanding of the mechanisms whereby structural racism and discrimination impact mar- ginalized persons with chronic pain. Ultimately, this knowledge has the potential to inform multi-level interven- tions to enhance pain outcomes in racialized and underserved peoples.