Psychosocial factors and risk of uterine fibroids in black women

描述（由申请人提供）：子宫平滑肌瘤（UL）或肌瘤是育龄妇女妇科疾病的主要来源，每年在美国的医疗保健费用中占21亿美元。黑人女性被诊断为UL的可能性是白色女性的2-3倍，并且在诊断时患有更严重的疾病。已知的UL风险因素不能解释黑人女性的高发病率。最近的证据表明，压力可能在UL的发展中发挥病因作用。我们建议评估各种心理社会压力的作用-虐待受害，不利的社会经济条件，家庭照顾者的责任，抑郁症状，和自我报告的日常压力-与事件UL诊断超过14年的后续（1997-2011）在黑人妇女的健康研究（BWHS），一个大型的前瞻性队列研究的非洲裔美国妇女。我们还将研究应对在缓冲这些影响中的作用。到目前为止，在一项对白色妇女的研究中，只评估了与UL事件有关的虐待受害情况。因此，拟议的研究将提供关于UL的合理原因的新数据，这些原因很少被研究。自1995年开始实施出生体重调查以来，每两年对参与者进行一次问卷调查，队列保留率一直很高（>80%）。BWHS的验证研究表明，自我报告的UL（>96%）和各种心理社会措施的高重现性的准确性高。在1997年至2011年的随访期间，将有超过7,500例UL病例通过超声或手术诊断。大量的事件病例将为实现研究目的提供出色的统计功效，并且还将允许对特别关注的亚组进行信息分析，例如35岁以下的女性（N= 3，000例病例）。黑人妇女UL的高发病率是一个具有公共卫生重要性的问题。假设会增加风险的心理社会因素（例如，儿童期虐待受害和社会经济困境）在黑人妇女中比在白色妇女中更为普遍。因此，拟议的研究将评估与黑人妇女特别相关的UL的潜在风险因素。该研究可以以低成本进行，因为随访和 数据收集得到其他赠款的支持。查明可改变的风险因素可以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。 公共卫生相关性：子宫平滑肌瘤或纤维瘤与育龄妇女相当多的妇科疾病发病率相关。非裔美国人子宫肌瘤的发病率是白人的3倍，但种族差异的原因尚不清楚。最近的证据表明，压力在子宫肌瘤的发展中起着重要作用。这项研究的目的是在一项针对非裔美国妇女的大型前瞻性队列研究中调查心理社会压力和子宫肌瘤的风险。

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. PUBLIC HEALTH RELEVANCE: Uterine leiomyomata, or fibroids, are associated with considerable gynecologic morbidity among reproductive aged women. The incidence of uterine fibroids is 3 times higher among African-Americans than among Whites, but reasons for the racial discrepancy are poorly understood. Recent evidence suggests that stress plays a role in uterine fibroid development. The goal of the proposed research is to investigate psychosocial stressors and risk of uterine fibroids in a large prospective cohort study of African-American women.