Exposure to Racial Discrimination and Ambulatory Blood Pressure in Women with Type 2 Diabetes

Wagner, Julie; Tennen, Howard; Finan, Patrick H.; Feinn, Richard; Burg, Matthew M.; Seawell, Asani H.; White, William Β.

doi:10.1002/smi.2622

Cited by 19 publications

(27 citation statements)

References 55 publications

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“…Dietary information was not collected in the MIDUS study, which may be an important confounding or mediating variable in the association between perceived weight discrimination and allostatic load—particularly because poor dietary choices have been related to the effects of discrimination on glycemic control [46]. Participant non-response rates on the questions about perceived discrimination also reduced the final sample size.…”

Section: Discussionmentioning

confidence: 99%

Perceived Weight Discrimination and 10-Year Risk of Allostatic Load Among US Adults

Vadiveloo

Mattei

2016

ann. behav. med.

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Background Discrimination promotes multisystem physiological dysregulation termed allostatic load, which predicts morbidity and mortality. It remains unclear whether weight-related discrimination influences allostatic load. Purpose The aim of this study was to prospectively examine 10-year associations between weight discrimination, allostatic load, and its components among adults 25–75 years in the Midlife Development in the US Biomarker Substudy. Methods Participants with information on weight discrimination were analyzed (n=986). At both timepoints, participants self-reported the frequency of perceived weight discrimination across nine scenarios as “never/rarely” (scored as 0), “sometimes” (1), or “often” (2). The two scores were averaged and then dichotomized as “experienced” versus “not experienced” discrimination. High allostatic load was defined as having ≥3 out of 7 dysregulated systems (cardiovascular, sympathetic/ parasympathetic nervous systems, hypothalamic pituitary axis, inflammatory, lipid/metabolic, and glucose metabolism), which collectively included 24 biomarkers. Relative risks (RR) were estimated from multivariate models adjusted for sociodemographic and health characteristics, other forms of discrimination, and BMI. Results Over 41% of the sample had obesity, and 6% reported weight discrimination at follow-up. In multivariable-adjusted analyses, individuals who experienced (versus did not experience) weight discrimination had twice the risk of high allostatic load (RR, 2.07; 95 % CI, 1.21; 3.55 for baseline discrimination; 2.16, 95 % CI, 1.39; 3.36 for long-term discrimination). Weight discrimination was associated with lipid/ metabolic dysregulation (1.56; 95 % CI 1.02, 2.40), glucose metabolism (1.99; 95 % CI 1.34, 2.95), and inflammation (1.76; 95 % CI 1.22, 2.54), but no other systems. Conclusions Perceived weight discrimination doubles the 10-year risk of high allostatic load. Eliminating weight stigma may reduce physiological dysregulation, improving obesity-related morbidity and mortality.

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Section: Discussionmentioning

confidence: 99%

Perceived Weight Discrimination and 10-Year Risk of Allostatic Load Among US Adults

Vadiveloo

Mattei

2016

ann. behav. med.

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“…This is the first study that provides information from the same population of patients with type 2 diabetes on physical health, mental health and self-care behaviors. Previous work in diabetes has focused on the relationship between psychological distress, mental health, and physical outcomes [15,18]; however, little research has investigated the impact of perceived discrimination on health behaviors. These results suggest that while a direct association to physical health outcomes may not exist, perceived discrimination has an influence on the mental component of quality of life and health behaviors, and thus should be addressed through educational programs focused on improving health in patients with type 2 diabetes.…”

Section: Discussionmentioning

confidence: 99%

“…In this study, while there was a significant association with MCS, perceived discrimination did not have an impact on biologic measures other than blood pressure in African Americans. Previous research found significant associations with mean continuous glucose, insulin resistance, and glycemic control [15,18], however, these studies were only conducted in women and sample sizes were much smaller. This study found that while a significant association with physical health outcomes was not present, health behaviors were associated with perceived discrimination and may be an appropriate way to mitigate the impact of perceived discrimination on health outcomes in patients with type 2 diabetes.…”

Section: Discussionmentioning

confidence: 99%

“…Reviews of research have found an inverse association between discrimination and morbidity, as well as associations between discrimination and physical, mental and emotional health outcomes [9-15]. Perceived discrimination can be defined as the belief that negative attitudes, judgment or unfair treatment occurs toward members of a group, and has been shown to cause stress due to its unpredictability [11,16].…”

