Racial Discrimination and Risk of Chronic Disease

描述（由申请人提供）：我们提出的研究目的是检验种族歧视与众所周知的慢性疾病的行为、人体测量和生理危险因素的发生有关的假设，并导致美国黑人/白人在健康方面的差异。为了突出2010年国家卫生和健康人研究所消除种族/民族健康差异的关键目标，我们提出的研究解决了明确调查种族歧视与躯体健康之间联系的严格实证研究的缺乏。两份新的国家报告：衡量种族歧视（国家研究委员会，2004年）和不平等待遇：面对医疗保健中的种族和民族差异（医学研究所，2003年）最近强调迫切需要对种族歧视和健康进行可靠的科学研究，两份报告都建议使用多种方法来衡量种族歧视的经历，因为任何一种方法都有其优点和局限性。基于一项新开展的试点研究，我们提出了一项多方法研究，以调查(A)种族歧视的显性和隐性测量，以及(B)代谢综合征和FRAMINGHAM冠心病预测评分中包括的因素：体重指数（BMI）；腰围（WC）；血压;空腹血糖;总胆固醇、高密度脂蛋白、低密度脂蛋白；甘油三酸酯;糖尿病;和吸烟。这些不同的已确定的风险因素与三种主要慢性疾病中的一种或多种有关——心血管疾病、癌症和糖尿病，每种疾病都有黑人/白人差异——这是黑人过早死亡的主要原因。研究人群将包括1000名美国出生的非西班牙裔黑人和白人成年人（每组35- 64,500人）的随机样本，这些人是从马萨诸塞州波士顿社区卫生中心联盟的成员基础中招募的。关于种族歧视的外显数据和内隐数据将分别通过：(1)自我报告，使用Krieger开发的新的心理计量学验证的“歧视经验”工具；(2)内隐联想测试（IAT），一种认知反应时间测量方法，在使用IAT测量种族偏见的基础上获得。在考虑相关协变量的情况下，将使用结构方程模型和其他相关统计方法进行分析，以调查所测量的种族歧视经历是否会导致在选定的健康结果中观察到的种族/族裔差异。拟议项目的公共卫生意义在于，它将提供新的证据，补充关于种族歧视与慢性病风险之间联系的文献不足，并提供与估计种族不平等造成的医疗保健费用有关的初步数据，从而产生关于种族/民族健康差异的新的和需要的数据和见解。

DESCRIPTION (provided by applicant): The purpose of our proposed study is to test the hypothesis that racial discrimination is associated with the occurrence of well-known behavioral, anthropometric, and physiological risk factors for chronic disease and contributes to US black/white disparities in health. Salient to key objectives of the National Institutes of Health and Healthy People 2010 to eliminate racial/ethnic health disparities, our proposed study addresses the paucity of rigorous empirical research explicitly investigating links between racial discrimination and somatic health. Two new national reports: Measuring Racial Discrimination (National Research Council, 2004) and Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare (Institute of Medicine, 2003) have recently emphasized the urgent need for sound scientific research on racial discrimination and health, with both additionally recommending use of multiple methods to measure experiences of racial discrimination, since any one method has its strengths and limitations. BUILDING ON A NEWLY CONDUCTED PILOT STUDY, We accordingly propose a multi-method study to investigate associations between (a) explicit and implicit measures of racial discrimination, AND (B) factors included in the metabolic syndrome AND THE FRAMINGHAM CORONARY HEART DISEASE PREDICTION SCORES: body mass index (BMI); waist circumference (WC); blood pressure; fasting glucose; TOTAL, HDL, and LDL cholesterol; triglycerides; DIABETES; AND SMOKING. These diverse well-established risk factors are relevant to 1 or more of the 3 major chronic diseases ~ cardiovascular disease, CANCER, AND DIABETES, each with black/white disparities - that contribute notably to black excess premature mortality. The study population will consist of a random sample of 1000 US-born non-Hispanic black and white adults (ages 35-64, 500 in each group) recruited from the membership base of a consortium of community-based health centers in Boston, MA. The explicit and implicit data on racial discrimination will be obtained, respectively, by: (1) self-report, using the newly psychometrically-validated "Experiences of Discrimination" instrument developed by Krieger, and (2) an implicit association test (IAT), a cognitive reaction-time measure, building on use of the IAT to measure racial prejudice. Analyses to investigate whether the measured experiences of racial discrimination contribute to observed racial/ethnic disparities in the selected health outcomes will use structural equation modeling and other relevant statistical methods, taking into account relevant covariates. The public health significance of the proposed project is that it will provide novel evidence adding to the scant literature on links between racial discrimination and risk of chronic disease, AND ALSO YIELD preliminary data relevant to estimating the health care costs imposed by racial inequality, thereby generating new and needed data and insights regarding racial/ethnic health disparities.