Psychosocial Factors and Lupus Disease Progression Among African American Women

项目摘要/摘要 系统性红斑狼疮(SLE)是一种多系统、慢性、 一种自身免疫性疾病，表现出明显的种族和性别特征。非裔美国女性不是 不仅系统性红斑狼疮的患病率更高，而且与之相比，病情更严重，进展更快 对于他们的白人同行，更频繁地受到器官损伤和合并症的影响 作为疾病活动和与疾病相关的慢性炎症和组织损伤的结果出现。 系统性红斑狼疮并发症和死亡率方面的种族差异是有据可查的；然而，这些差异的原因 人们对差异知之甚少。为了解决这些知识上的差距，本研究旨在：(1)考察 非裔美国女性经历的心理社会压力在加剧SLE方面 人口；(2)确定具有保护或缓冲作用的社会因素和心理资源 应激对系统性红斑狼疮相关健康的影响；以及(3)探讨心理社会应激源和 系统性红斑狼疮，与全身炎症加剧和细胞水平的衰老加速有关。 患有系统性红斑狼疮的非裔美国女性的经历尤其具有挑战性，包括 与疾病管理有关的心理社会压力源，以及不成比例的更大的贫困和生活 在弱势社区；除了与工作、家庭和 关系需求、育儿和照顾。种族歧视经历构成了一种定性的 心理社会压力的独特来源，增加了现有的日常麻烦。在这项研究中，我们将研究如何 这些应激源通过纵向研究设计影响系统性红斑狼疮的严重程度和进展。我们将收集三个 来自480名非裔美国女性的一波又一波数据，她们都患有经过验证的系统性红斑狼疮。参赛者将从 格鲁吉亚人组织起来反对狼疮(GOAL)队列，这是一项真正独一无二的、以人群为基础的SLE研究 亚特兰大，包括来自社会经济阶层的所有患者，涉及一系列疾病 严肃性。我们将研究种族歧视、金融和邻里关系紧张的影响，以及 其他与各种角色压力相关的压力源。潜在的保护因素，包括与种族有关的因素 身份认同和社会支持，也将进行评估。我们将收集干血斑(DBS)，一种微创的 静脉穿刺术的替代方案，以检查生物调节失调的指标，我们假设 受心理社会压力和SLE活动的影响。这项研究将是对 心理社会应激源的多因素性质及其对非洲SLE疾病进展的影响 从而填补了这种未被充分研究的疾病的科学空白。这项研究是 在增进对社会环境和心理过程的各个方面的了解方面很重要 影响患有系统性红斑狼疮的非裔美国女性的健康，并有助于了解 在这种疾病的发展过程中，种族差异的基础。

PROJECT SUMMARY/ABSTRACT There is a lack of research on systematic lupus erythematosus (SLE), a multisystem, chronic, autoimmune disease that shows clear patterns along racial and gender lines. African American women not only have a greater prevalence of SLE, but also experience greater severity and faster progression compared to their White counterparts, being more frequently affected by organ damage and comorbid conditions that emerge as a consequence of disease activity and disease-related chronic inflammation and tissue damage. Racial disparities in SLE complications and mortality are well documented; however, the reasons for these disparities are poorly understood. To address these gaps in knowledge, this study aims to: (1) examine the role that psychosocial stressors experienced by African American women have in exacerbating SLE in this population; (2) identify social factors and psychological resources that are protective or buffer the effects of stress on SLE-related health declines; and (3) explore the biological implications of psychosocial stressors and SLE, in relation to elevated systemic inflammation and accelerated aging at the cellular level. The experiences of African American women with SLE are particularly challenging, and include psychosocial stressors related to disease management, as well as disproportionately greater poverty and living in disadvantaged communities; in addition to routine stressors such as those associated with work, family and relationship demands, parenting, and caregiving. Experiences of racial discrimination constitute a qualitatively distinct source of psychosocial stress, adding to existing everyday hassles. In this study, we will examine how these stressors impact SLE severity and progression through a longitudinal study design. We will collect three waves of data from 480 African American women, all with validated SLE. Participants will be recruited from the Georgians Organized Against Lupus (GOAL) cohort, a truly one-of-a-kind, population-based study of SLE in Atlanta, including a full spectrum of patients from all levels of socioeconomic strata, across a range of disease severity. We will examine the effects of racial discrimination, financial and neighborhood-related strains, and other stressors associated with various role strains. Potential protective factors, including those related to racial identity and social support, will also be assessed. We will collect dried blood spots (DBS), a minimally invasive alternative to venipuncture, to examine indicators of biological dysregulation which we hypothesize will be impacted by psychosocial stress as well as SLE activity. This study will be the most in-depth investigation of the multifactorial nature of psychosocial stressors and their impact on SLE disease progression among African American women, and thus fills an important gap in the science on this understudied disease. This research is important in advancing knowledge of how aspects of the social environment and psychological processes impact health among African American women with SLE, and also contributes to scientific knowledge on the underpinnings of racial disparities in the progression of this disease.