Section: Introductionmentioning

confidence: 99%

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Effect of perceived racial discrimination on self-care behaviors, glycemic control, and quality of life in adults with type 2 diabetes

et al. 2014

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Objective This study used a large sample size of Black and White patients with type 2 diabetes to investigate the influence of perceived racial discrimination on biologic measures (glycemic control, blood pressure, and LDL-cholesterol), the mental component of quality of life (MCS), and health behaviors known to improve diabetes outcomes. Methods 602 patients were recruited from two adult primary care clinics in the southeastern United States. Linear regression models were used to assess the associations between perceived racial discrimination, self-care, clinical outcomes, mental component of quality of life (MCS), adjusting for relevant covariates. Race stratified models were conducted to examine differential associations by race, Results The mean age was 61 years, with 64.9% non-Hispanic black, and 41.6% earning less than $20,000 annually. Perceived discrimination was significantly negatively associated with MCS (β= -0.56, 95% CI -0.90, 0.23), general diet (β= -0.37, CI -0.65, -0.08), and specific diet (β= -0.25, CI -0.47, -0.03). In African Americans, perceived discrimination was significantly associated with higher systolic blood pressure (β= 10.17, CI 1.13, -19.22). In Whites, perceived discrimination was significantly associated with lower mental component of quality of life (β= -0.51, CI -0.89, -0.14), general diet (β= -0.40, CI -0.69, -0.99), specific diet (β= -0.25, CI -0.47, -0.03), and blood glucose testing (β= -0.43, CI -0.80, -0.06). Conclusions While no association was found with biologic measures, perceived discrimination was associated with health behaviors and the mental component of quality of life. In addition, results showed a difference in influence of perceived discrimination by race.

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“…11 Discrimination in daily life has been documented to negatively influence well-being 12 and glycemic control, 13,14 partially mediated through psychological distress. 15,16 Research has found a negative relationship between discrimination and an array of health outcomes.…”

Section: Introductionmentioning

confidence: 99%

Differential Effect of Race, Education, Gender, and Language Discrimination on Glycemic Control in Adults with Type 2 Diabetes

Reynolds

Walker

Campbell

et al. 2015

Diabetes Technology & Therapeutics

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Background: Discrimination has been linked to negative health outcomes, but little research has investigated different types of discrimination to determine if some have a greater impact on outcomes. We examined the differential effect of discrimination based on race, level of education, gender, and language on glycemic control in adults with type 2 diabetes. Patients and Methods: Six hundred two patients with type 2 diabetes from two adult primary care clinics in the southeastern United States completed validated questionnaires. Questions included perceived discrimination because of race/ethnicity, level of education, sex/gender, or language. A multiple linear regression model assessed the differential effect of each type of perceived discrimination on glycemic control while adjusting for relevant covariates, including race, site, gender, marital status, duration of diabetes, number of years in school, number of hours worked per week, income, and health status. Results: The mean age was 61.5 years, and the mean duration of diabetes was 12.3 years. Of the sample, 61.6% were men, and 64.9% were non-Hispanic black. In adjusted models, education discrimination remained significantly associated with glycemic control (b = 0.47; 95% confidence interval, 0.03, 0.92). Race, gender and language discrimination were not significantly associated with poor glycemic control in either unadjusted or adjusted analyses. Conclusions: Discrimination based on education was found to be significantly associated with poor glycemic control. The findings suggest that education discrimination may be an important social determinant to consider when providing care to patients with type 2 diabetes and should be assessed separate from other types of discrimination, such as that based on race.

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Exposure to Racial Discrimination and Ambulatory Blood Pressure in Women with Type 2 Diabetes

Cited by 19 publications

References 55 publications

Perceived Weight Discrimination and 10-Year Risk of Allostatic Load Among US Adults

Perceived Weight Discrimination and 10-Year Risk of Allostatic Load Among US Adults

Effect of perceived racial discrimination on self-care behaviors, glycemic control, and quality of life in adults with type 2 diabetes

Differential Effect of Race, Education, Gender, and Language Discrimination on Glycemic Control in Adults with Type 2 Diabetes

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