RACISM, STRESS AND CHRONIC DISEASE IN OLDER BLACKS

Johns Hopkins University, Baltimore MD

Investigators

Abstract

The proposed study is a survey to determine the prevalence of the psychosocial stressor, perceived-racism, in an older African- American community and its association with hypertension, diabetes, and sub-optimal health care. Chronic psychological stress is thought to contribute to the pathogenesis of certain metabolic and endocrine disturbances. The defeatist and defensive coping methods have been postulated to alter the hypothalamic-pituitary-axis leading to increased corticosteroids and to stimulate over-production of hormones. This chronic hormonal surge would be expected to increase the waist-hip ratio, induce insulin resistance, and increase blood pressure, triggering the development of hypertension and type 2 diabetes. The chronic stress of perceived-racist treatment experienced by African-Americans may also result in aberrations of these metabolic processes and initiation of these diseases. In fact, the excess risk of hypertension and type 2 diabetes in African-Americans unexplained heretofore by known risk factors, could potentially be explained by this psychosocial risk factor. To accomplish our objectives we will interview a sample of 625 African Americans aged 50 and older residing in the Baltimore metropolitan area, selected using a list-assisted, random-digit dialing technique. A trained telephone interviewer using the Perceived Racism Scale will assess the frequency of exposure to racist events and the coping-style employed when confronted with racism. The medical outcomes of hypertension and diabetes mellitus will be assessed by self-report. The health-care service outcome of health utilization will be determined by use of preventive services and usual care measures. Confounding or mediating factors of access to health-care services, neighborhood crime, socioeconomic status, overall coping method, and global stress will also be evaluated. The characteristics of the population, including the prevalence of perceived racism, will be evaluated using descriptive statistics. The correlation between perceived racism and perceived stress will be examined. Using logistic and linear regression techniques, the association between perceived racism, hypertension, diabetes, and use of health-care services, adjusting for covariates, will be explored for each outcome separately. Modification of the impact of perceived racism on the outcomes (diabetes, hypertension, and utilization of health- care services) by other variables will be assessed. Since both hypertension and diabetes are associated with high morbidity and mortality, the factors that accelerate the progression and initiation of these diseases must be modified. The proposed study can aid in the identification of another modifiable risk factor for two of the most prevalent conditions in the older African-American community as well as lay a foundation for other studies to explore the causal relationship between perceived racism and chronic medical conditions.