Johns Hopkins School of Medicine, Division of General Internal Medicine, Baltimore, Maryland, USA.
George Washington University, Milken Institute School of Public Health, Department of Health Policy and Management, Washington, DC, USA.
Am J Hypertens. 2018 Jan 12;31(2):197-204. doi: 10.1093/ajh/hpx164.
Vigilant coping refers to individuals who, potentially as a result of experiencing discrimination in the past, proactively prepare for the possibility that they will be discriminated against or mistreated because of their race. The extent to which vigilant coping is linked with hypertension, a highly prevalent condition with well-documented racial/ethnic disparities, remains largely unknown.
We performed a cross-sectional analysis of data from the Exploring Health Disparities in Integrated Communities (EHDIC) study-Southwest Baltimore (n = 715). We used a series of multivariate logistic regression models to evaluate vigilance as a potential mediator or moderator of the association between race, discrimination, and hypertension within the context of a racially integrated community.
There was no difference in prevalence of hypertension between African-Americans and Whites in this sample (66.8 vs. 66.2; P = 0.86). A higher proportion of African-Americans reported discrimination (41.1 vs. 22.9; P < 0.0001) and vigilance (67.3 vs. 46.9; P < 0.0001) compared to Whites; however, neither measure was associated with hypertension. In stratified analyses, bothersome discrimination alongside vigilant coping was associated with higher odds of hypertension among African-Americans and lower odds among Whites.
Overall, prevalence of hypertension was high and there were no racial differences in this racially integrated community. Discrimination, vigilance, and hypertension were differently associated among African-Americans and Whites. Studying lived experiences in integrated communities may illuminate how structural inequalities impact the health of African-Americans more broadly. Further, raising awareness of social factors as they relate to hypertension may help to inform clinical management of low-income patients.
警惕应对是指个体可能由于过去经历过歧视，因此积极准备应对因为种族而受到歧视或虐待的可能性。警惕应对与高血压（一种高度普遍且具有充分记录的种族/族裔差异的疾病）之间的关联程度在很大程度上仍不清楚。
我们对探索综合社区健康差异（EHDIC）研究-巴尔的摩西南部的数据（n = 715）进行了横断面分析。我们使用一系列多元逻辑回归模型，在种族融合社区的背景下，评估警惕应对作为种族、歧视与高血压之间关联的潜在中介或调节因素。
在该样本中，非裔美国人和白人的高血压患病率没有差异（66.8%与 66.2%；P = 0.86）。与白人相比，非裔美国人报告的歧视（41.1%比 22.9%；P < 0.0001）和警惕应对（67.3%比 46.9%；P < 0.0001）的比例更高；然而，这两个指标都与高血压无关。在分层分析中，与警惕应对相关的令人烦恼的歧视与非裔美国人高血压的几率较高和白人的几率较低相关。
总体而言，高血压的患病率较高，在这个种族融合的社区中，没有种族差异。在非裔美国人和白人中，歧视、警惕应对和高血压之间的关联不同。在融合社区中研究生活经历可以阐明结构性不平等如何更广泛地影响非裔美国人的健康。此外，提高对与高血压相关的社会因素的认识，可能有助于为低收入患者的临床管理提供信息。
