Biopsyochosocial Mechanisms of Lupus Progression in African American Women

项目总结 系统性红斑狼疮(SLE)是一种炎症性、自身免疫性疾病， 非裔美国女性的负担比她们的疾病进展更快，结果更差 白人同龄人。越来越多的证据表明，SLE进展中的种族差异在一定程度上是由于 不成比例地暴露在心理社会压力下，以及质量上独特的少数族裔压力来源， 这会加速生理恶化，并可能破坏共同的炎性应激反应途径 参与了SLE的发病机制。心理社会压力的日常体验在老年人的生活中很常见 患有系统性红斑狼疮的非裔美国女性，可能包括管理慢性病固有的压力源，在 除了那些源于社区劣势和贫困的因素之外。非洲裔美国女性也面临着 不同形式的心理社会压力，包括种族歧视和接触其他种族的经历-- 相关的压力源。尽管有现有证据，但系统性红斑狼疮进展中种族差异的机制很差。 明白了。为了解决患有系统性红斑狼疮的非裔美国女性在知识上的这些差距，这项研究旨在 目的：(1)研究种族相关的心理社会压力与疾病活动和 器官损害；(2)考察地区水平的邻里特征和应激源对发病率的影响 SLE进展；以及(3)确定与SLE相关的炎症生物标志物的轨迹，并确定高- 风险亚组。建议分析的数据来自黑人妇女与狼疮的生活经历 (BeWell)研究，这是关于SLE社会流行病学的最大和最全面的研究之一。这个 BeWell研究代表了对丰富的心理社会因素的严格评估，以及对疾病的有效衡量 非洲创新人群样本的结果和客观炎症生物标记物 确诊为系统性红斑狼疮(n=438)的美国妇女居住在佐治亚州亚特兰大市。拟议的研究 将利用BeWell研究的优势并深入了解可能有助于 非裔美国女性的系统性红斑狼疮进展速度不成比例。我们将调查 新的种族相关心理社会应激源对系统性红斑狼疮结局的作用，包括二手性或替代性 暴露在种族主义事件中，微妙的日常轻视或微攻击，以及对经历的预期 种族威胁。多层次分析将考察空间因素的影响，特别是社会经济因素。 劣势和种族居住隔离对SLE结局的影响。炎症的轨迹将是 确定和探索与社会人口、心理和身体健康因素有关的问题。纵向 方法论方法将被用来帮助支持因果推理。培训活动贯穿于整个 拟议的研究金将发展技能并增强进行预期分析所需的知识 并为从事研究工作做好准备。为专业发展和指导提供各种机会 多元化的学者团队将促进这一目标的实现。

PROJECT SUMMARY Systemic lupus erythematous (SLE) is an inflammatory, autoimmune disease that disproportionally burdens African American women with more rapid disease progression and worse outcomes compared to their White counterparts. Increasing evidence suggests racial disparities in SLE progression are due in part to disproportionate exposure to psychosocial stress, as well as qualitatively unique racial minority stressors, which accelerate physiologic deterioration and may undermine shared inflammatory stress-response pathways involved in the pathogenesis of SLE. Routine experiences of psychosocial stress are common in the lives of African American women with SLE and can include stressors inherent with managing a chronic illness, in addition to those stemming from community disadvantage and poverty. African American women also face distinct forms of psychosocial stress, including experiences of racial discrimination and exposure to other race- related stressors. Despite existing evidence, mechanisms for racial disparities in SLE progression are poorly understood. To address these gaps in knowledge among African American women with SLE, this study aims to: (1) examine understudied dimensions of race-related psychosocial stress in relation to disease activity and organ damage; (2) examine the influence of area-level neighborhood characteristics and stressors on rates of SLE progression; and (3) identify trajectories in biomarkers of inflammation relevant to SLE and identify high- risk subgroups. Data for the proposed analyses are from the Black Women's Experiences Living with Lupus (BeWELL) Study, one of the largest and most comprehensive studies on the social epidemiology of SLE. The BeWELL Study represents a rigorous assessment of rich psychosocial factors, validated measures of disease outcomes, and objective inflammatory biomarkers among an innovative population-based sample of African American women with confirmed SLE (n=438) living in metropolitan Atlanta, Georgia. The proposed research will leverage the strengths of the BeWELL Study and yield insight into specific pathways that may contribute to the disproportionate rate of SLE progression experienced by African American women. We will investigate the role of novel race-related psychosocial stressors on SLE outcomes, including “secondhand” or vicarious exposure to racist incidents, subtle everyday slights or microaggressions, and anticipation of experiencing racial threats. Multilevel analyses will examine the influence of spatial factors, specifically socioeconomic disadvantage and racial residential segregation on SLE outcomes. Trajectories in inflammation will be identified and explored in relation to sociodemographic, mental and physical health factors. Longitudinal methodological approaches will be utilized to help support causal inference. Training activities throughout the proposed fellowship will develop skill sets and enhance knowledge needed to conduct the intended analyses and prepare for a career in research. Various opportunities for professional development and mentorship from a diverse team of scholars will facilitate this goal.