The impact of structural racism and discrimination on chronic pain in Black or African American older adults: Biopsychosocial mechanisms

结构性种族主义和歧视对黑人或非裔美国老年人慢性疼痛的影响：生物心理社会机制

• 批准号: 10635199
• 负责人: Elizabeth R Losin
• 金额: $ 77.57万
• 依托单位: UNIVERSITY OF FLORIDA
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-01 至 2028-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10635199
• 关键词: Acceleration; Adult; Adverse effects; Affect; African American; African American population; Aging; Area; Biological; Biological Process; Black American; Black Populations; Black race; Brain; Buffers; Chronic; Chronic disabling pain; Communities; DNA Methylation; Data; Disadvantaged; Discrimination; Elderly; Epigenetic Process; Ethnic Origin; Food; Frequencies; Health; Individual; Intervention; Knowledge; Measures; Mediating; Mediator; Modeling; Movement; Musculoskeletal Diseases; Musculoskeletal Pain; Neighborhoods; Neurobiology; Not Hispanic or Latino; Outcome; Pain; Pain interference; Pathway interactions; Personal Satisfaction; Physical Function; Political Systems; Process; Race; Reduce health disparities; Reporting; Research; Sampling; Severities; Social support; Societies; Socioeconomic Status; Structural Racism; Testing; Underserved Population; United States; Work; biopsychosocial; brain circuitry; chronic musculoskeletal pain; chronic pain; chronic painful condition; clinical pain; deprivation; disability; experience; improved; indexing; innovation; knee pain; marginalized population; neurobiological mechanism; novel; optimism; pain catastrophizing; pain outcome; pain-related disability; perceived discrimination; perceived stress; psychosocial; psychosocial stressors; racial minority population; racial population; racism; residential segregation; resilience; resilience factor; skin color; social; social cohesion; socioeconomic disadvantage; statistics

PROJECT SUMMARY/ABSTRACT In the United States, Black individuals are the group most affected by interpersonal discrimination and struc- tural racism and older Black adults experience a disproportionate burden of chronic-pain and related disability. Accumulating evidence suggests both interpersonal discrimination and structural racism may increase the like- lihood of developing chronic pain and worsen chronic pain outcomes. The psychosocial and neurobiological mechanisms through which structural racism and discrimination adversely affect chronic pain-related out- comes, whether these pathways differ from one another, and what factors may protect against these deleteri- ous effects, remain largely unknown. Understanding these mechanisms is critical to identifying modifiable fac- tors that may serve as actionable intervention targets. Our central hypothesis is that structural racism (racial residential segregation and neighborhood socioeconomic disadvantage) and interpersonal discrimination (di- rect and vicarious) will adversely impact chronic pain-related outcomes via different psychosocial and neurobi- ological pathways. The rationale for this project is that structural racism and discrimination directly impact re- ciprocally interactive biological and psychosocial processes, promoting more rapid progression of musculoskel- etal pain and pain-related disability among Black or African American older adults. The central hypothesis will be tested by three specific aims: 1) Characterize the independent and combined impact of structural racism and discrimination on chronic pain-related outcomes; 2) Test hypothesized pathways of psychosocial and bio- logical mediators whereby structural racism and discrimination influence chronic pain-related outcomes; and 3) Identify resilience factors that may protect against the adverse effects of structural racism and discrimination on pain-related outcomes by either reducing the effects of racism/discrimination on psychosocial stressors, bio- logical mechanisms, or both. Under the first aim, structural racism will be measured using racial residential segregation (neighborhood-level Getis-Ord Gi* statistic) and neighborhood socioeconomic disadvantage (Area Deprivation Index). Experiences of discrimination will include both perceived individual discrimination and vi- carious racism. The research proposed in this application is innovative, because it investigates the individual and combined effects of structural racism and discrimination, examines multiple biopsychosocial mechanisms, and measures individual and community resilience. The proposed research is significant because it is ex- pected to improve understanding of the mechanisms whereby structural racism and discrimination impact mar- ginalized persons with chronic pain. Ultimately, this knowledge has the potential to inform multi-level interven- tions to enhance pain outcomes in racialized and underserved peoples.

项目摘要/摘要 在美国，黑人是受到人际歧视和结构影响最大的群体 术语种族主义和年长的黑人成年人承受着慢性痛苦和相关残疾的负担不成比例的负担。 积累的证据表明，人际歧视和结构性种族主义可能会增加类似 患上慢性疼痛并加剧慢性疼痛结果的精神。社会心理和神经生物学 结构性种族主义和歧视通过不利影响慢性疼痛相关的机制 来了，这些途径是否彼此不同，哪些因素可能会防止这些删除 OUS效应，在很大程度上未知。了解这些机制对于确定可修改的FAC-至关重要 可以用作可行的干预目标的TOR。我们的中心假设是结构性种族主义（种族 住宅隔离和邻里社会经济劣势）和人际歧视（di- 乳房和替代性）将通过不同的社会心理和神经性影响慢性疼痛相关的结果不利 科学途径。该项目的理由是结构性种族主义和歧视直接影响 互动的生物学和社会心理过程，促进肌肉的进展更快 黑人或非裔美国人老年人的eTal疼痛和与疼痛有关的残疾。中心假设将 通过三个特定目的进行测试：1）表征结构种族主义的独立和综合影响 并歧视与慢性疼痛有关的结果； 2）测试假设的社会心理和生物的途径 结构性种族主义和歧视会影响慢性疼痛相关的结果； 3） 确定可以防止结构种族主义和歧视的不利影响的弹性因素 通过降低种族主义/歧视对社会心理压力源的影响，生物 - 逻辑机制，或两者兼而有之。在第一个目标下，将使用种族住宅来衡量结构性种族主义 种族隔离（邻里级别的Getis-ord Gi*统计量）和邻里社会经济劣势（地区 剥夺指数）。歧视的经历将包括感知的个人歧视和VI- 狂热的种族主义。本应用程序中提出的研究具有创新性，因为它研究了个人 以及结构性种族主义和歧视的结合影响，研究多种生物心理社会机制， 并衡量个人和社区的弹性。拟议的研究很重要，因为它是 旨在提高对结构性种族主义和歧视影响机制的理解的理解 慢性疼痛的杂种人。最终，这些知识有可能告知多层次中间 - 为了增加种族和服务不足的民族的痛苦结果。