Psychosocial Factors and Lupus Disease Progression Among African American Women

描述（由申请人提供）：缺乏对系统性红斑狼疮（SLE）的研究，SLE是一种多系统、慢性、自身免疫性疾病，沿着种族和性别方面表现出明显的模式。与白色女性相比，非裔美国女性不仅SLE的患病率更高，而且病情严重程度更高，进展更快，更频繁地受到疾病活动和疾病相关慢性炎症和组织损伤导致的器官损伤和共病状况的影响。SLE并发症和死亡率的种族差异是有据可查的;然而，这些差异的原因知之甚少。为了解决这些知识上的差距，本研究旨在：（1）检查非裔美国妇女所经历的心理社会压力在该人群中SLE恶化中的作用;（2）确定保护或缓冲压力对SLE相关健康下降影响的社会因素和心理资源;以及（3）探讨心理社会应激源和SLE的生物学意义，在细胞水平上与全身炎症升高和加速衰老有关。 患有SLE的非裔美国女性的经历尤其具有挑战性，包括与疾病管理相关的心理社会压力，以及不成比例的更大贫困和生活在弱势社区;此外还有常规压力，如与工作，家庭和关系需求，养育和养育有关的压力。种族歧视的经历是心理社会压力的一个性质独特的来源，增加了现有的日常麻烦。在这项研究中，我们将通过纵向研究设计来研究这些压力因素如何影响SLE的严重程度和进展。我们将收集来自480名非洲裔美国妇女的三波数据，所有这些妇女都患有经验证的SLE。参与者将从格鲁吉亚人组织抗狼疮（GOAL）队列中招募，这是亚特兰大一项真正独一无二的、基于人群的SLE研究，包括来自社会经济阶层各个层次的全方位患者，包括一系列疾病严重程度。我们将研究种族歧视，金融和邻里相关的压力，以及与各种角色压力相关的其他压力源的影响。还将评估潜在的保护因素，包括与种族认同和社会支持有关的因素。我们将收集干血斑（DBS），一种微创替代静脉穿刺，以检查生物失调的指标，我们假设这将受到心理社会压力以及SLE活动的影响。这项研究将是对心理社会压力的多因素性质及其对非裔美国妇女SLE疾病进展的影响的最深入的调查，从而填补了这一未充分研究的疾病的科学空白。这项研究对于促进了解社会环境和心理过程如何影响SLE非裔美国妇女的健康非常重要，也有助于了解这种疾病进展中种族差异的基础。

DESCRIPTION (provided by applicant): 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 o 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 suppor 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.