Perceived discrimination — unfair treatment because of their race, gender, ethnicity, socioeconomic status, or other factors — in daily life was common among young survivors of myocardial infarction (MI) and was associated with poorer recovery, new research shows.
In this study, patients completed three questionnaires assessing perceived discrimination, general mental and physical health, physical health, and quality of life related to angina pectoris, while in hospital and 1 month and 12 months later.
Perceived discrimination was reported by 35% of patients, and patients with higher levels of perceived discrimination had a higher likelihood of reporting physical limitations and angina symptoms at 1 month and 1 year when recovering MI, independent of other factors.
Andrew J. Arakaki, MPH, presented these results from 2,670 patients in the Variation in Recovery: Role of Gender on Outcomes (VIRGO) study at the 2022 Scientific Sessions of the American Heart Association (AHA).
The results demonstrate “that perceived discrimination has an independent deleterious impact on patient-reported health status during the first year of recovery,” after controlling for “several important sociodemographic, clinical, and psychosocial factors.” -he declares. lecoeur.org | Medscape Cardiology in an email.
“Much of the existing literature has focused on the impact of discrimination experienced in healthcare settings on health outcomes,” noted Arakaki, a doctoral student in the Department of Chronic Disease Epidemiology at Yale. School of Public Health in New Haven, Connecticut.
“Our study demonstrates that discrimination experienced outside of the healthcare system also negatively impacts AMI outcomes,” he said.
“Perceived discrimination impacted all specific cardiac outcomes measured using the [Seattle Angina Questionnaire] but was not associated with general physical health status,” he explained, “suggesting that perceived discrimination may be particularly important in patients with cardiovascular disease.”
“We were surprised to find out how common perceived discrimination was among participants in our study sample, and healthcare professionals should be aware that it appears to play an important role in patients’ recovery,” said Arakaki said in an AHA press release.
This may be particularly important to consider when treating young patients (aged 18 to 55) recovering from myocardial infarction, he added.
“Future research is needed to understand how to support patients with high levels of perceived discrimination during heart attack recovery and whether perceived discrimination is a stronger determinant of outcomes among people of diverse racial, ethnic, or social groups. or those who live in disadvantaged communities, or whether other social determinants of health may also play a role,” Arakaki added.
Viola Vaccarino, MD, PhD, who was not involved in this research but is the lead author of a related study, among others, said these findings are consistent with a large literature linking psychological stress to poor health. outcomes in cardiac patients.
“This is yet further evidence that the sphere of psychosocial adversity needs attention in the assessment and counseling of patients with heart disease,” Vaccarino, Professor and Chair, Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, Told lecoeur.org | Medscape Cardiology in an email.
“The Discrimination Scale is a continuous measure capturing both the number and frequency of various types of discrimination exposures that are not uncommon in the population,” she said, “so a rate of 35% is not at all surprising when defined as a score > 0.”
Microaggressions and MI Recovery
Perceived discrimination refers to the perceived indignities, microaggressions and other types of mistreatment that members of privileged groups inflict on members of disadvantaged groups, Arakaki said.
Perceived discrimination has been associated with biomarkers of cardiovascular disease, risk factors for myocardial infarction, and risk of myocardial infarction in middle-aged and older adults.
To investigate discrimination and outcomes among young adults who survived MI, researchers analyzed data from the VIRGO study, which recruited twice as many women as men.
The current study included 2,670 adults aged 18 to 55 who were hospitalized for MI from August 2008 to May 2012.
Two-thirds were women. Most patients (76%) were white, 17% were black, 6% were American Indian/Alaska Native, Asian, Pacific Islander, or East Indian, and 7.7 % were Hispanic.
Patients completed three questionnaires – the Daily Discrimination Scale, the Seattle Angina Questionnaire, and the 12-Point Survey (SF-12) (with a physical health component and a mental health component) at hospital, then 1 month and 12 months later.
They were asked to indicate the main source of discrimination they experienced, if any – race, ethnicity, gender, age, income, language, physical appearance, sexual orientation or other – explained Arakaki.
In the “other” category, patients reported perceived discrimination based on their occupation, level of education, medical history or disability, or personal history (divorce, prior incarceration, prior abuse or drug use).
The researchers used the Daily Discrimination Scale, with an added question number 10, which has been used in other studies.
Patients had to answer “never”, “rarely”, “sometimes” or “often” in response to 10 questions:
“In your daily life, how often do any of the following things happen to you?
1. You are treated less courteously than others.
2. You are treated with less respect than others.
3. You receive worse service than other people in restaurants or stores.
4. People act like they think you’re not smart.
5. People act like they’re scared of you.
6. People act like they think you’re dishonest.
7. People act like they’re better than you.
8. You are insulted or insulted.
9. You are threatened or harassed.
10. People ignore you or act like you’re not there.”
Responses were scored as never (0), rarely (1), sometimes (2), and often (3) for each item, giving a total of 0 to 30, with higher scores indicating greater perceived discrimination .
Data were adjusted for sociodemographic variables (gender, race, marital status, education level, employment status, income level, and health insurance status), medical history, and cardiac risk factors ( hypertension, diabetes, hypercholesterolemia, history of smoking, obesity, history of heart failure, previous MI, previous stroke, previous transient ischemic attack, history of peripheral arterial disease, renal dysfunction, lung disease chronic obstructive disorder, history of major psychiatric disorders) and psychosocial factors (history of depression, perception of social support and low social support at baseline).
The authors and Vaccarino have reported no relevant financial information.
2022 American Heart Association (AHA) Scientific Sessions. Abstract 547.
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