Psychosocial factors and risk of uterine fibroids in black women

描述(申请人提供)：子宫肌瘤(UL)，或肌瘤，是育龄妇女妇科疾病的主要来源，在美国每年造成21亿美元的医疗费用。黑人女性被诊断为UL的可能性是白人女性的2-3倍，而且她们在确诊时患有更严重的疾病。已知的UL危险因素不能解释黑人女性的高发病率。最近的证据表明，应激可能在UL的发生中起到病因学作用。我们建议评估各种心理社会应激源--虐待受害者、不利的社会经济条件、家庭照顾者责任、抑郁症状和自我报告的日常压力--在黑人妇女健康研究(BWHS)中被诊断为UL事件的14年随访(1997-2011年)中的作用，BWHS是一项针对非裔美国女性的大型前瞻性队列研究。我们还将研究应对在缓冲这些影响方面的作用。到目前为止，在一项针对白人女性的研究中，只评估了与UL事件有关的虐待受害情况。因此，这项拟议的研究将为UL的可能原因提供新的数据，这些原因还很少被研究。自1995年BWHS成立以来，参与者每两年接受一次问卷调查，队列保留率一直很高(80%)。BWHS的验证研究表明，自我报告的UL的准确性很高(96%)，各种心理社会测量的重复性很高。在1997-2011年的随访期间，将有超过7,500例UL事件通过超声波或手术诊断出来。大量的事件案例将为实现研究目标提供极好的统计能力，还将允许对特别感兴趣的亚群进行信息丰富的分析，例如35岁以下的妇女(N=3,000例)。UL在黑人女性中的高发病率是一个重要的公共卫生问题。假定会增加风险的心理社会因素(例如，童年虐待、受害和社会经济逆境)在黑人妇女中比白人妇女更普遍。因此，这项拟议的研究将评估与黑人女性特别相关的UL的潜在风险因素。这项研究可以低成本进行，因为跟踪和 数据收集得到其他赠款的支持。确定可改变的风险因素可为初级预防工作提供有用的数据，并可能对疾病的公共卫生负担产生重大影响。

DESCRIPTION (provided by applicant): Uterine leiomyomata (UL), or fibroids, are a major source of gynecologic morbidity among reproductive aged women and account for 2.1 billion dollars in health care costs each year in the United States. Black women are 2-3 times more likely than white women to be diagnosed with UL and they have more severe disease at the time of diagnosis. Known risk factors for UL do not explain the high incidence among black women. Recent evidence suggests that stress may play an etiologic role in UL development. We propose to assess the role of various psychosocial stressors-abuse victimization, adverse socioeconomic conditions, family caregiver responsibilities, depressive symptoms, and self-reported daily stress-in relation to incident UL diagnosed over 14 years of follow-up (1997-2011) in the Black Women's Health Study (BWHS), a large prospective cohort study of African-American women. We will also examine the role of coping in buffering these effects. To date, only abuse victimization has been assessed in relation to incident UL, in a study of white women. Thus, the proposed study will provide novel data on plausible causes of UL that have been little studied. Since the inception of the BWHS in 1995, participants have been followed biennially by questionnaire, and cohort retention has been high (>80%). Validation studies in the BWHS have demonstrated high accuracy of self-reported UL (>96%) and high reproducibility of various psychosocial measures. During follow-up from 1997-2011, more than 7,500 incident cases of UL will have been diagnosed by ultrasound or surgery. The large number of incident cases will provide excellent statistical power to achieve the study aims and will also allow for informative analyses of subgroups of special interest, such as women under age 35 (N=3,000 cases). The high incidence of UL in black women is a problem of public health importance. Psychosocial factors hypothesized to increase risk (e.g., childhood abuse victimization and socioeconomic adversity) are more prevalent in black women than white women. Thus, the proposed study will assess potential risk factors for UL that are of special relevance to black women. The study can be carried out at low cost because follow-up and data collection are supported by other grants. The identification of modifiable risk factors could yield useful data for primary prevention efforts and potentially have a large impact on the public health burden of disease.