Department of Medicine, Medical School, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
J Am Geriatr Soc. 2023 May;71(5):1515-1525. doi: 10.1111/jgs.18215. Epub 2023 Jan 3.
To understand the relationship between perceived discrimination, allostatic load, and all-cause mortality; and to determine whether allostatic load is a mediator in the relationship between perceived discrimination and all-cause mortality among an older adult US population.
Data from the Health and Retirement Study (2006-2012) was analyzed. Cox proportional hazard models were used to investigate the relationship between all-cause mortality and perceived discrimination, and all-cause mortality and allostatic load. Linear regression models were used to investigate the relationship between perceived discrimination and allostatic load. A mediation model with perceived discrimination and allostatic loads as independent variables was used to determine the association with all-cause mortality.
There were 5062 adults over the age of 50 included in the analysis. The relationship between perceived discrimination and allostatic load was statistically significant (b:0.14, [95%CI 0.10,0.19]; p < 0.001). The relationship between perceived discrimination and all-cause mortality was statistically significant (HR: 1.12, [95%CI 1.03,1.22]; p = 0.01). The relationship between allostatic load and all-cause mortality was statistically significant (HR: 1.11, [95%CI 1.08,1.13]; p < 0.001). The mediation model resulted in a decrease in hazard ratio and loss of statistical significance for perceived discrimination (HR: 1.09, [95%CI 0.98,1.21]; p = 0.13) when allostatic load (HR: 1.17, [95%CI 1.10,1.24]; p < 0.001) was added to the Cox regression model, indicating full mediation.
Allostatic load fully mediates the relationship between perceived discrimination and all-cause mortality. Understanding the role of allostatic load in this relationship provides an additional implication for screening and indications for tighter control of the modifiable components of allostatic load by healthcare providers, especially among individuals who experience discrimination.
了解感知歧视、应激负荷和全因死亡率之间的关系；并确定在老年美国人群体中，应激负荷是否是感知歧视与全因死亡率之间关系的中介。
分析了健康与退休研究（2006-2012 年）的数据。使用 Cox 比例风险模型调查全因死亡率与感知歧视之间的关系，以及全因死亡率与应激负荷之间的关系。使用线性回归模型调查感知歧视与应激负荷之间的关系。使用包含感知歧视和应激负荷作为自变量的中介模型来确定与全因死亡率的关联。
纳入分析的 5062 名 50 岁以上成年人中，感知歧视与应激负荷之间的关系具有统计学意义（b：0.14，[95%CI 0.10，0.19]；p<0.001）。感知歧视与全因死亡率之间的关系具有统计学意义（HR：1.12，[95%CI 1.03，1.22]；p=0.01）。应激负荷与全因死亡率之间的关系具有统计学意义（HR：1.11，[95%CI 1.08，1.13]；p<0.001）。当将应激负荷（HR：1.17，[95%CI 1.10，1.24]；p<0.001）添加到 Cox 回归模型中时，中介模型导致感知歧视的危险比降低且失去统计学意义（HR：1.09，[95%CI 0.98，1.21]；p=0.13），表明完全中介。
应激负荷完全中介了感知歧视与全因死亡率之间的关系。了解应激负荷在这种关系中的作用为医疗保健提供者提供了额外的意义，特别是在经历歧视的个体中，这为筛查和指示提供了更多的意义，以更严格地控制应激负荷的可调节成分。
