Department of Data Science, John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson, Mississippi, USA
Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA.
J Investig Med. 2021 Feb;69(2):382-387. doi: 10.1136/jim-2020-001510. Epub 2020 Dec 17.
African Americans (AAs) are disproportionately affected by kidney disease and also report higher psychosocial stressors than other racial groups. Goal-striving stress (GSS) is an understudied psychosocial stressor related to attempting to accomplish one's life goals. Given the numerous social determinants that contribute to health inequities among AAs, stress from goal striving may also disproportionately affect the health of AAs and in particular kidney disease outcomes. The objective of this study was to explore the association between GSS and rapid kidney function decline (RKFD) in an AA cohort. Using examination 1 (2000-2004) and examination 3 (2009-2013) data from the Jackson Heart Study (n=2630), we examined associations of baseline levels of GSS with RKFD among AAs using multivariable Poisson regression models, adjusting for sociodemographics, health behaviors, chronic disease and discrimination. We also explored baseline cortisol as a mediator. The incidence of RKFD in this sample was 7.34% (mean years of follow-up: 8.06±0.84 years). The mean GSS score was 3.80 (±4.88) and total GSS score ranged from 0 to 36. Those who reported high (vs low) GSS were 1.60 times more likely to experience RKFD after full adjustment (incidence rate ratio (IRR) 1.60; 95% CI 1.11 to 2.14, p=0.01). After confirming cortisol as a mediator and adding it to the model, those who reported high (vs low) GSS had 1.58 times the rate of RKFD (IRR 1.58; 95% CI 1.09 to 2.30, p=0.0153). Stress related to not achieving goals was associated with a greater risk of RKFD in this sample of AAs.
非裔美国人（African Americans，AAs）受肾脏疾病的影响不成比例，而且报告的心理社会压力源也高于其他种族群体。目标追求压力（Goal-striving stress，GSS）是一种研究不足的心理社会压力源，与试图实现个人生活目标有关。鉴于导致非裔美国人健康不平等的众多社会决定因素，目标追求带来的压力也可能不成比例地影响非裔美国人的健康，尤其是肾脏疾病的结局。本研究的目的是探讨非裔美国人队列中 GSS 与快速肾功能下降（Rapid kidney function decline，RKFD）之间的关系。使用来自 Jackson Heart 研究的检查 1（2000-2004 年）和检查 3（2009-2013 年）的数据（n=2630），我们使用多变量泊松回归模型，调整社会人口统计学、健康行为、慢性疾病和歧视等因素，检验基线 GSS 水平与非裔美国人 RKFD 之间的关系。我们还探讨了基线皮质醇作为中介的作用。在该样本中，RKFD 的发生率为 7.34%（平均随访时间：8.06±0.84 年）。GSS 的平均得分为 3.80（±4.88），总 GSS 得分范围为 0 至 36。与低 GSS 相比，报告高 GSS 的人发生 RKFD 的可能性高 1.60 倍（发病率比（Incidence rate ratio，IRR）1.60；95%置信区间（Confidence interval，CI）1.11 至 2.14，p=0.01）。在确认皮质醇为中介物并将其添加到模型后，报告高 GSS（vs 低 GSS）的人 RKFD 发生率高 1.58 倍（IRR 1.58；95%CI 1.09 至 2.30，p=0.0153）。在这个非裔美国人样本中，与未实现目标相关的压力与 RKFD 的风险增加有关。
