Psychosocial Stress and the Risk of Uterine Fibroids

描述(由申请人提供)：子宫肌瘤(“肌瘤”)引起的严重发病率影响每四到五名生殖生活中的一名妇女。许多女性会经历严重的不适，最终导致子宫切除术，这是一种侵入性的手术。与白人女性相比，非裔美国女性在更年轻的时候和/或患有更大更晚期的肌瘤的风险往往高出2到9倍。这项应用的目的是在随机选择的一组年龄在35岁到49岁之间的绝经前妇女中，检查压力测量和子宫肌瘤风险之间的联系。有关肌瘤的已知危险因素和病因的文献正在减少，研究表明，肌瘤是激素依赖性的。心理社会压力已被证明与女性的肥胖和高血压等心理和身体健康结果有关。有证据表明，压力会导致生殖激素水平的波动，在动物和人类研究中都有报道。中心假设是，肌瘤是由于压力水平增加而导致激素水平上升所致。利用国家环境健康科学研究所子宫肌瘤研究(UFS)的数据，提议进行二次数据分析，以解决四个具体目标：1)描述压力的测量(即心理社会、皮质醇和感知种族主义)；2)检查定性测量(即感知压力和生活事件应激)和子宫肌瘤之间的联系；3)检查尿皮质醇(压力的生物标记物)和子宫肌瘤之间的关联；以及4)使用UFS的辅助研究-感知种族主义研究的数据，检查非裔美国女性中感知到的种族主义和肌瘤风险之间的关系。多重Logistic和多分类回归分析将用于确定与压力相关的子宫肌瘤的风险，同时控制诸如未生育、月经初潮年龄和年龄增加等因素。这项研究意义重大，因为它有望促进和扩大我们对应激如何在体内表现并影响肌瘤发育的理解。这项拟议的研究是一个对妇女健康调查不足的领域，有可能为生殖流行病学提供信息，并提高我们对子宫肌瘤发病机制的理解。

DESCRIPTION (provided by applicant): Significant morbidity due to uterine leiomyomata ("fibroids") affects one of every four to five women in reproductive life. Many women experience severe discomfort that ultimately results in a hysterectomy, an invasive procedure. African American women tend to be at a 2 to 9-fold higher risk of being diagnosed at a younger age and/or with larger more advanced fibroids than white women. The objective of this application is to examine the association between measures of stress and the risk of fibroids among a randomly selected group of premenopausal women between the ages of 35 and 49 years. The literature on known risk factors and the etiology of fibroids is slowing increasing with research suggesting that fibroids are hormonally dependent. Psychosocial stress has been shown to be associated with mental and other physical health outcomes such as obesity and hypertension among women. Evidence of stress causing fluctuations in reproductive hormone levels has been reported in both animal and human studies. The central hypothesis is that fibroids result from an increase in hormone levels as a result of increased levels of stress. Using data from the National Institute of Environmental Health Sciences, Uterine Fibroid Study (UFS), a secondary data analyses is proposed to address four specific aims: 1) Describe the measures of stress (i.e. psychosocial, cortisol, and perceived racism); 2) Examine the association between qualitative measures (i.e. perceived stress and life events stress) psychosocial stress and fibroids; 3) Examine the association between urinary cortisol, a biomarker of stress, and fibroids; and 4) Examine the association between perceived racism and the risk of fibroids among African American women using data from the Perceived Racism Study, an ancillary study to the UFS. Multiple Logistic and Polytomous regression analyses will be used to determine the risk of fibroids associated with stress while controlling for factors such as nulliparity, age at menarche, and increasing age. This research is significant because it is expected to advance and expand our understanding of how stress may manifest in the body and influence fibroid development. The proposed research is an under-investigated area of women's health that has the potential to inform reproductive epidemiology as well as improve our understanding of the pathogenesis of uterine fibroids.