The associations among depression, social support and racial/ethnic disparities in cardiovascular risk profile membership in the National health and nutritional examination survey: a latent profile analysis

UNCG Author/Contributor (non-UNCG co-authors, if there are any, appear on document)
Amber Jamill Johnson (Creator)
The University of North Carolina at Greensboro (UNCG )
Web Site:
William Dudley

Abstract: Although rates of morbidity and mortality from cardiovascular disease have improved over the past decades, racial disparities in cardiovascular disease risk have persisted for ethnic and racial minorities. Research seeking to explain these disparities has largely focused on traditional risk factors such as obesity, hypertension, diet, and physical activity. However, a large body of literature has evidenced the psychological and social implications of race on cardiovascular risk. The weathering hypothesis posits that stress associated with racial inequities, racism, and discrimination may cause physiological deterioration among African Americans as early as young adulthood, thus contributing to cardiovascular disease disparities. Allostatic load is widely accepted as a quantitative metric used to study the consequences of weathering. This metric provides researchers with the ability to measure both the acute and long-term outcomes of the stress response. Measurement of allostatic load is based on a set of biomarkers that represent the current status of each physiological system that responds to stress (e.g. hypothalamic-pituitary-adrenal (HPA) axis, cardiovascular system, metabolic processes and the immune system). An algorithm is then used to compute allostatic load by demarcating clinical cut points to dichotomize continuous biological measurement into binary high risk variables (0 = low, 1 = high). This value is then summed to yield an allostatic load score which determines the presence of allostatic load. There are three important limitations to this approach. First, clinical cut points may not capture the full extent of biological risk. Second, categorizing otherwise continuous data results in loss of valuable information captured by the variables used to calculate allostatic load. Third, it is improbable that each biomarker equally contributes to the calculation of an allostatic score. The purpose of this study was to expand the weathering hypothesis by developing cardiovascular risk profiles using latent profile analyses on biomarkers commonly used in allostatic load calculations as an alternative to the traditional algorithm.. In addition, this study examined the relationship between demographic variables (race, age, sex, SES), psychosocial factors (depression, social support) and membership in cardiovascular disease risk profiles. Initial analysis using a national sample of a population age 3 to 85 identified four profile groups; low overall risk, kidney risk, vascular risk, and inflammation risk. Compared to Whites, Hispanics were more likely to exhibit an inflammation risk profile while African Americans were more likely to exhibit both inflammatory and vascular risk profiles. In addition, age, sex, and poverty to income ratio were significant predictors of all risk profiles. When focusing on depression and social support in a sample of individuals 40 years and older, analysis identified two profile groups; a low overall risk profile and an inflammation risk profile. Compared to Whites, African Americans were more likely to be members of the inflammatory risk profile. Further, an increase in depression score significantly increased the odds of an inflammatory risk profile membership. Moreover, the relationship between inflammation risk profile membership and social support (emotional, financial, social network) was examined in which no significant relationship was found. However, analysis revealed that the relationship between depression and inflammatory risk was moderated by emotional support, such that having received emotional support significantly decreased the association between depression and inflammatory risk. Findings from this study suggests that examining cardiovascular risk profiles that account for age, race, sex, and socioeconomic status may be useful for extending the weathering hypothesis and identifying different patterns of risk among those who experience allostatic load. Further understanding of the racial differences in depression and inflammatory risk may be beneficial in eliminating disparities in cardiovascular disease. Results from this project indicate that a higher level of emotional support may be promising strategy to reduce cardiovascular risk.

Additional Information

Language: English
Date: 2016
Cardiovascular Disease, Latent Profile Analysis, Risk Profiles
Cardiovascular system $x Diseases $x Risk factors $z United States
Heart $x Diseases $x Psychosomatic aspects $z United States
Heart $x Diseases $x Social aspects $z United States
Racism $x Health aspects $z United States
Racism $z United States $x Psychological aspects
Health and race $z United States

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