Cumulative psychosocial factors are associated with cardiovascular disease risk factors and management among African Americans in the Jackson Heart Study

Abstract

Background: Racial disparities in cardiovascular disease (CVD) have been attributed in part to negative psychosocial factors. Prior studies have demonstrated associations between individual psychosocial factors and CVD risk factors, but little is known about their cumulative effects.

Methods: Using the Jackson Heart Study, we examined the cross-sectional associations of cumulative psychosocial factors with CVD risk factors among 5306 African Americans. We utilized multivariable Poisson regression to estimate sex-stratified prevalence ratios (PR 95% confidence interval-CI) of obesity, hypertension and diabetes prevalence and hypertension and diabetes control with negative affect (cynicism, anger-in, anger-out, depressive symptoms and cumulative negative affect) and stress (global stress, weekly stress, major life events-MLEs and cumulative stress), adjusting for demographics, socioeconomic status, and behaviors.

Results: After full adjustment, high (vs. low) cumulative negative affect was associated with prevalent obesity among men (PR 1.36 95% CI 1.16-1.60), while high (vs. low) cumulative stress was similarly associated with obesity among men and women (PR 1.24 95% CI 1.01-1.52 and PR 1.13 95% CI 1.03-1.23, respectively). Psychosocial factors were more strongly associated with prevalent hypertension and diabetes among men than women. For example, men who reported high cynicism had a 12% increased prevalence of hypertension (PR 1.12, 95% CI 1.03-1.23). Psychosocial factors were more strongly associated with lower hypertension and diabetes control for women than men. Women who reported high (vs. low) cynicism had a 38% lower prevalence of hypertension control (PR 0.62, 95% CI 0.46-0.84).

Conclusions: Cumulative psychosocial factors were associated with CVD risk factors and disease management among African Americans. The joint accumulation of psychosocial factors was more associated with risk factors for men than women.

Keywords: African Americans; Diabetes; Hypertension; Jackson Heart Study; Obesity; Psychosocial factors.

Fig. 1

Predicted associations of obesity prevalence (a and b), hypertension prevalence (c and d) and diabetes prevalence (e and f) with levels of cumulative negative affect and cumulative stress by sex with 95% confidence intervals-CIs, JHS 2000–2004. Notes: Fully adjusted models of the association of predicted prevalence ratios (PR, 95% CI) of obesity, hypertension, and diabetes at baseline with low, medium, and high cumulative negative affect and cumulative stress by sex. All predicted models are adjusted for age, education, income, smoking, physical activity, fat in diet, alcohol consumption, and body mass index (except in the obesity analysis). P for trend represents the linear trend across categories of cumulative negative affect and cumulative stress stratified by women and men

Fig. 2

Predicted associations of prevalent hypertension control (a and b) and prevalent diabetes control (c and d) with levels of cumulative negative affect and cumulative stress by sex with 95% confidence intervals-CIs, JHS 2000–2004. Notes: Fully adjusted models of the association of predicted prevalence ratios (PR, 95% CI) of hypertension control and diabetes control at baseline with low, medium, and high cumulative negative affect and cumulative stress by sex. All predicted models are adjusted for age, education, income, smoking, physical activity, fat in diet, alcohol consumption, and body mass index. P for trend represents the linear trend across categories of cumulative negative affect and cumulative stress stratified by women and men