Racial Disparities in Heart Attack Recovery: Role of Stress and Stigma

心脏病康复中的种族差异：压力和耻辱的作用

• 批准号: 7880003
• 负责人: BECCA R LEVY
• 金额: $ 77.13万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-07-01 至 2012-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7880003
• 关键词: Acute; Acute myocardial infarction; Address; Admission activity; Affect; African American; Age; Ageism; Autonomic nervous system; Belief; Blood Pressure; Cardiovascular system; Categories; Chronic; Clinical; Data; Depressed mood; Dimensions; Discrimination; Disease Progression; Elderly; Equilibrium; Event; Exposure to; Functional disorder; Future; Glossary; Goals; Health; Health Services Accessibility; Heart; Heart Rate; Hospitals; Hour; Individual; Intervention; Label; Laboratories; Laboratory Finding; Lead; Literature; Measures; Mediating; Mediator of activation protein; Mental Depression; Methods; Minority; Modeling; Myocardial Infarction; National Heart, Lung, and Blood Institute; Nervous system structure; Outcome; Participant; Pathway interactions; Performance; Persons; Physiological; Procedures; Process; Psychological Factors; Public Health; Race; Recovery; Recovery of Function; Reporting; Research; Resources; Risk; Role; Sampling; Severities; Socioeconomic Status; Speed; Stereotyping; Stigmata; Stress; Time; Translating; United States; United States National Institutes of Health; Variant; Walking; age group; aged; base; biological adaptation to stress; clinical application; cognitive function; coping; cost; experience; health disparity; heart rate variability; improved; longitudinal design; member; mortality; prospective; psychologic; psychosocial; public health relevance; racial difference; racism; response; secondary outcome; social; social stigma; stressor; theories; Acute; Acute myocardial infarction; Address; Admission activity; Affect; African American; Age; Ageism; Autonomic nervous system; Belief; Blood Pressure; Cardiovascular system; Categories; Chronic; Clinical; Data; Depressed mood; Dimensions; Discrimination; Disease Progression; Elderly; Equilibrium; Event; Exposure to; Functional disorder; Future; Glossary; Goals; Health; Health Services Accessibility; Heart; Heart Rate; Hospitals; Hour; Individual; Intervention; Label; Laboratories; Laboratory Finding; Lead; Literature; Measures; Mediating; Mediator of activation protein; Mental Depression; Methods; Minority; Modeling; Myocardial Infarction; National Heart, Lung, and Blood Institute; Nervous system structure; Outcome; Participant; Pathway interactions; Performance; Persons; Physiological; Procedures; Process; Psychological Factors; Public Health; Race; Recovery; Recovery of Function; Reporting; Research; Resources; Risk; Role; Sampling; Severities; Socioeconomic Status; Speed; Stereotyping; Stigmata; Stress; Time; Translating; United States; United States National Institutes of Health; Variant; Walking; age group; aged; base; biological adaptation to stress; clinical application; cognitive function; coping; cost; experience; health disparity; heart rate variability; improved; longitudinal design; member; mortality; prospective; psychologic; psychosocial; public health relevance; racial difference; racism; response; secondary outcome; social; social stigma; stressor; theories

