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The contribution of stress to the social patterning of clinical and subclinical CVD risk factors in African Americans: The Jackson Heart Study

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  • Gebreab, Samson Y.
  • Diez-Roux, Ana V.
  • Hickson, DeMarc A.
  • Boykin, Shawn
  • Sims, Mario
  • Sarpong, Daniel F.
  • Taylor, Herman A.
  • Wyatt, Sharon B.
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    Abstract

    It is often hypothesized that psychosocial stress may contribute to associations of socioeconomic position (SEP) with risk factors for cardiovascular disease (CVD). However, few studies have investigated this hypothesis among African Americans, who may be more frequently exposed to stressors due to social and economic circumstances. Cross-sectional data from the Jackson Heart Study (JHS), a large population-based cohort of African Americans, were used to examine the contributions of stressors to the association of SEP with selected cardiovascular (CVD) risk factors and subclinical atherosclerotic disease. Among women, higher income was associated with lower prevalence of hypertension, obesity, diabetes and carotid plaque and lower levels of stress. Higher stress levels were also weakly, albeit positively, associated with hypertension, diabetes, and obesity, but not with plaque. Adjustment for the stress measures reduced the associations of income with hypertension, diabetes and obesity by a small amount that was comparable to, or larger, than the reduction observed after adjustment for behavioral risk factors. In men, high income was associated with lower prevalence of diabetes and stressors were not consistently associated with any of the outcomes examined. Overall, modest mediation effects of stressors were observed for diabetes (15.9%), hypertension (9.7%), and obesity (5.1%) among women but only results for diabetes were statistically significant. No mediation effects of stressors were observed in men. Our results suggest that stressors may partially contribute to associations of SEP with diabetes and possibly hypertension and obesity in African American women. Further research with appropriate study designs and data is needed to understand the dynamic and interacting effects of stressors and behaviors on CVD outcomes as well as sex differences in these effects.

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    Bibliographic Info

    Article provided by Elsevier in its journal Social Science & Medicine.

    Volume (Year): 75 (2012)
    Issue (Month): 9 ()
    Pages: 1697-1707

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    Handle: RePEc:eee:socmed:v:75:y:2012:i:9:p:1697-1707

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    Keywords: U.S.A.; Stress; Social patterning; Cardiovascular disease; Risk factors; Mediation analysis; African Americans;

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    1. Macleod, John & Davey Smith, George & Metcalfe, Chris & Hart, Carole, 2005. "Is subjective social status a more important determinant of health than objective social status? Evidence from a prospective observational study of Scottish men," Social Science & Medicine, Elsevier, vol. 61(9), pages 1916-1929, November.
    2. Borrell, Luisa N. & Kiefe, Catarina I. & Williams, David R. & Diez-Roux, Ana V. & Gordon-Larsen, Penny, 2006. "Self-reported health, perceived racial discrimination, and skin color in African Americans in the CARDIA study," Social Science & Medicine, Elsevier, vol. 63(6), pages 1415-1427, September.
    3. Warren, John Robert & Hoonakker, Peter & Carayon, Pascale & Brand, Jennie, 2004. "Job characteristics as mediators in SES-health relationships," Social Science & Medicine, Elsevier, vol. 59(7), pages 1367-1378, October.
    4. Wamala, Sarah P. & Mittleman, Murray A. & Horsten, Myriam & Schenck-Gustafsson, Karin & Orth-Gomér, Kristina, 2000. "Job stress and the occupational gradient in coronary heart disease risk in women: The Stockholm Female Coronary Risk Study," Social Science & Medicine, Elsevier, vol. 51(4), pages 481-489, August.
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