Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.
From the Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI.
Menopause. 2024 Jun 1;31(6):484-493. doi: 10.1097/GME.0000000000002357. Epub 2024 Apr 9.
Vasomotor symptoms (VMS), including hot flashes and night sweats, are hallmark symptoms of the menopause transition. Previous research has documented greater frequency, duration, and severity of VMS in Black women compared with women from other racial/ethnic groups, even after accounting for other factors. This analysis examined the association between discrimination and VMS and the extent to which discrimination accounts for the disproportionate burden of VMS in Black women.
Using available discrimination and VMS data from the SWAN cohort study (n = 2,377, 48% White, 32% Black, 6% Japanese, 4% Chinese, and 9% Hispanic women) followed approximately yearly in midlife from premenopause (42-52 y) through postmenopause (~20 y), we assessed concurrent associations between discrimination and VMS frequency in the past 2 weeks using weighted generalized mixed models. We also assessed associations between chronic discrimination across first four visits and VMS trajectories from premenopause to postmenopause using weighted multinomial logistic regression. Models were adjusted for known risk factors for VMS.
Higher levels of discrimination were associated with concurrent reporting of any (odds ratio [OR], 1.57 [1.31-1.89]) and frequent (≥6 d) VMS (OR, 1.55 [1.21-1.99]). After adjustment, associations remained significant for any (OR, 1.30 [1.09-1.54]) but not frequent VMS. For any VMS trajectories, chronic discrimination was associated with "continuously high" (OR, 1.69 [1.03-2.77]) and "high pre-FMP-decline post-FMP" (OR, 1.70 [1.01-2.88]) versus "FMP-onset low" trajectories. After adjusting for discrimination, odds of reporting any, frequent, and of being in the "continuously high" any VMS trajectory remained elevated for Black versus White women.
Discrimination is associated with greater concurrent risk of any (but not frequent) VMS, and chronic discrimination is associated with a continuously high reporting of any VMS over time, independent of known risk factors. Adjusting for discrimination attenuates but does not eliminate the increased risk of VMS for Black women.
血管舒缩症状（VMS），包括热潮红和盗汗，是更年期过渡的标志性症状。先前的研究表明，即使在考虑了其他因素后，与其他种族/族裔群体的女性相比，黑人女性的 VMS 发生频率、持续时间和严重程度更高。本分析检查了歧视与 VMS 之间的关联，以及歧视在多大程度上解释了黑人女性 VMS 负担不成比例的原因。
使用来自 SWAN 队列研究的可用歧视和 VMS 数据（n=2377 名女性，48%为白人，32%为黑人，6%为日本人，4%为中国人，9%为西班牙裔），这些女性从中绝经前期（42-52 岁）到绝经后（约 20 年）每年大约随访一次，我们使用加权广义混合模型评估了过去 2 周内歧视与 VMS 频率之间的并发关联。我们还使用加权多项逻辑回归评估了绝经前期到绝经后期期间前四次就诊时的慢性歧视与 VMS 轨迹之间的关联。模型调整了 VMS 的已知危险因素。
较高水平的歧视与报告任何 VMS（比值比[OR]，1.57[1.31-1.89]）和频繁（≥6 天）VMS（OR，1.55[1.21-1.99]）的情况相关。调整后，任何 VMS（OR，1.30[1.09-1.54]）的关联仍然显著，但频繁 VMS 则不然。对于任何 VMS 轨迹，慢性歧视与“持续高”（OR，1.69[1.03-2.77]）和“绝经前高-绝经后低”（OR，1.70[1.01-2.88]）相比，“FMP 发病时低”轨迹相关。调整歧视后，黑人女性报告任何 VMS、频繁 VMS 以及处于“持续高”任何 VMS 轨迹的几率仍然高于白人女性。
歧视与同时发生的任何 VMS（但不是频繁 VMS）的风险增加有关，慢性歧视与随着时间的推移持续高报告任何 VMS 有关，独立于已知的风险因素。调整歧视后，黑人女性 VMS 的风险增加仍然存在，但程度有所降低。
