Racial disparities in the association between childhood and adult life stress and adverse cardiovascular outcomes among patients with a history of myocardial infarction in Georgia, USA Open Access
Teferi, Henok Mulatu (Spring 2024)
Abstract
Background: Although studies have identified associations between overall childhood life stress and adverse cardiovascular outcomes among myocardial infarction (MI) patients, limited studies have assessed the association of specific forms of childhood stress with adverse cardiovascular outcomes and the role of adult life stress in these associations. This study aimed to assess 1) racial disparities in childhood and adult life stress and its association with adverse cardiovascular outcomes; 2) the association of specific forms of childhood stress with cardiovascular outcomes; and 3) the role of adult life stress and race/ethnicity in these associations.
Methods: Data from the Myocardial infarction and mental stress 2 (MIMS2) study from Emory's affiliated hospitals was used. The analytical sample included 300 MI patients aged between 18-60 years. The study outcome was time to composite adverse cardiovascular event. Childhood general trauma, physical, emotional, and sexual abuse were assessed with the Early Trauma Inventory. Logistic and linear regression were used to assess differences by race in childhood and adult stress. Kaplan-Meier survival curves were used to assess event free survival differences by race. Cox-proportional hazard regression was used to estimate hazard ratio and 95% confidence interval.
Results: Black participants (55.8%) had higher prevalence of overall childhood life stress than ‘White and other races’ (41.6%). The mean difference in adult life stress between Black and ‘White and other races’ was 1.04 score point (95% CI: -0.08, 2.17). After controlling for sex and age, Blacks had higher odds of childhood general trauma (OR=2.0; 95% CI: 1.22-3.41) and physical abuse (OR=2.0; 1.18-3.4) than ‘Whites and other races.’ Black had higher risk of a composite adverse cardiovascular event at the study end point compared to ‘White and other races’ (HR=2.2; 95% CI: 1.29-3.79). Black participants who experienced overall childhood life stress (HR=1.9; 95% CI: 1.02-3.58) and specifically, general trauma (HR=1.9; 95% CI: 1.01-3.78) were more likely to develop adverse cardiovascular outcomes at the study end point than White and other races.
Conclusion: This study identified racial disparities in childhood and adult stress, particularly general trauma, was significantly associated with adverse cardiovascular outcomes among Black individuals. Race-specific interventions to address childhood stress and reduce future adverse cardiovascular outcomes is recommended.
Table of Contents
Introduction 1
Methods 4
Data source, study design and sampling 4
Measurements 5
Study Outcome 5
Study Exposures 6
Covariates 6
Statistical analysis 7
Ethical considerations 8
Results 8
Characteristics of the study participants 8
Overall Childhood and adult life stress events 9
Specific forms of Childhood life stress events 11
Racial differences in childhood life stress events 12
Racial differences in adult life stress events 13
Racial Differences in time to adverse cardiovascular outcomes 14
The association between childhood life stress and cardiovascular outcomes 15
Discussion 17
Strength and limitations 20
Conclusion 21
Policy Implication 21
References 22
Supplemental Materials 25
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Racial disparities in the association between childhood and adult life stress and adverse cardiovascular outcomes among patients with a history of myocardial infarction in Georgia, USA () | 2024-04-25 13:10:39 -0400 |
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