Division of General Infernal Medicine/Health Services Research, University of California, Los Angeles, 911 Broxton Plaza, Los Angeles, CA 90095, USA.
J Natl Med Assoc. 2012 Jan-Feb;104(1-2):89-95. doi: 10.1016/s0027-9684(15)30120-6.
Black-white disparities in mortality persist after adjustment for socioeconomic status and health behaviors. We examined whether allostatic load, the physiological profile influenced by repeated or chronic life stressors, is associated with black-white mortality disparities independent of traditional sociobehavioral risk factors.
We studied 4515 blacks and whites aged 35 to 64 years from the third National Health and Nutrition Examination Survey (1988-1994), using the linked mortality file, to ascertain participant deaths through 2006. We estimated unadjusted sex-specific black-white disparities in cardiovascular/diabetes-related mortality and noninjury mortality. We constructed baseline allostatic load scores based on 10 biomarkers and examined attenuation of mortality disparities in 4 sets of sex-stratified multivariate models, sequentially adding risk factors: (1) age/clinical conditions, (2) socioeconomic status (SES) variables, (3) health behaviors, and (4) allostatic load.
Blacks had higher allostatic load scores than whites; for men, 2.5 vs 2.1, p < .01; and women, 2.6 vs 1.9, p < .01. For cardiovascular/diabetes-related mortality among women, the magnitude of the disparity after adjustment for other risk factors (hazard ratio [HR], 1.63; 95% confidence interval [CI], 0.96-2.75) decreased after adjustment for allostatic load (HR, 1.15; 95% CI, 0.70-1.88). For noninjury mortality among women, the magnitude of the disparity after adjustment for other risk factors (HR, 1.43; 95% CI, 1.00-2.04) also decreased after adjustment for allostatic load (HR, 1.26; 95% CI, 0.90-1.78). For men, disparities were attenuated but persisted after adjustment for allostatic load.
Allostatic load burden partially explains higher mortality among blacks, independent of SES and health behaviors. These findings underscore the importance of chronic physiologic stressors as a negative influence on the health and lifespan of blacks in the United States.
在调整了社会经济地位和健康行为因素后，黑人和白人之间的死亡率仍存在差异。我们研究了压力源反复或长期作用下形成的生理综合指标——全身适应综合征（allostatic load），是否与传统的社会行为危险因素无关，与黑人和白人的死亡率差异有关。
我们研究了第三次国家健康和营养调查（1988-1994 年）中的 4515 名 35 至 64 岁的黑人和白人，使用链接的死亡率文件，确定参与者在 2006 年之前的死亡情况。我们估计了心血管/糖尿病相关死亡率和非伤害性死亡率的未经调整的性别特异性黑人和白人之间的差异。我们根据 10 种生物标志物构建了基线全身适应综合征评分，并在 4 组性别分层多变量模型中检查了死亡率差异的衰减情况，依次添加了危险因素：（1）年龄/临床情况；（2）社会经济地位（SES）变量；（3）健康行为；（4）全身适应综合征。
与白人相比，黑人的全身适应综合征评分更高；男性为 2.5，白人为 2.1，p<.01；女性为 2.6，白人为 1.9，p<.01。对于女性的心血管/糖尿病相关死亡率，在调整其他风险因素（危险比[HR]，1.63；95%置信区间[CI]，0.96-2.75）后，差异的幅度在调整全身适应综合征（HR，1.15；95%CI，0.70-1.88）后减小。对于女性的非伤害性死亡率，在调整其他风险因素（HR，1.43；95%CI，1.00-2.04）后，差异的幅度在调整全身适应综合征（HR，1.26；95%CI，0.90-1.78）后也减小。对于男性，调整全身适应综合征后，差异虽有所减弱，但仍存在。
全身适应综合征负担部分解释了黑人死亡率较高的原因，与 SES 和健康行为无关。这些发现强调了慢性生理应激源作为美国黑人健康和寿命的负面影响的重要性。
