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标题：Perceived Discrimination and Hypertension Among African Americans in the Jackson Heart Study
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作者：Mario Sims ; Ana V. Diez-Roux ; Amanda Dudley 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2012
卷号：102
期号：Suppl 2
页码：S258-S265
DOI：10.2105/AJPH.2011.300523
语种：English
出版社：American Public Health Association
摘要：Objectives. Using Jackson Heart Study data, we examined whether perceived discrimination was associated with prevalent hypertension in African Americans. Methods. Everyday discrimination, lifetime discrimination, burden of discrimination, and stress from discrimination were examined among 4939 participants aged 35 to 84 years (women = 3123; men = 1816). We estimated prevalence ratios of hypertension by discrimination, and adjusted for age, gender, socioeconomic status, and risk factors. Results. The prevalence of hypertension was 64.0% in women and 59.7% in men. After adjustment for age, gender, and socioeconomic status, lifetime discrimination and burden of discrimination were associated with greater hypertension prevalence (prevalence ratios for highest vs lowest quartile were 1.08 [95% confidence interval (CI) = 1.02, 1.15] and 1.09 [95% CI = 1.02,1.16] for lifetime discrimination and burden of discrimination, respectively). Associations were slightly weakened after adjustment for body mass index and behavioral factors. No associations were observed for everyday discrimination. Conclusions. Further understanding the role of perceived discrimination in the etiology of hypertension may be beneficial in eliminating hypertension disparities. Previous research reported an association between perceived discrimination and health outcomes. 1,2 In particular, hypertension (which is higher among African Americans than Whites) was linked to discrimination, 3–6 although findings were not always consistent. 4,7–10 Although traditional biobehavioral risk factors might explain some of the African American–White disparity in hypertension, differences in exposure to discrimination by race might also contribute. African Americans’ exposure to discrimination could influence their risk for hypertension through various mechanisms. These include negative coping behaviors, such as unhealthy eating, sedentary lifestyles, and tobacco and alcohol intake. The experience of discrimination could also cause emotional distress, 3 which can trigger physiological responses involving the hypothalamic–pituitary–adrenal axis and the sympathetic–parasympathetic systems, which play an important role in the pathophysiology of hypertension. 7,11,12 Although exceptions exist, most previous studies of perceived discrimination and hypertension in African Americans employed relatively small samples 13,14 and focused on a single measure of discrimination. 3,5 The Jackson Heart Study (JHS), the largest prospective study of cardiovascular disease in African Americans, offered a unique opportunity to examine the association between multiple dimensions of discrimination (everyday, lifetime, burden, and stress from discrimination) and hypertension in a large sample of African Americans. The measures of various dimensions of discrimination obtained in JHS included everyday discrimination, which captured daily hassles associated with discrimination, 15 lifetime discrimination, which captured acute and observable experiences similar to life events in the stress literature, and perceived burden and stress from discrimination. 4 Because discrimination was conceptualized as a multifactorial construct, the inclusion of multiple measures might be necessary to accurately capture the impact of discrimination on health. 2,16–18 We hypothesized that perceived discrimination would be positively associated with hypertension, and that health behaviors would partially mediate the association. Because previous work documented associations of discrimination with hypertension among women, but not men, 5 and because of differences in hypertension prevalence by gender, we tested for effect modification by gender.