在欧洲和加纳生活的加纳移民和非移民中，心理社会压力源与慢性肾脏病之间关联的横断面研究：RODAM研究
Cross-sectional study of association between psychosocial stressors with chronic kidney disease among migrant and non-migrant Ghanaians living in Europe and Ghana: the RODAM study.
作者信息
Adjei David Nana, Stronks Karien, Adu Dwomoa, Beune Erik, Meeks Karlijn, Smeeth Liam, Addo Juliet, Owusu-Dabo Ellis, Klipstein-Grobusch Kerstin, Mockenhaupt Frank, Schulze Matthias, Danquah Ina, Spranger Joachim, Bahendeka Silver Karaireho, Agyemang Charles
机构信息
Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, Accra, Ghana.
出版信息
BMJ Open. 2019 Aug 1;9(8):e027931. doi: 10.1136/bmjopen-2018-027931.
OBJECTIVES
The association between psychosocial stressors (PS) and chronic kidney disease (CKD) among sub-Saharan African (SSA) populations is unknown. We examined the association between PS and CKD prevalence among rural and urban Ghanaians and Ghanaian migrants living in three European cities. We also assessed if the influence of PS on CKD is partially mediated by primary risk factors (hypertension and diabetes) of CKD.
DESIGN
A multi-centred cross sectional data from the Research on Obesity and Diabetes among African Migrants study.
SETTING
Rural and urban Ghana and three European cities (Amsterdam, Berlin and London).
PARTICIPANTS
A random sample of 5659 adults (Europe 3167, rural Ghana 1043 and urban Ghana 1449) aged 25-70 years.
EXPLANATORY MEASURES
PS defined by negative life events, perceived discrimination, perceived stress at work/home and depressive symptoms. Three CKD outcomes were considered using the 2012 Kidney Disease: Improving Global Outcomes severity of CKD classification. Comparisons between PS and CKD outcomes were made using logistic regression analyses across all sites.
RESULTS
We observed higher proportion of negative life events (68.7%) and perceived permanent stress (15.9%) among Ghanaians living in Ghana than Ghanaians living in Europe. Depressive symptoms (7.5%) and perceived discrimination (29.7%) were more common among Ghanaians living in Europe than Ghanaians living in Ghana. No significant association was observed between any of the PS constructs and CKD outcomes across sites except for positive association between stress at work/home and albuminuria (2.81, 95% CI 1.46 to 5.40) and CKD risk (2.78, 95% CI 1.43 to 5.43) among Ghanaians living in Berlin.
CONCLUSION
Our study found a positive association between stress at work/home and albuminuria and CKD risk. There was no convincing evidence of associations between the other PS constructs and the prevalence of CKD risk. Further studies are needed to identify potential factors driving the high prevalence of CKD among these populations.
目的
撒哈拉以南非洲（SSA）人群中心理社会压力源（PS）与慢性肾脏病（CKD）之间的关联尚不清楚。我们研究了生活在加纳农村和城市以及居住在欧洲三个城市的加纳移民中PS与CKD患病率之间的关联。我们还评估了PS对CKD的影响是否部分由CKD的主要危险因素（高血压和糖尿病）介导。
设计
来自非洲移民肥胖与糖尿病研究的多中心横断面数据。
地点
加纳农村和城市以及欧洲三个城市（阿姆斯特丹、柏林和伦敦）。
参与者
随机抽取5659名年龄在25至70岁之间的成年人（欧洲3167名、加纳农村1043名和加纳城市1449名）。
解释性指标
PS由负面生活事件、感知到的歧视、工作/家庭中的感知压力和抑郁症状定义。使用2012年《肾脏病：改善全球结局》CKD严重程度分类来考虑三种CKD结局。在所有地点使用逻辑回归分析对PS和CKD结局进行比较。
结果
我们观察到，生活在加纳的加纳人比生活在欧洲的加纳人有更高比例的负面生活事件（68.7%）和感知到的长期压力（15.9%）。生活在欧洲的加纳人比生活在加纳的加纳人更常见抑郁症状（7.5%）和感知到的歧视（29.7%）。除了在柏林生活的加纳人工作/家庭压力与蛋白尿（2.81，95%可信区间1.46至5.40）和CKD风险（2.78，95%可信区间1.43至5.43）之间存在正相关外，各地点的任何PS结构与CKD结局之间均未观察到显著关联。
结论
我们的研究发现工作/家庭压力与蛋白尿和CKD风险之间存在正相关。没有令人信服的证据表明其他PS结构与CKD风险患病率之间存在关联。需要进一步研究以确定导致这些人群中CKD高患病率的潜在因素。
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