城市成年人感知歧视与肾功能的纵向变化。
Perceived Discrimination and Longitudinal Change in Kidney Function Among Urban Adults.
机构信息
From the Laboratory of Epidemiology and Population Sciences (Beydoun, Poggi-Burke, Zonderman, Rostant, Evans), National Institute on Aging, National Institutes of Health; Division of Nephrology (Crews), Department of Medicine, Johns Hopkins University School of Medicine; and Welch Center for Prevention (Crews), Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland.
出版信息
Psychosom Med. 2017 Sep;79(7):824-834. doi: 10.1097/PSY.0000000000000478.
OBJECTIVE
Perceived discrimination has been associated with psychosocial distress and adverse health outcomes. We examined associations of perceived discrimination measures with changes in kidney function in a prospective cohort study, the Healthy Aging in Neighborhoods of Diversity across the Life Span.
METHODS
Our study included 1620 participants with preserved baseline kidney function (estimated glomerular filtration rate [eGFR] ≥ 60 mL/min/1.73 m) (662 whites and 958 African Americans, aged 30-64 years). Self-reported perceived racial discrimination and perceived gender discrimination (PGD) and a general measure of experience of discrimination (EOD) ("medium versus low," "high versus low") were examined in relation to baseline, follow-up, and annual rate of change in eGFR using multiple mixed-effects regression (γbase, γrate) and ordinary least square models (γfollow).
RESULTS
Perceived gender discrimination "high versus low PGD" was associated with a lower baseline eGFR in all models (γbase = -3.51 (1.34), p = .009 for total sample). Among white women, high EOD was associated with lower baseline eGFR, an effect that was strengthened in the full model (γbase = -5.86 [2.52], p = .020). Overall, "high versus low" PGD was associated with lower follow-up eGFR (γfollow = -3.03 [1.45], p = .036). Among African American women, both perceived racial discrimination and PGD were linked to lower follow-up kidney function, an effect that was attenuated with covariate adjustment, indicating mediation through health-related, psychosocial, and lifestyle factors. In contrast, EOD was not linked to follow-up eGFR in any of the sex by race groups.
CONCLUSIONS
Perceived racial and gender discrimination are associated with lower kidney function assessed by glomerular filtration rate and the strength of associations differ by sex and race groups. Perceived discrimination deserves further investigation as a psychosocial risk factors for kidney disease.
目的
感知到的歧视与心理社会困扰和不良健康结果有关。我们在一项前瞻性队列研究中检查了感知歧视测量与肾功能变化的关联，该研究称为多样性在整个生命周期中的邻里健康老龄化。
方法
我们的研究包括 1620 名基线肾功能正常的参与者（估计肾小球滤过率[eGFR]≥60 mL/min/1.73 m）（662 名白人和 958 名非裔美国人，年龄 30-64 岁）。使用多混合效应回归（γ base ，γ rate ）和普通最小二乘模型（γ follow ），检查自我报告的感知种族歧视和感知性别歧视（PGD）以及经验歧视的一般衡量标准（EOD）（“中与低”，“高与低”）与 eGFR 的基线，随访和年度变化率之间的关系。
结果
在所有模型中，感知性别歧视“高与低 PGD”与较低的基线 eGFR 相关（γ base =-3.51（1.34），p=0.009 总样本）。在白人女性中，高 EOD 与较低的基线 eGFR 相关，这种影响在全模型中得到加强（γ base =-5.86 [2.52]，p=0.020）。总体而言，“高与低”PGD 与较低的随访 eGFR 相关（γ follow =-3.03 [1.45]，p=0.036）。在非裔美国女性中，感知到的种族歧视和 PGD 都与较低的随访肾脏功能有关，这种影响在进行协变量调整后减弱，表明通过与健康相关的心理社会和生活方式因素进行中介。相比之下，EOD 在任何性别和种族群体中均与随访 eGFR 无关。
结论
感知到的种族和性别歧视与肾小球滤过率评估的肾脏功能降低有关，并且关联的强度因性别和种族群体而异。感知歧视值得进一步研究，作为肾脏疾病的心理社会危险因素。
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