目标:血管舒缩症状(VMS),包括潮热和盗汗,是更年期过渡的标志性症状。以前的研究记录了更高的频率,持续时间,与其他种族/族裔群体的女性相比,黑人女性的VMS的严重程度,即使考虑了其他因素。这项分析研究了歧视与VMS之间的关联,以及歧视在多大程度上造成了黑人妇女VMS的不成比例的负担。
方法:使用SWAN队列研究的现有歧视和VMS数据(n=2,377,48%白人,32%黑色,6%日本人,4%中国人,和9%的西班牙裔女性)从绝经前(42-52年)到绝经后(~20年),我们使用加权广义混合模型评估了过去2周内辨别与VMS频率之间的并发关联.我们还使用加权多项逻辑回归评估了前四次就诊的慢性歧视与从绝经前到绝经后的VMS轨迹之间的关联。针对VMS的已知风险因素对模型进行了调整。
结果:较高的歧视水平与同时报告任何(优势比[OR],1.57[1.31-1.89])和频繁(≥6d)VMS(OR,1.55[1.21-1.99])。调整后,协会对任何(或,1.30[1.09-1.54]),但不频繁的VMS。对于任何VMS轨迹,慢性歧视与“持续高”(或,1.69[1.03-2.77])和“高FMP前下降后下降”(或,1.70[1.01-2.88])与“FMP起始低”轨迹。在适应歧视之后,报告任何的可能性,频繁,对于黑人和白人女性来说,任何VMS轨迹都保持较高的状态。
结论:歧视与任何(但不频繁)VMS的并发风险更大相关,长期歧视与任何VMS的持续高报告有关,独立于已知的危险因素。调整歧视可以减轻但不能消除黑人女性VMS风险的增加。
OBJECTIVE: Vasomotor symptoms (VMS), including hot flashes and night sweats, are hallmark symptoms of the menopause transition. Previous research has documented greater frequency, duration, and severity of VMS in Black women compared with women from other racial/ethnic groups, even after accounting for other factors. This analysis examined the association between discrimination and VMS and the extent to which discrimination accounts for the disproportionate burden of VMS in Black women.
METHODS: Using available discrimination and VMS data from the SWAN cohort
study (n = 2,377, 48% White, 32% Black, 6% Japanese, 4% Chinese, and 9% Hispanic women) followed approximately yearly in midlife from premenopause (42-52 y) through postmenopause (~20 y), we assessed concurrent associations between discrimination and VMS frequency in the past 2 weeks using weighted generalized mixed models. We also assessed associations between chronic discrimination across first four visits and VMS trajectories from premenopause to postmenopause using weighted multinomial logistic regression. Models were adjusted for known risk factors for VMS.
RESULTS: Higher levels of discrimination were associated with concurrent reporting of any (odds ratio [OR], 1.57 [1.31-1.89]) and frequent (≥6 d) VMS (OR, 1.55 [1.21-1.99]). After adjustment, associations remained significant for any (OR, 1.30 [1.09-1.54]) but not frequent VMS. For any VMS trajectories, chronic discrimination was associated with \"continuously high\" (OR, 1.69 [1.03-2.77]) and \"high pre-FMP-decline post-FMP\" (OR, 1.70 [1.01-2.88]) versus \"FMP-onset low\" trajectories. After adjusting for discrimination, odds of reporting any, frequent, and of being in the \"continuously high\" any VMS trajectory remained elevated for Black versus White women.
CONCLUSIONS: Discrimination is associated with greater concurrent risk of any (but not frequent) VMS, and chronic discrimination is associated with a continuously high reporting of any VMS over time, independent of known risk factors. Adjusting for discrimination attenuates but does not eliminate the increased risk of VMS for Black women.