Getz Mara, Charleston Larry, Armand Cynthia E, Willis Allison W, Seng Elizabeth
Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York.
Charleston Health, Neurology and Head Pain Consultants, Pinckney, Michigan.
Headache. 2025 Jun 2. doi: 10.1111/head.14970.
To examine the associations between perceived lifetime discrimination and discrimination in medical settings with migraine-specific quality of life in Black/African Americans with migraine.
Perceived discrimination negatively impacts health outcomes and quality of life, particularly in minoritized populations. African Americans with migraine disease face compounded challenges due to limited access to specialized treatments and discrimination in medical settings, leading to disparities in migraine care and outcomes. However, few studies have investigated how perceived discrimination affects migraine-specific quality of life in this population. This study evaluated whether higher levels of perceived lifetime discrimination and discrimination in medical settings were associated with worse migraine-specific quality of life in Black/African Americans with migraine.
Black/African American adults with a migraine diagnosis (N = 91) were recruited from a tertiary headache center between October 2023 and April 2024 for this cross-sectional study. Participants underwent testing using validated research tools to measure migraine-specific quality of life (Migraine-Specific Quality-of-Life Questionnaire), lifetime perceived discrimination (Perceived Ethnic Discrimination Questionnaire-Community Version [PEDQ-CV]), and discrimination in medical settings (Discrimination in Medical Settings Scale [DMS]). Headache frequency and pain intensity were assessed via Migraine Disability Assessment items (MIDAS Item A and B). Associations between discrimination measures and migraine-specific quality of life, controlling for headache pain, frequency, and sex at birth were examined.
Higher levels of lifetime perceived discrimination and discrimination in medical settings were significantly associated with worse migraine-specific quality of life (PEDQ-CV: β = -0.30, p = 0.004, 95% confidence interval [CI] -0.49 to -0.10; DMS: β = -0.27, p = 0.016, 95% CI -0.47 to -0.06), independent of headache frequency and sex at birth. Headache pain intensity was also significantly associated with poorer quality of life across models (β = -0.43, p < 0.001, 95% CI -0.63 to -0.23). Headache frequency and sex at birth were not significantly associated with outcomes. Together, discrimination measures and pain intensity accounted for 28.3-31.6% of the variance in migraine-specific quality of life.
Experiences of discrimination, both across the lifetime and within the medical setting, significantly impact migraine-specific quality of life in Black/African Americans. These findings highlight the critical need for interventions that reduce bias in migraine care, improve pain management, and address the psychosocial stress linked to discrimination. Future research should focus on investigating the pathways through which discrimination exacerbates health disparities and on developing multidisciplinary, culturally competent strategies to improve care and reduce inequities for minoritized populations.
探讨在患有偏头痛的黑人/非裔美国人中，感知到的终生歧视以及医疗环境中的歧视与偏头痛特异性生活质量之间的关联。
感知到的歧视会对健康结果和生活质量产生负面影响，尤其是在少数族裔人群中。患有偏头痛疾病的非裔美国人由于获得专科治疗的机会有限以及在医疗环境中受到歧视，面临着更为复杂的挑战，这导致了偏头痛护理和结果方面的差异。然而，很少有研究调查感知到的歧视如何影响该人群的偏头痛特异性生活质量。本研究评估了在患有偏头痛的黑人/非裔美国人中，更高水平的感知终生歧视和医疗环境中的歧视是否与更差的偏头痛特异性生活质量相关。
在2023年10月至2024年4月期间，从一家三级头痛中心招募了91名被诊断为偏头痛的黑人/非裔美国成年人参与这项横断面研究。参与者使用经过验证的研究工具进行测试，以测量偏头痛特异性生活质量（偏头痛特异性生活质量问卷）、终生感知到的歧视（感知种族歧视问卷 - 社区版[PEDQ - CV]）以及医疗环境中的歧视（医疗环境中的歧视量表[DMS]）。通过偏头痛残疾评估项目（MIDAS项目A和B）评估头痛频率和疼痛强度。研究了在控制头痛疼痛、频率和出生时性别的情况下，歧视测量指标与偏头痛特异性生活质量之间的关联。
更高水平的终生感知歧视和医疗环境中的歧视与更差的偏头痛特异性生活质量显著相关（PEDQ - CV：β = -0.30，p = 0.004，95%置信区间[CI] -0.49至-0.10；DMS：β = -0.27，p = 0.016，95% CI -0.47至-0.06），独立于头痛频率和出生时性别。在所有模型中，头痛疼痛强度也与较差的生活质量显著相关（β = -0.43，p < 0.001，95% CI -0.63至-0.23）。头痛频率和出生时性别与结果无显著关联。歧视测量指标和疼痛强度共同解释了偏头痛特异性生活质量变异的28.3 - 31.6%。
终生以及医疗环境中的歧视经历对黑人/非裔美国人的偏头痛特异性生活质量有显著影响。这些发现凸显了采取干预措施以减少偏头痛护理中的偏见、改善疼痛管理以及解决与歧视相关的心理社会压力的迫切需求。未来的研究应专注于调查歧视加剧健康差异的途径，并制定多学科、具有文化胜任力的策略，以改善护理并减少少数族裔人群的不平等现象。
