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

结构性种族主义和歧视对黑人或非裔美国老年人慢性疼痛的影响：生物心理社会机制

• 批准号: 10635199
• 负责人: Elizabeth R Losin
• 金额: $ 77.57万
• 依托单位: UNIVERSITY OF FLORIDA
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-01 至 2028-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10635199
• 关键词: Acceleration; Adult; Adverse effects; Affect; African American; African American population; Aging; Area; Biological; Biological Process; Black American; Black Populations; Black race; Brain; Buffers; Chronic; Chronic disabling pain; Communities; DNA Methylation; Data; Disadvantaged; Discrimination; Elderly; Epigenetic Process; Ethnic Origin; Food; Frequencies; Health; Individual; Intervention; Knowledge; Measures; Mediating; Mediator; Modeling; Movement; Musculoskeletal Diseases; Musculoskeletal Pain; Neighborhoods; Neurobiology; Not Hispanic or Latino; Outcome; Pain; Pain interference; Pathway interactions; Personal Satisfaction; Physical Function; Political Systems; Process; Race; Reduce health disparities; Reporting; Research; Sampling; Severities; Social support; Societies; Socioeconomic Status; Structural Racism; Testing; Underserved Population; United States; Work; biopsychosocial; brain circuitry; chronic musculoskeletal pain; chronic pain; chronic painful condition; clinical pain; deprivation; disability; experience; improved; indexing; innovation; knee pain; marginalized population; neurobiological mechanism; novel; optimism; pain catastrophizing; pain outcome; pain-related disability; perceived discrimination; perceived stress; psychosocial; psychosocial stressors; racial minority population; racial population; racism; residential segregation; resilience; resilience factor; skin color; social; social cohesion; socioeconomic disadvantage; statistics

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.

项目摘要/摘要 在美国，黑人个人是受人际歧视和结构影响最大的群体。 文化种族主义和老年黑人成年人承受着不成比例的慢性疼痛和相关残疾的负担。 越来越多的证据表明，人际歧视和结构性种族主义都可能增加类似的-- 可能会发展成慢性疼痛，并使慢性疼痛的结果恶化。心理社会和神经生物学 结构性种族主义和歧视对慢性疼痛相关输出产生不利影响的机制-- 来了，这些途径是否彼此不同，以及哪些因素可以防止这些有害因素- 我们的影响，在很大程度上仍是未知的。了解这些机制对于确定可修改的面至关重要。 可以作为可操作的干预目标的TORS。我们的中心假设是结构性种族主义(种族 居住隔离和邻里社会经济劣势)和人际歧视(双亲) 直肠和代谢性)将通过不同的心理社会和神经障碍对慢性疼痛相关的结局产生不利影响。 生理路径。这一项目的理由是结构性种族主义和歧视直接影响到 循环互动的生物和心理社会过程，促进肌肉松弛的更快进展- 黑人或非裔美国老年人的疼痛和与疼痛相关的残疾。中心假说将 通过三个具体目标进行检验：1)确定结构性种族主义的独立和综合影响 和对慢性疼痛相关结果的辨别；2)测试假设的心理社会和生物路径- 结构性种族主义和歧视影响慢性疼痛相关结果的逻辑调解人；以及3) 确定可防止结构性种族主义和歧视的不利影响的复原力因素 通过减少种族主义/歧视对心理社会应激源的影响，生物-- 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居住地来衡量 隔离(邻居级Getis-Ord Gi*统计)和邻里社会经济劣势(面积 剥夺指数)。受歧视的经历将包括感知到的个人歧视和 令人发指的种族主义。这项申请中提出的研究是创新的，因为它调查了个人 和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。这项拟议的研究具有重要意义，因为它以前是 预期将增进对结构性种族主义和歧视影响损害的机制的了解 有慢性疼痛的患者。最终，这些知识有可能为多层次的干预提供信息- 在种族主义和未得到充分服务的人民中改善疼痛结果的行动。