Wise Lauren A, Palmer Julie R, Cozier Yvette C, Hunt Matthew O, Stewart Elizabeth A, Rosenberg Lynn
Slone Epidemiology Center, Boston University, Boston, MA 02215, USA.
Epidemiology. 2007 Nov;18(6):747-57. doi: 10.1097/EDE.0b013e3181567e92.
The incidence of uterine leiomyomata (fibroids, myomas) is 2-3 times higher in black women than white women. Black women also report higher levels of racial discrimination. We evaluated the hypothesis that greater exposure to racism increases myoma risk in black women.
Data were derived from the Black Women's Health Study, a prospective cohort study of US black women age 21-69 years in 1995. In 1997, women reported on "everyday" and "lifetime" experiences of racism. From 1997 through 2003, we followed 22,002 premenopausal women to assess the association between self-reported racism and risk of myomas. Incidence rate ratios (IRRs) and 95% confidence intervals (CIs) were estimated from Cox regression models.
During 107,127 person-years of follow-up, 3440 new cases of uterine myomas confirmed by ultrasound (n = 2774) or surgery (n = 666) were reported. All IRRs for "lifetime" and "everyday" experiences of racism were above 1.0. Using a summary variable that averaged the responses from 5 "everyday" racism items, multivariable IRRs comparing quartiles 2, 3, and 4 to quintile 1 (lowest) were 1.16 (95% CI = 1.04-1.29), 1.19 (1.06-1.32), and 1.27 (1.14-1.43), respectively. Multivariable IRRs comparing women who reported 1, 2, or 3 lifetime occurrences of major discrimination (ie, job, housing, or police) relative to those who reported none were 1.04 (0.96-1.13), 1.17 (1.07-1.28), and 1.24 (1.10-1.39), respectively. Results did not vary according to case definition (ultrasound vs. surgery) or health care utilization. Associations were weaker among foreign-born women and among women with higher coping skills.
Perceived racism was associated with an increased risk of uterine myomas in US-born black women.
黑人女性子宫平滑肌瘤（纤维瘤、肌瘤）的发病率比白人女性高2至3倍。黑人女性报告的种族歧视程度也更高。我们评估了一个假设，即更多地遭受种族主义会增加黑人女性患肌瘤的风险。
数据来源于黑人女性健康研究，这是一项对1995年年龄在21至69岁的美国黑人女性进行的前瞻性队列研究。1997年，女性报告了种族主义的“日常”和“一生”经历。从1997年到2003年，我们对22,002名绝经前女性进行随访，以评估自我报告的种族主义与肌瘤风险之间的关联。发病率比（IRR）和95%置信区间（CI）通过Cox回归模型进行估计。
在107,127人年的随访期间，报告了3440例经超声（n = 2774）或手术（n = 666）确诊的子宫肌瘤新病例。种族主义“一生”和“日常”经历的所有IRR均高于1.0。使用一个汇总变量，该变量对5个“日常”种族主义项目的回答进行平均，将第2、3和4四分位数与第1五分位数（最低）进行比较的多变量IRR分别为1.16（95%CI = 1.04 - 1.29）、1.19（1.06 - 1.32）和1.27（1.14 - 1.43）。将报告有1次、2次或3次一生主要歧视事件（即工作、住房或警察方面）的女性与报告没有此类事件的女性进行比较的多变量IRR分别为1.04（0.96 - 1.13）、1.17（1.07 - 1.28）和1.24（1.10 - 1.39）。结果根据病例定义（超声与手术）或医疗保健利用情况没有差异。在外国出生的女性和应对技能较高的女性中，关联较弱。
在美国出生的黑人女性中，感知到的种族主义与子宫肌瘤风险增加有关。
