Neighborhood poverty and hemodynamic, neuroendocrine, and immune response to acute stress among patients with coronary artery disease.
Acute Disease
Adult
Aged
Coronary Artery Disease
/ complications
Female
Hemodynamics
/ physiology
Humans
Immune System
/ physiopathology
Male
Middle Aged
Neurosecretory Systems
/ physiopathology
Poverty
/ psychology
Residence Characteristics
/ statistics & numerical data
Risk Factors
Social Class
Socioeconomic Factors
Stress, Psychological
/ complications
Sympathetic Nervous System
/ physiopathology
United States
/ epidemiology
Blood pressure
Hemodynamics
Inflammation
Mental stress
Neuroendocrine
Sympathetic nervous system
Journal
Psychoneuroendocrinology
ISSN: 1873-3360
Titre abrégé: Psychoneuroendocrinology
Pays: England
ID NLM: 7612148
Informations de publication
Date de publication:
02 2019
02 2019
Historique:
received:
04
06
2018
revised:
30
08
2018
accepted:
28
09
2018
pubmed:
20
10
2018
medline:
25
3
2020
entrez:
19
10
2018
Statut:
ppublish
Résumé
Living in neighborhoods characterized by poverty may act as a chronic stressor that results in physiological dysregulation of the sympathetic nervous system. No previous study has assessed neighborhood poverty with hemodynamic, neuroendocrine, and immune reactivity to stress. We used data from 632 patients with coronary artery disease. Patients' residential addresses were geocoded and merged with poverty data from the 2010 American Community Survey at the census-tract level. A z-transformation was calculated to classify census tracts (neighborhoods) as either having 'high' or 'low' poverty. Systolic blood pressure, diastolic blood pressure, heart rate, rate-pressure product, epinephrine, interleukin-6, and high-sensitivity C-reactive protein were measured before and after a public speaking stress task. Multilevel models were used for repeated measures and accounting for individuals nested within census tracts. Adjusted models included demographics, lifestyle and medical risk factors, and medication use. Another set of models included propensity scores weighted by the inverse probability of neighborhood status for sex, age, race, and individual-level income. The mean age was 63 years and 173 were women. After adjusting for potential confounders, participants living in high (vs. low) poverty neighborhoods had similar hemodynamic values at rest and lower values during mental stress for systolic blood pressure (157 mmHg vs. 161 mmHg; p = 0.07), heart rate (75 beats/min vs. 78 beats/min; p = 0.02) and rate-pressure product (11839 mmHg x beat/min vs 12579 mmHg x beat/min; p = 0.01). P-values for neighborhood poverty-by-time interactions were <0.05. Results were similar in the propensity weighted models. There were no significant differences in inflammatory and epinephrine responses to mental stress based on neighborhood poverty status. A blunted hemodynamic response to mental stress was observed among participants living in high poverty neighborhoods. Future studies should explore whether neighborhood poverty and blunted hemodynamic response to stress translate into differences in long-term cardiovascular outcomes.
Identifiants
pubmed: 30336337
pii: S0306-4530(18)30550-X
doi: 10.1016/j.psyneuen.2018.09.040
pmc: PMC6530548
mid: NIHMS1509757
pii:
doi:
Types de publication
Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
145-155Subventions
Organisme : NHLBI NIH HHS
ID : R56 HL126558
Pays : United States
Organisme : NIAID NIH HHS
ID : R38 AI140299
Pays : United States
Organisme : NICHD NIH HHS
ID : K01 HD074726
Pays : United States
Organisme : NHLBI NIH HHS
ID : K24 HL077506
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL125246
Pays : United States
Organisme : NHLBI NIH HHS
ID : T32 HL130025
Pays : United States
Organisme : NHLBI NIH HHS
ID : K23 HL127251
Pays : United States
Organisme : NHLBI NIH HHS
ID : P01 HL086773
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR000454
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR002378
Pays : United States
Organisme : NIMH NIH HHS
ID : K24 MH076955
Pays : United States
Organisme : NCATS NIH HHS
ID : KL2 TR000455
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL109413
Pays : United States
Organisme : NICHD NIH HHS
ID : K12 HD085850
Pays : United States
Organisme : NIA NIH HHS
ID : U54 AG062334
Pays : United States
Organisme : NHLBI NIH HHS
ID : P20 HL113451
Pays : United States
Organisme : NHLBI NIH HHS
ID : P01 HL101398
Pays : United States
Informations de copyright
Copyright © 2018 Elsevier Ltd. All rights reserved.
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