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Perceived Discrimination and Cardiovascular Outcomes in Older African Americans: Insights From the Jackson Heart Study.

Publication ,  Journal Article
Dunlay, SM; Lippmann, SJ; Greiner, MA; O'Brien, EC; Chamberlain, AM; Mentz, RJ; Sims, M
Published in: Mayo Clin Proc
May 2017

OBJECTIVE: To assess the associations of perceived discrimination and cardiovascular (CV) outcomes in African Americans (AAs) in the Jackson Heart Study. PATIENTS AND METHODS: In 5085 AAs free of clinical CV disease at baseline enrolled in the Jackson Heart Study from September 26, 2000, through March 31, 2004, and followed through 2012, associations of everyday discrimination (frequency of occurrences of perceived unfair treatment) and lifetime discrimination (perceived unfair treatment in 9 life domains) with CV outcomes (all-cause mortality, incident coronary heart disease [CHD], incident stroke, and heart failure [HF] hospitalization) were examined using Cox proportional hazards regression models. RESULTS: Higher levels of everyday and lifetime discrimination were more common in participants who were younger and male and had higher education and income, lower perceived standing in the community, worse perceived health care access, and fewer comorbidities. Before adjustment, higher levels of everyday and lifetime discrimination were associated with a lower risk of all-cause mortality, incident CHD, stroke, and HF hospitalization. After adjustment for potential confounders, we found no association of everyday and lifetime discrimination with incident CHD, incident stroke, or HF hospitalization; however, a decrease in all-cause mortality with progressively higher levels of everyday discrimination persisted (hazard ratio per point increase in discrimination measure, 0.90; 95% CI, 0.82-0.99; P=.02). The unexpected association of everyday discrimination and all-cause mortality was partially mediated by perceived stress. CONCLUSION: We found no independent association of perceived discrimination with risk of incident CV disease or HF hospitalization in this AA population. An observed paradoxical negative association of everyday discrimination and all-cause mortality was partially mediated by perceived stress.

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Published In

Mayo Clin Proc

DOI

EISSN

1942-5546

Publication Date

May 2017

Volume

92

Issue

5

Start / End Page

699 / 709

Location

England

Related Subject Headings

  • Stroke
  • Stress, Psychological
  • Statistics, Nonparametric
  • Social Discrimination
  • Sex Distribution
  • Risk Assessment
  • Proportional Hazards Models
  • Perception
  • Middle Aged
  • Male
 

Citation

APA
Chicago
ICMJE
MLA
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Dunlay, S. M., Lippmann, S. J., Greiner, M. A., O’Brien, E. C., Chamberlain, A. M., Mentz, R. J., & Sims, M. (2017). Perceived Discrimination and Cardiovascular Outcomes in Older African Americans: Insights From the Jackson Heart Study. Mayo Clin Proc, 92(5), 699–709. https://doi.org/10.1016/j.mayocp.2017.01.024
Dunlay, Shannon M., Steven J. Lippmann, Melissa A. Greiner, Emily C. O’Brien, Alanna M. Chamberlain, Robert J. Mentz, and Mario Sims. “Perceived Discrimination and Cardiovascular Outcomes in Older African Americans: Insights From the Jackson Heart Study.Mayo Clin Proc 92, no. 5 (May 2017): 699–709. https://doi.org/10.1016/j.mayocp.2017.01.024.
Dunlay SM, Lippmann SJ, Greiner MA, O’Brien EC, Chamberlain AM, Mentz RJ, et al. Perceived Discrimination and Cardiovascular Outcomes in Older African Americans: Insights From the Jackson Heart Study. Mayo Clin Proc. 2017 May;92(5):699–709.
Dunlay, Shannon M., et al. “Perceived Discrimination and Cardiovascular Outcomes in Older African Americans: Insights From the Jackson Heart Study.Mayo Clin Proc, vol. 92, no. 5, May 2017, pp. 699–709. Pubmed, doi:10.1016/j.mayocp.2017.01.024.
Dunlay SM, Lippmann SJ, Greiner MA, O’Brien EC, Chamberlain AM, Mentz RJ, Sims M. Perceived Discrimination and Cardiovascular Outcomes in Older African Americans: Insights From the Jackson Heart Study. Mayo Clin Proc. 2017 May;92(5):699–709.
Journal cover image

Published In

Mayo Clin Proc

DOI

EISSN

1942-5546

Publication Date

May 2017

Volume

92

Issue

5

Start / End Page

699 / 709

Location

England

Related Subject Headings

  • Stroke
  • Stress, Psychological
  • Statistics, Nonparametric
  • Social Discrimination
  • Sex Distribution
  • Risk Assessment
  • Proportional Hazards Models
  • Perception
  • Middle Aged
  • Male