歧视经历与全因和心血管死亡率：动脉粥样硬化的多种族研究。
Discrimination Experiences and All-Cause and Cardiovascular Mortality: Multi-Ethnic Study of Atherosclerosis.
机构信息
Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD (W.R.L., G.S.J., M.S.S.).
Division of Community Health and Population Science (J.A.J.), National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD.
出版信息
Circ Cardiovasc Qual Outcomes. 2023 Apr;16(4):e009697. doi: 10.1161/CIRCOUTCOMES.122.009697. Epub 2023 Apr 5.
BACKGROUND
Epidemiologic studies have documented the associations between experiences of discrimination and adverse health outcomes. However, the relationship between discrimination and mortality, and the factors that may moderate this relationship are not well understood. This study examined whether lifetime and everyday discrimination were associated with all-cause and cardiovascular mortality and whether these associations differed by race and ethnicity, gender, and racial and ethnic residential segregation.
METHODS
The study included 1633 Black, 1403 Hispanic/Latino, and 2473 White participants aged 45 to 84 years from the Multi-Ethnic Study of Atherosclerosis, enrolled from 2000 to 2002 and followed across 5 exams (2002-2018). Discrimination was measured using the lifetime discrimination (major experiences of unfair treatment) and everyday discrimination (day-to-day experiences of unfair treatment) scales. Racial and ethnic residential segregation was measured using the statistic. Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% CIs, adjusting for sociodemographic characteristics, health behaviors, and clinical risk factors.
RESULTS
Each increase in reports of lifetime discrimination was associated with increased all-cause (HR, 1.06 [95% CI, 1.00-1.11]) and cardiovascular (HR, 1.15 [95% CI, 1.04-1.27]) mortality, adjusting for sociodemographic factors, health behaviors, and clinical risk factors. Associations between lifetime discrimination and cardiovascular mortality were observed across all racial and ethnic groups but were strongest and only statistically significant among Black participants (HR, 1.18 [95% CI, 1.02-1.37]). Additionally, in the fully adjusted model, each increase in reports of everyday discrimination was strongly associated with increased cardiovascular mortality (HR, 1.21 [95% CI, 1.03-1.43]). Associations for lifetime and everyday discrimination with all-cause and cardiovascular mortality were not modified by race and ethnicity, gender, or racial and ethnic residential segregation.
CONCLUSIONS
These findings suggest that experiences of discrimination are associated with increased all-cause and cardiovascular mortality.
背景
流行病学研究记录了歧视经历与不良健康结果之间的关联。然而，歧视与死亡率之间的关系以及可能调节这种关系的因素尚不清楚。本研究检验了一生中经历和日常经历的歧视是否与全因死亡率和心血管死亡率相关，以及这些关联是否因种族和民族、性别以及种族和民族居住隔离而有所不同。
方法
这项研究纳入了来自动脉粥样硬化多民族研究的 1633 名黑人、1403 名西班牙裔/拉丁裔和 2473 名白人参与者，年龄在 45 岁至 84 岁之间，他们于 2000 年至 2002 年期间入组，并在 5 次检查中进行了随访（2002-2018 年）。歧视是通过使用一生中经历的歧视（不公平待遇的主要经历）和日常经历的歧视（日常不公平待遇的经历）量表来衡量的。种族和民族居住隔离使用 统计量来衡量。使用 Cox 比例风险回归来估计风险比（HR）和 95%置信区间（CI），并调整了社会人口统计学特征、健康行为和临床风险因素。
结果
一生中经历的歧视每增加一个报告，与全因死亡率（HR，1.06[95%CI，1.00-1.11]）和心血管死亡率（HR，1.15[95%CI，1.04-1.27]）的增加相关，调整了社会人口统计学因素、健康行为和临床风险因素。一生中经历的歧视与心血管死亡率之间的关联在所有种族和民族群体中均可见，但在黑人参与者中最强且仅具有统计学意义（HR，1.18[95%CI，1.02-1.37]）。此外，在完全调整的模型中，日常经历的歧视每增加一个报告，与心血管死亡率的增加密切相关（HR，1.21[95%CI，1.03-1.43]）。一生中经历的歧视和日常经历的歧视与全因死亡率和心血管死亡率之间的关联不受种族和民族、性别或种族和民族居住隔离的影响。
结论
这些发现表明，歧视经历与全因死亡率和心血管死亡率的增加有关。
Zotero 插件