Race Difference in Physical and Mental Health Disparities:

a MiCDA Research Project Description

Investigators: James S. Jackson

Funding: Robert Wood Johnson Foundation, 2010-2014 (67864)

Compared to non-Hispanic whites, black Americans have greater physical health morbidity and mortality at every point during their life spans. Higher rates of hypertension, cardiovascular disease and Type II diabetes place black Americans disproportionally at increased risk for death and disability from stroke and coronary disease. For example, black women are twice as likely as white women to die of hypertensive cardiovascular disease. Blacks have a lower life expectancy (70 years) than whites (77 years), with black men having a life expectancy of only 66 years. Although the causes of these differences are debated, the existence of disparities cannot be questioned. Attention paid to disparities in physical health conditions has obscured an interesting paradox: the lack of disparities (or disparities favoring blacks) in mental disorders among black and white race groups. Psychiatric epidemiologists have long argued that the stress associated with disadvantaged status and discrimination increases the vulnerability of black Americans to physical and mental health disorders. Findings from several studies, including the Epidemiologic Catchment Area (ECA) Study, the National Comorbidity Studies (NCS and NCS-R), and the National Survey of American Life (NSAL), however, indicate that in comparison to whites, black Americans have similar or lower rates for most mental disorders; and, in many respects better than might be expected based on the hypothesized effects of discrimination and other unique stressors associated with racial group status. We hypothesize and present a complex framework in our work that involves environmental factors, chronic stressors, and the stress response through the HPA-Axis and related hormonal systems, to account for the contrasting interrelationships among mental disorders and metabolic and other physical health outcomes. We are examining this observed epidemiological, clinical, and behavioral paradox through studies of existing epidemiological datasets, population based epidemiological studies with biomarkers, and clinic based (population selected), closed cohort, longitudinal panel studies of cardiovascular and Type II diabetes, and related metabolic physical disorders’ risk behaviors, and clinical health biomarkers; and the potential mediating influences of these biomarkers for stress and HPA functioning, and increased risks for mood disorders among black American and non-Hispanic white patients. We believe that the proposed framework and study may address a critical problem in metabolic health disorders -- the lack of patient adherence to life-style and other behavioral changes requested by physicians to address identified risk factors that exacerbate metabolic health disorders. Understandings gained form this research can be used to develop more effective interventions and policies to address new techniques of behavioral adherence and control of physician mandated changes in lifestyle and related health behaviors.

Research Signature Themes:

Disparities by Race, Ethnicity, and Socioeconomic Status

Country of Focus: USA