School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, USA.
Department of Epidemiology and Public Health, University College London, UK.
J Gerontol A Biol Sci Med Sci. 2022 Feb 3;77(2):375-382. doi: 10.1093/gerona/glab234.
Associations between multiple forms of discrimination and blood pressure control in older populations remain unestablished.
Participants were 14 582 noninstitutionalized individuals (59% women) in the Health and Retirement Study aged at least 51 years (76% non-Hispanic White, 15% non-Hispanic Black, 9% Hispanic/Latino). Primary exposures included the mean frequency of discrimination in everyday life, intersectional discrimination (defined as marginalization ascribed to more than one reason), and the sum of discrimination over the life span. We assessed whether discrimination was associated with a change in measured hypertension status (N = 14 582) and concurrent medication use among reported hypertensives (N = 9 086) over 4 years (2008-2014).
There was no association between the frequency of everyday discrimination and change in measured hypertension. Lifetime discrimination was associated with higher odds of hypertension 4 years later among men (odds ratio [OR]: 1.21, 95% confidence interval [CI]: 1.08-1.36) but not women (OR: 0.98, 95% CI: 0.86-1.13). Only among men, everyday discrimination due to at least 2 reasons was associated with a 1.44-fold (95% CI: 1.03-2.01) odds of hypertension than reporting no everyday discrimination, reporting intersectional discrimination was not associated with developing hypertension among women (OR: 0.91, 95% CI: 0.70-1.20). All 3 discriminatory measures were inversely related to time-averaged antihypertensive medication use, without apparent gender differences (eg, OR for everyday discrimination-antihypertensive use associations: 0.85, 95% CI: 0.77-0.94).
Gender differences in marginalization may more acutely elevate hypertensive risk among older men than similarly aged women. Experiences of discrimination appear to decrease the likelihood of antihypertensive medication use among older adults overall.
在老年人群体中，多种形式的歧视与血压控制之间的关联尚未确定。
参与者为健康与退休研究中的 14582 名非机构化个体（59%为女性），年龄至少为 51 岁（76%为非西班牙裔白人，15%为非西班牙裔黑人，9%为西班牙裔/拉丁裔）。主要暴露因素包括日常生活中歧视的平均频率、交叉歧视（定义为归因于多种原因的边缘化）以及一生中的歧视总和。我们评估了歧视是否与 4 年内（2008-2014 年）测量的高血压状态变化（N=14582）和报告的高血压患者同时使用药物有关。
日常生活中歧视的频率与测量的高血压变化之间没有关联。一生中的歧视与男性 4 年后高血压的发生风险较高相关（优势比[OR]：1.21，95%置信区间[CI]：1.08-1.36），但与女性无关（OR：0.98，95%CI：0.86-1.13）。只有在男性中，至少有 2 种原因导致的日常歧视与高血压的发生风险增加 1.44 倍（95%CI：1.03-2.01），而没有日常歧视的报告、报告的交叉歧视与女性高血压的发生无关（OR：0.91，95%CI：0.70-1.20）。所有 3 项歧视性措施都与平均时间的降压药物使用呈负相关，且没有明显的性别差异（例如，日常歧视与降压药物使用关联的 OR：0.85，95%CI：0.77-0.94）。
在老年男性中，边缘化的性别差异可能比同龄女性更严重地增加高血压风险。在老年人中，歧视经历似乎降低了使用降压药物的可能性。
