Udo Tomoko, Grilo Carlos M
Department of Health Policy, Management, and Behavior, School of Public Health, University at Albany, State University of New York, 12144, USA.
Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, USA; Department of Psychology, Yale University, New Haven, CT 06510, USA.
J Psychosom Res. 2017 Sep;100:83-88. doi: 10.1016/j.jpsychores.2017.07.007. Epub 2017 Jul 13.
To date, most research on perceived discrimination and cardiovascular disease (CVD) has examined racial discrimination although other forms of discrimination may also impact physical and mental health. The current study investigated the relationship between three forms of discrimination (weight, race, and gender) and 3-year incidence of CVD in a large national sample of U.S. adults.
26,992 adults (55.5% women) who participated in the 2001-2002 and 2004-2005 National Epidemiologic Survey of Alcohol and Related Conditions (NESARC) were included in this study. Multiple logistic regression analyses were used to calculate odds ratios (OR) and 95% confidence intervals (CI) for three forms of perceived discrimination (simultaneously included in equations after adjusting for relevant potential confounds) for predicting CVD incidence at Wave 2.
Perceived weight and racial discrimination were associated with significantly greater likelihood of reporting myocardial infarction (OR=2.56 [95% CI=1.31-4.98], OR=1.84 [95% CI=1.19-2.84], respectively) and minor heart conditions (OR=1.48 [95% CI=1.11-1.98], OR=1.41 [95% CI=1.18-1.70], respectively). Perceived racial discrimination was also significantly associated with greater likelihood of reporting arteriosclerosis (OR=1.61 [95% CI=1.11-2.34]). Odds ratios for diagnoses of arteriosclerosis, myocardial infarction, and other minor heart disease were largest for individuals reporting multiple forms of discrimination.
Adults who experience weight and racial discrimination, and especially multiple forms of discrimination, may be at heightened risk for CVD. Perceived discrimination may be important to consider during assessment of life stressors by health providers. Future research should address the mechanisms that link discrimination and CVD to assist public health and policy efforts to reduce discrimination.
迄今为止，大多数关于感知到的歧视与心血管疾病（CVD）的研究都考察了种族歧视，尽管其他形式的歧视也可能影响身心健康。本研究调查了美国成年人全国大样本中三种形式的歧视（体重、种族和性别）与CVD三年发病率之间的关系。
本研究纳入了参与2001 - 2002年和2004 - 2005年全国酒精及相关疾病流行病学调查（NESARC）的26992名成年人（55.5%为女性）。采用多元逻辑回归分析来计算三种形式的感知歧视（在调整相关潜在混杂因素后同时纳入方程）预测第2波时CVD发病率的比值比（OR）和95%置信区间（CI）。
感知到的体重和种族歧视与报告心肌梗死的可能性显著增加相关（分别为OR = 2.56 [95% CI = 1.31 - 4.98]，OR = 1.84 [95% CI = 1.19 - 2.84]）以及与轻微心脏疾病相关（分别为OR = 1.48 [95% CI = 1.11 - 1.98]，OR = 1.41 [95% CI = 1.18 - 1.70]）。感知到的种族歧视也与报告动脉硬化的可能性显著增加相关（OR = 1.61 [95% CI = 1.11 - 2.34]）。对于报告多种形式歧视的个体，动脉硬化、心肌梗死和其他轻微心脏病诊断的比值比最大。
经历体重和种族歧视，尤其是多种形式歧视的成年人，可能患CVD的风险更高。在医疗服务提供者评估生活应激源时，感知到的歧视可能是一个重要的考虑因素。未来的研究应探讨将歧视与CVD联系起来的机制，以协助公共卫生和政策方面减少歧视的努力。
