Sarcoidosis, a systemic disorder characterized by chronic granulomatous inflammation, occurs more frequently among US black women, as do overweight and obesity. Little is known about the relation of ...overweight and obesity, which induce chronic inflammation, to incidence of sarcoidosis.
We assessed the relation of obesity and weight gain to the incidence of sarcoidosis in the Black Women's Health Study, a follow-up study of 59,000 US black women aged 21 to 69 years at baseline in 1995. Information on weight at age 18 years, height, current weight, incident sarcoidosis, and covariates was collected at baseline and on biennial follow-up questionnaires. Cox regression models adjusted for age, education, geographic region, smoking, alcohol consumption, and physical activity were used to estimate incidence rate ratios (IRRs) and 95% CIs.
From 1995 through 2011, 454 incident cases of sarcoidosis occurred during 707,557 person-years of follow-up. The incidence of sarcoidosis increased with increasing BMI and weight gain. The IRR was 1.40 (95% CI, 0.88-2.25) for BMI ≥ 30 kg/m2 at age 18 years relative to 20 to 24 kg/m2 (P trend = .18), 1.42 (95% CI, 1.07-1.89) for BMI ≥ 35 kg/m2 at baseline relative to 20 to 24 kg/m2 (P trend = .01), and 1.47 (95% CI, 1.10-1.97) for a weight gain between age 18 years and baseline of ≥ 30 kg relative to 0 to 9 kg (P trend = .16). In stratified analyses, there were significant trends of sarcoidosis incidence with increasing BMI and weight gain in women aged ≥ 45 years and ever smokers.
The present study provides evidence that weight gain and obesity during adulthood are associated with increased sarcoidosis incidence.
Purpose Obesity is more common in black women than in white women. Racial discrimination is a form of chronic stress that may influence weight. Methods We assessed the association of perceived racism ...with weight change between 1997 and 2005 in 43,103 women from the Black Women's Health Study, a prospective follow-up of U.S. black women aged 21–69 years at entry in 1995. Eight questions about perceptions and experiences of racism were asked in 1997 from which two summary variables were created: everyday racism (e.g., how often do people act “as if you are not intelligent?”), and lifetime racism (e.g., unfair treatment due to race “on the job”). Mixed linear regression models were used to calculate the multivariate adjusted means for changes in body weight across categories of perceived racism. Results Weight gain increased as levels of everyday and lifetime racism increased. The mean multivariable-adjusted difference in weight change between the highest and the lowest quartile of everyday racism was 0.56 kg. The mean difference comparing the highest category of lifetime racism to the lowest was 0.48 kg. Conclusion These prospective data suggest that experiences of racism may contribute to the excess burden of obesity in U.S. black women.
Neighborhood socioeconomic status (SES) is associated with adverse health outcomes, but longitudinal data among Black Americans, who tend to live in more deprived neighborhoods, is lacking.
We ...prospectively assessed the relation of neighborhood SES to mortality in the Black Women's Health Study.
A prospective cohort of 59,000 Black women was followed from 1995-2011. Participant addresses were geocoded and US Census block group was identified. Neighborhood SES was measured by a score based on US Census block group data for six indicators of income, education and wealth.
Deaths were identified through the National Death Index. Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% CIs with control for covariates.
Based on 2,598 deaths during 1995-2011, lower neighborhood SES was associated with increased all-cause and cancer mortality irrespective of individual education: among those with 16 or more years of education, HRs for lowest relative to highest neighborhood SES quartile were 1.42 (95% CI 1.18-1.71) for all-cause and 1.54 (95% CI 1.14-2.07) for cancer mortality. Neighborhood SES was associated with cardiovascular mortality among less-educated women.
Lower neighborhood SES is associated with greater risk of mortality among Black women. The presence of the association even among women with high levels of education suggests that individual SES may not overcome the unfavorable influence of neighborhood deprivation.
Exposure to psychosocial stressors may contribute to the onset of systemic lupus erythematosus (SLE) through dysregulation of the adaptive stress response. We assessed the relationship of childhood ...physical and sexual abuse to SLE risk among Black women.
Using data from the Black Women's Health Study, we followed 36,152 women from 1995 through 2015 with biennial questionnaires. Women reported on exposure to abuse during childhood (up to age 11) in 2005. Self-reported incident SLE cases were confirmed as meeting American College of Rheumatology SLE classification criteria by medical record review. Cox proportional hazards regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (95% CI) for SLE among women exposed to physical or sexual abuse during childhood, controlling for potential confounders.
We confirmed 101 cases of incident SLE who had completed the child abuse questions, during 670,822 person-years of follow-up. Both physical and sexual abuse during childhood were associated with statistically significant increases in SLE incidence. The HR for SLE associated with ≥ 2 episodes of severe sexual abuse compared to no abuse was 2.51 (95% CI 1.29-4.85) after adjustment for alcohol consumption, smoking, body mass index, oral contraceptive use, age at menarche, and parental education. The multivariable-adjusted HR for SLE with ≥ 5 episodes of severe physical abuse was 2.37 (1.13-4.99).
