Under the Skin: Understanding the Role of Stress and Immune Function in Health Di

描述（由申请人提供）：社会经济地位（SES）与健康之间的关系在许多健康结果和许多环境中都得到了很好的确立。尽管研究关注健康不平等，但人们对社会经济地位与健康之间的物理机制了解甚少。终生接触感染和炎症已被认为是死亡率的一个重要决定因素。人们对美国人群中多种慢性感染或免疫功能的社会模式以及这些因素如何导致健康差异知之甚少。社会心理压力也被认为是社会经济地位较低会损害健康的潜在途径。大量研究描述了社会心理压力与感染易感性之间的一致联系，以及对现有感染的免疫控制减弱。然而，SES可能通过其对社会心理压力的影响在免疫功能中发挥的作用尚不清楚。该项目将利用几个不同强度的数据集，推进目前关于感染、免疫和应激在健康差异中的潜在作用的研究。使用来自国家健康与营养调查（NHANES） III（包括保密死亡率数据）、萨克拉门托地区拉丁裔老龄化研究（SALSA）、芝加哥社区成人健康调查（CCAHS）和健康与退休调查（HRS）的数据，我们将首先评估SES的测量是否与美国人口慢性感染负担和免疫反应相关。接下来，我们将研究感染负担和免疫反应是否介导了社会经济地位和健康结果（如美国的死亡率）之间的关系。最后，我们将评估社会经济地位和免疫功能之间的关系是否由社会心理和经济压力源标记介导。我们相信这项工作将填补理解压力和免疫系统可能在社会和生物风险的相互作用中发挥作用的重要空白，这些风险在生命过程中进化，造成疾病和死亡率的差异。这项研究的结果可能会确定针对生物学风险因素的新干预措施，例如需要有针对性的疫苗接种或对常见慢性感染进行早期治疗。公共卫生相关性：本研究旨在探讨压力和免疫功能对美国人群健康差异的影响。使用几个人口水平调查，包括经济和生物学数据，我们将测试社会经济地位（SES）和慢性感染负担之间的关系，以及对感染的免疫反应。我们将测试这些免疫和感染标记是否与社会心理和经济压力源有关，以及它们是否介导SES与健康结果（包括死亡率）之间的关系。

DESCRIPTION (provided by applicant): The relationship between socioeconomic status (SES) and health is well established for many health outcomes and in many contexts. Despite the research attention being paid to health inequalities, the physical mechanisms linking SES and health are poorly understood. Lifelong exposure to infections and inflammation has been proposed as an important determinant of mortality. Little is known about the social patterning of multiple chronic infections or immune function in the U.S. population and how these factors may contribute to health disparities. Psychosocial stress has also been proposed as a potential pathway whereby lower SES can harm one's health. There is a large body of research describing a consistent link between psychosocial stress and susceptibility to infection, as well as reduced immune control over existing infections. However, the role that SES may play in immune function via its effects on psychosocial stress is unknown. This project will advance current research on the potential role of infection, immunity and stress in health disparities using several datasets with different strengths. Using data from the National Health and Nutrition Examination Survey (NHANES) III (including confidential mortality data), the Sacramento Area Latino Study of Aging (SALSA), the Chicago Community Adult Health Survey (CCAHS), and the Health and Retirement Survey (HRS), we will first assess whether measures of SES are associated with the burden of chronic infection and immune response in the U.S population. Next, we will examine whether infectious burden and immune response mediate the relationship between SES and health outcomes such as mortality in the U.S. Finally, we will assess whether any relationships between SES and immune function are mediated by markers of psychosocial and economic stressors. We believe this work will fill important gaps in understanding the role that stress and the immune system might play in the interplay of social and biological risks that evolve over the life course to create disparities in disease and mortality. The results from this study may identify novel interventions for biological risk factors, such as the need for targeted vaccination or early treatment of common chronic infections. PUBLIC HEALTH RELEVANCE: This study proposes to explore the contribution of stress and immune function to health disparities in the U.S. population. Using several population level surveys with both economic and biological data, we will test relationships between socioeconomic status (SES) and the burden of chronic infection, as well as immune response to infection. We will test whether these immune and infection markers are related to psychosocial and economic stressors and whether they mediate the relationship between SES and health outcomes including mortality.