DESCRIPTION (provided by applicant): Following an acute myocardial infarction (AMI), older African Americans tend to have significantly worse functional recovery and higher mortality rates than same-aged Whites. Race differences in older individuals' cardiovascular outcomes remain after adjusting for factors that traditionally have been used to explain this disparity, such as socioeconomic status and access to health care. Our overall goal is to examine whether this racial disparity in older individuals' AMI-recovery outcomes is partially explained by the combined influence of age stigma and race stigma, both of which can generate stress. Based on our pilot data, the stigma literature, and Rutter's theory of cumulative risk, we will examine the following hypotheses for the first time: (1) African Americans and Whites with greater age stigma will have worse functional recovery; (2) Age stigma's deleterious influence on functional recovery will be greater among African Americans than Whites; (3) Among African Americans, (a) those with greater age stigma and race stigma will have worse functional recovery, and (b) age stigma and race stigma will act in a synergistic way to worsen functional recovery; and (4) Autonomic nervous system (ANS) dysfunction will mediate the process by which (a) age stigma impacts the functional recovery of African Americans and Whites, and (b) race stigma impacts the functional recovery of African Americans. The secondary aim of the proposed study is to identify methods to help older persons recovering from an AMI cope with age stigma and race stigma. We will focus on coping strategies that may be amenable to future interventions. Using a prospective, longitudinal design, our interdisciplinary team will assess 200 African Americans and 200 Whites, aged 50 and over, within a week of hospital admission following an AMI, and assess them again one month, four months, eight months, and twelve months later. Functional recovery will be assessed by physical performance over time. The mediator, ANS dysfunction, will be measured by 24-hour heart-rate variability and acute response to laboratory stressors. Secondary outcomes consist of depression, cognitive functioning, and adverse cardiovascular events. Relevant covariates will be included in analyses, such as age, AMI severity, and depression. This study is responsive to PA-05-029, Societal and Cultural Dimensions of Health, because we will examine how the societal construct of stigma influences AMI recovery. Additionally, the study fits the NHLBI Strategy for Addressing Health Disparities which includes identifying psychosocial mechanisms that contribute to the progression of diseases that disproportionately affect minorities. The proposed research could illuminate an unexplored mechanism that enable stigmas to worsen health. In addition, it could lay the groundwork for future interventions to improve the AMI-recovery experience of older persons in general and African American older persons in particular. Public Health Relevance: The worse recovery of older African Americans following a heart attack has been a persistent public-health problem. We expect to show how a previously unexplored psychological factor, in combination with a physical factor, contributes to the disparity between African American and White recovery. Further, our research could lay the groundwork for future cost-effective procedures to improve heart attack recovery of older persons in general and African American older persons in particular.

描述（由申请人提供）：急性心肌梗塞（AMI）之后，年龄较大的非洲裔美国人的功能恢复明显较差，而死亡率则比同期白人更高。调整传统上用于解释这种差异的因素，例如社会经济状况和获得医疗保健的差异，在调整了传统上用来解释这种差异的因素后，还保留了年龄较大的心血管结局的种族差异。我们的总体目标是检查老年人的AMI恢复结果中这种种族差异是否由年龄污名和种族污名的综合影响来部分解释，这两者都会产生压力。 根据我们的试点数据，污名文献以及Rutter的累积风险理论，我们将首次研究以下假设：（1）年龄更高的非洲裔美国人和白人的功能恢复较差； （2）年龄的污名对非裔美国人的有害影响力将比白人更大； （3）在非裔美国人中，（a）那些年龄更高和种族污名的人的功能恢复较差，（b）年龄的污名和种族污名将以协同的方式行动，以使功能恢复恶化； （4）自主神经系统（ANS）功能障碍将介导（a）年龄污名会影响非裔美国人和白人的功能恢复，以及（b）种族污名会影响非裔美国人的功能恢复。 拟议的研究的次要目的是确定帮助老年人从AMI应对年龄污名和种族污名中恢复的方法。我们将专注于应对可能未来干预措施的策略。 使用前瞻性的纵向设计，我们的跨学科团队将在AMI后一周内评估200名非洲裔美国人和200名50岁及50岁的白人，并在一个月，四个月，八个月和十二个月后再次对其进行评估。随着时间的推移，功能恢复将通过身体表现评估。调解人ANS功能障碍将通过24小时心率的变异性和对实验室压力源的急性反应来衡量。次要结果包括抑郁，认知功能和不良心血管事件。相关的协变量将包括在年龄，AMI严重程度和抑郁等分析中。 这项研究对PA-05-029的响应敏感，即健康的社会和文化维度，因为我们将研究污名的社会结构如何影响AMI恢复。此外，该研究适合解决健康差异的NHLBI策略，其中包括确定有助于对少数群体影响不成比例的疾病进展的社会心理机制。拟议的研究可能会阐明一种未开发的机制，使污名化恶化。此外，它可以为将来的干预措施奠定基础，以改善一般年龄和非裔美国人老年人的AMI恢复经验。 公共卫生相关性：心脏病发作后年长的非洲裔美国人的康复率更高，这是一个持续的公共卫生问题。我们期望展示以前未开发的心理因素与身体因素结合在一起，有助于非裔美国人和白人恢复之间的差异。此外，我们的研究可以为未来的成本效益的程序奠定基础，以改善一般和非裔美国人老年人的心脏病发作恢复。