Our results suggest that sexual and physical abuse during childhood increase SLE risk during adulthood among Black women. Research is necessary both to confirm this finding and to understand potential mediating mechanisms.
Background Chronic stress resulting from experiences of racism may increase the incidence of adult-onset asthma through effects on the immune system and the airways. We conducted prospective analyses ...of the relation of experiences of racism with asthma incidence in the Black Women's Health Study, a prospective cohort of black women in the United States followed since 1995 with mailed biennial questionnaires. Methods Among 38,142 participants followed from 1997 to 2011, 1,068 reported incident asthma. An everyday racism score was created based on five questions asked in 1997 and 2009 about the frequency in daily life of experiences of racism (eg, poor service in stores), and a lifetime racism score was based on questions about racism on the job, in housing, and by police. We used Cox regression models to derive multivariable incidence rate ratios (IRRs) and 95% CIs for categories of each racism score in relation to incident asthma. Results The IRRs were 1.45 (95% CI, 1.19-1.78) for the highest compared with the lowest quartile of the 1997 everyday racism score ( P for trend <.0001) and 1.44 (95% CI, 1.18-1.75) for the highest compared with the lowest category of 1997 lifetime racism. Among women who reported the same levels of racism in 1997 and 2009, the IRRs for the highest categories of everyday and lifetime racism were 2.12 (95% CI, 1.55-2.91) and 1.66 (95% CI, 1.20-2.30), respectively. Conclusions Given the high prevalence of experiences of racism and asthma in black women in the United States, a positive association between racism and asthma is of public health importance.
Sarcoidosis is a systemic granulomatous disorder of unknown cause that occurs among men and women of all races. In the United States, black women are most frequently and most severely affected. There ...have been few epidemiologic studies of sarcoidosis focusing on black women.
In this article, we present data on incidence, prevalence, and clinical characteristics of sarcoidosis among participants in the Black Women's Health Study, a cohort study of 59,000 black women from across the United States. Data on incident disease and potential risk factors are obtained through biennial questionnaires. Follow-up has been > 80% through six completed cycles.
There were 685 prevalent cases of sarcoidosis at baseline in 1995 and 435 incident cases reported during 611,585 person-years of follow-up through 2007, for an average annual incidence rate of 71/100,000 and a current prevalence of 2.0%. The sarcoid diagnosis was confirmed in 96% of self-reported cases for whom medical records or physician checklists were obtained. The most frequently affected site was the lung. Most patients also had extrapulmonary involvement, with the most common sites being lymph nodes, skin, and eyes. Prednisone had the highest prevalence of use, followed by inhaled corticosteroids.
This study confirms previous reports of high incidence and prevalence of sarcoidosis among black women, as well as the extent of extrapulmonary disease, frequent need for steroid therapy, and comorbid conditions in this population. The prospective identification of sarcoidosis cases from a defined population will enable a valid assessment of risk factors for incident disease as follow-up continues.
Abstract
Background
Hypertension is a significant public health issue, particularly for Blacks, Hispanics/Latinos, and South Asians who are at greater risk than whites. Religion and spirituality ...(R/S) have been shown to be protective, but this has been identified primarily in whites with limited R/S measures examined (i.e., religious service attendance).
Purpose
To assess hypertension prevalence (HP) in four racial/ethnic groups while incorporating an array of R/S variables, including individual prayer, group prayer, nontheistic daily spiritual experiences, yoga, gratitude, positive religious coping, and negative religious coping.
Methods
Data were drawn from the Study on Stress, Spirituality, and Health, a consortium of ethnically diverse U.S. cohorts. The sample included 994 Black women, 838 Hispanic/Latino men and women, 879 South Asian men and women, and 3681 white women. Using a cross-sectional design, prevalence ratios for R/S and hypertension were reported for each cohort, in addition to pooled analyses. Given differences in R/S among men and women, all models were stratified by gender.
Results
Different patterns of associations were found between women and men. Among women: 1) religious attendance was associated with lower HP among Black and white women; 2) gratitude was linked to lower HP among Hispanic/Latino, South Asian, and white women; 3) individual prayer was associated with higher HP among Hispanic/Latino and white women; 4) yoga was associated with higher HP among South Asian women, and 5) negative religious coping was linked to higher HP among Black women. Among men: significant results were only found among Hispanic/Latino men. Religious attendance and individual prayer were associated with higher HP, while group prayer and negative religious coping were associated with lower HP.
Conclusion
Religion/spirituality is a multifaceted construct that manifests differently by race/ethnicity and gender. Medical practitioners should avoid a one-size-fits-all approach to this topic when evaluating prevalent hypertension in diverse communities.
