Psychosocial Factors and Lupus Disease Progression Among African American Women

描述(申请人提供)：缺乏对系统性红斑狼疮(SLE)的研究，系统性红斑狼疮是一种多系统、慢性、自身免疫性疾病，显示出明显的种族和性别特征。非裔美国女性不仅系统性红斑狼疮的患病率更高，而且与白人女性相比，她们的病情更严重，进展更快，更容易受到器官损伤和由于疾病活动以及与疾病相关的慢性炎症和组织损伤而出现的合并症的影响。系统性红斑狼疮并发症和死亡率方面的种族差异有很好的文献记载；然而，造成这些差异的原因却知之甚少。为了解决这些认识上的差距，这项研究的目的是：(1)检查非裔美国女性经历的心理社会应激源在这一人群中加剧SLE的作用；(2)确定保护或缓冲压力对SLE相关健康下降的影响的社会因素和心理资源；以及(3)探索心理社会应激源和SLE在细胞水平上与升高的全身炎症和加速衰老有关的生物学影响。患有系统性红斑狼疮的非裔美国妇女的经历尤其具有挑战性，包括与疾病管理有关的心理社会压力源，以及不成比例的更严重的贫困和生活在弱势社区；除了与工作、家庭和关系需求、育儿和照料有关的常规压力源。种族歧视的经历构成了心理社会压力的一个本质上不同的来源，再加上现有的日常麻烦。在这项研究中，我们将通过一项纵向研究设计来检验这些应激源如何影响SLE的严重程度和进展。我们将收集480名非裔美国女性的三波数据，她们都患有经过验证的系统性红斑狼疮。参与者将从佐治亚州组织的反对狼疮(GOAL)队列中招募，这是一项真正独一无二的、以人群为基础的亚特兰大系统性红斑狼疮研究，包括来自不同社会经济阶层、各种疾病严重程度的全方位患者。我们将研究种族歧视、经济和邻里关系紧张以及其他与各种角色紧张相关的压力源的影响。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)，这是静脉穿刺术的一种微创替代方法，以检查生物调节失调的指标，我们假设这些指标将受到心理社会压力和SLE活动的影响。这项研究将是对心理社会应激源的多因素性质及其对非裔美国女性SLE疾病进展的影响的最深入调查，从而填补了关于这种未被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的各个方面如何影响患有SLE的非裔美国妇女的健康具有重要意义，也有助于促进关于这种疾病发展过程中种族差异基础的科学知识。

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.