Barry Declan T, Glenn Corey Pilver, Hoff Rani A, Potenza Marc N
Department of Psychiatry (DTB, RAH, MNP), Yale University School of Medicine; APT Foundation Pain Treatment Services (DTB); Department of Biostatistics (CPG), Yale School of Public Health; Department of Neurobiology (RAH, MNP); Yale Child Study Center (MNP); CASA Columbia, Yale University School of Medicine (MNP); and Connecticut Mental Health Center, New Haven, CT (MNP).
J Addict Med. 2017 Mar/Apr;11(2):98-105. doi: 10.1097/ADM.0000000000000281.
To assess how race might moderate relationships between pain interference and psychopathology, and general medical conditions among a nationally representative sample of black and white adults.
Chi-square tests and multivariable logistic regression analyses were performed on data from the National Epidemiologic Survey on Alcohol and Related Conditions on 32,474 adult respondents (25% black, 75% white), who were categorized according to 1 of 3 levels of pain interference (ie, no/low, moderate, or severe).
Pain interference was associated with race in bivariate analyses (P < .001); relative to white respondents, black respondents had lower rates of no/low pain interference (78.9% vs 80.3%), lower rates of moderate pain interference (6.8% vs 7.8%), and higher rates of severe pain interference (14.3% vs 11.9%). Pain interference was associated with past-year axis I psychiatric disorders in both black and white respondents (P < 0.001) with the largest odds typically observed in association with moderate or severe pain interference. A stronger relationship was observed in black as compared with white respondents between severe pain interference and any axis I disorder (odds ratio [OR] 1.28, P < 0.05) and alcohol abuse or dependence (OR 1.90, P < 0.05), and between moderate pain interference and tachycardia (OR 1.69, P < 0.05). In contrast, a weaker relationship was observed in black as compared with white respondents between moderate pain interference and any general medical condition (OR 0.70, P < 0.05).
These findings underscore the complexity of race-related disparities in health and suggest the importance of further study of the possible mechanisms underlying the apparent differences between black and white groups in the relationships between pain interference, psychopathology, and general medical conditions.
在一个具有全国代表性的黑人和白人成年人样本中,评估种族如何调节疼痛干扰与精神病理学以及一般医疗状况之间的关系。
对来自全国酒精及相关状况流行病学调查的32474名成年受访者(25%为黑人,75%为白人)的数据进行卡方检验和多变量逻辑回归分析,这些受访者根据疼痛干扰的三个级别之一(即无/低、中度或重度)进行分类。
在双变量分析中,疼痛干扰与种族相关(P<0.001);与白人受访者相比,黑人受访者无/低疼痛干扰的发生率较低(78.9%对80.3%),中度疼痛干扰的发生率较低(6.8%对7.8%),重度疼痛干扰的发生率较高(14.3%对11.9%)。在黑人和白人受访者中,疼痛干扰均与过去一年的轴I精神障碍相关(P<0.001),通常在与中度或重度疼痛干扰相关时观察到最大的比值比。与白人受访者相比,黑人受访者中重度疼痛干扰与任何轴I障碍(比值比[OR]1.28,P<0.05)以及酒精滥用或依赖(OR 1.90,P<0.05)之间的关系更强,中度疼痛干扰与心动过速之间的关系也更强(OR 1.69,P<0.05)。相比之下,与白人受访者相比,黑人受访者中中度疼痛干扰与任何一般医疗状况之间的关系较弱(OR 0.70,P<0.05)。
这些发现强调了健康方面种族相关差异的复杂性,并表明进一步研究黑人和白人群体在疼痛干扰、精神病理学和一般医疗状况之间关系中明显差异的潜在机制的重要性。