Lay Summary
Hypertension is a serious public health issue that affects many Americans, though non-whites are at greater risk than whites. In this study, we examine Black, Hispanic/Latino, and South Asian samples, comparing their hypertension rates to whites. We ask whether one or more aspects of religion and spirituality (R/S) might be associated with prevalent hypertension (i.e., prevalence of hypertension at a single point in time). Religious service attendance is the primary R/S variable examined in relation to hypertension, but we expand this to include individual prayer, prayer in groups, daily spiritual experiences, yoga practice, feelings of gratitude, using God to help cope with problems (positive religious coping), and experiencing doubt or fear about God in the face of challenges (negative religious coping). The results were mixed across racial/ethnic group and gender. Among women, higher religious attendance and gratitude were associated with lower hypertension prevalence, but individual prayer was associated with higher prevalence. Few associations were noted between R/S and hypertension among men. Given these findings, along with extant research, it is important for medical practitioners serving diverse communities to recognize R/S may operate differently for men and women in varied religious and ethnic groups, with differing implications for prevalent hypertension.
An array of religion and spirituality variables have divergent associations with prevalence of hypertension across gender and racial/ethnic statuses.
Abstract
Background
The few studies of the relationship between religion and/or spirituality (R/S) and hypertension are conflicting. We hypothesized that R/S may reduce the risk of hypertension by ...buffering adverse physiological effects of stress.
Methods
We prospectively assessed the association of R/S with hypertension within the Black Women’s Health Study (BWHS), a cohort study initiated in 1995 that follows participants through biennial questionnaires. The 2005 questionnaire included four R/S questions: (i) extent to which one’s R/S is involved in coping with stressful situations, (ii) self-identification as a religious/spiritual person, (iii) frequency of attending religious services, and (iv) frequency of prayer. Incidence rate ratios (IRRs) and 95% confidence intervals were calculated for each R/S variable in relation to incident hypertension using Cox proportional hazards regression models, controlling for demographics, known hypertension risk factors, psychosocial factors, and other R/S variables.
Results
During 2005–2013, 5,194 incident cases of hypertension were identified. High involvement of R/S in coping with stressful events compared with no involvement was associated with reduced risk of hypertension (IRR: 0.87; 95% CI: 0.75, 1.00). The association was strongest among women reporting greater levels of perceived stress (IRR: 0.77; 95% CI: 0.61, 0.98; p interaction = .01). More frequent prayer was associated with increased risk of hypertension (IRR: 1.12; 95% CI: 0.99, 1.27). No association was observed for the other R/S measures.
Conclusion
R/S coping was associated with decreased risk of hypertension in African American women, especially among those reporting higher levels of stress. Further research is needed to understand the mechanistic pathways through which R/S coping may affect health.
Women who utilized their religiosity/spirituality to cope with stress were less likely to develop hypertension than were women who did not utilize this coping mechanism.
Abstract
Objective
We assessed whether race or ethnicity was associated with the incidence of high-impact chronic low back pain (cLBP) among adults consulting a primary care provider for acute low ...back pain (aLBP).
Methods
In this secondary analysis of a prospective cohort study, patients with aLBP were identified through screening at seventy-seven primary care practices from four geographic regions. Incidence of high-impact cLBP was defined as the subset of patients with cLBP and at least moderate disability on Oswestry Disability Index ODI >30) at 6 months. General linear mixed models provided adjusted estimates of association between race/ethnicity and high-impact cLBP.
Results
We identified 9,088 patients with aLBP (81.3% White; 14.3% Black; 4.4% Hispanic). Black/Hispanic patients compared to White patients, were younger and more likely to be female, obese, have Medicaid insurance, worse disability on ODI, and were at higher risk of persistent disability on STarT Back Tool (all P < .0001). At 6 months, more Black and Hispanic patients reported high-impact cLBP (30% and 25%, respectively) compared to White patients (15%, P < .0001, n = 5,035). After adjusting for measured differences in socioeconomic and back-related risk factors, compared to White patients, the increased odds of high-impact cLBP remained statistically significant for Black but not Hispanic patients (adjusted odds ration aOR = 1.40, 95% confidence interval CI: 1.05–1.87 and aOR = 1.25, 95%CI: 0.83–1.90, respectively).
Conclusions
We observed an increased incidence of high-impact cLBP among Black and Hispanic patients compared to White patients. This disparity was partly explained by racial/ethnic differences in socioeconomic and back-related risk factors. Interventions that target these factors to reduce pain-related disparities should be evaluated.
ClinicalTrials.gov Identifier
NCT02647658.
Gestational diabetes mellitus (GDM) has been hypothesized to increase breast cancer risk, but results from the few prior epidemiologic studies are conflicting, and no studies have examined the ...association in African American women.
We analyzed data from the prospective Black Women's Health Study to evaluate associations of history of GDM with breast cancer risk among 41,767 parous African American women, adjusting for potential confounders. HRs and 95% confidence intervals (CI) were estimated from multivariable Cox proportional hazards regression models.
There was no evidence of an association between history of GDM and risk of invasive breast cancer, overall or by estrogen receptor status.
Results of this study do not support the hypothesis that GDM is an important risk factor for breast cancer in African American women overall.
On the basis of these data, breast cancer risk is not increased among African American women with a history of GDM compared with parous women without a history of GDM.
PDF
