In:
Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 147, No. Suppl_1 ( 2023-02-28)
Abstract:
Background: The John Henryism Hypothesis (JHH) posits that repeated high-effort coping in response to systemic social and economic stressors accelerates physiological wear and tear and is, as a result, a major contributor to the well-documented high cardiovascular disease (CVD) risk among African American adults, especially the poor and working-class. There is, however, a paucity of studies that test the JHH using multiple socioeconomic status (SES) indicators and include incident CVD events among African American adults. Objective: Determine whether the associations between SES indicators and CVD events are moderated by John Henryism (JH). Hypothesis: The inverse association between SES and CVD events will be more pronounced among those who score “high” on the 12-item John Henryism Scale for Active Coping (JHAC) versus those who do not. Methods: Jackson Heart Study participants with complete data and no CVD at baseline (2000-2004) were utilized (n=1828, mean age: 52.15 years). SES indicators included insurance status, income, years of education, and years of maternal and paternal education. JH was defined using a tertile distribution of the JHAC scores (0-36): low JHS ( 〈 28), moderate JHS (29-32), and high JH ( 〉 32). CVD events from baseline to 2016 included coronary heart disease (CHD), stroke, and heart failure (HF). Cox proportional hazards regressions determined the hazard ratio (HR, 95% CI) of CVD events by SES variables. Moderation by JH was determined by including interaction terms in the models and stratification of results. Models were adjusted for age, sex, smoking, physical activity, nutrition, obesity, hypertension, and diabetes. Results: There were 94, 61, and 100 CHD, stroke, and HF events, respectively that occurred by 2016 (mean follow-up: 13 years for CHD and Stroke and 10 years for HF). Each SES indicator was inversely associated with CVD events, except for income (only associated with HF) and insurance (not associated with CHD). There was a significant interaction between income and JH in the hazard of HF (p=0.04). Specifically, low-income participants with high JH had a greater hazard of HF after full adjustment (HR 1.85, 95% CI 1.21, 2.83). Low-income participants with low JH also had a greater hazard of HF (HR 1.43, 95% CI 1.06, 1.93) after adjustment for age and sex, but the association attenuated after adding health behaviors and risk factors. Conclusion: Engaging in high-effort coping and having low SES is detrimental to cardiovascular health. The association between income and HF was moderated by JH, thus interventionists should consider interactions between SES and high-effort coping when exploring ways to prevent CVD.
Type of Medium:
Online Resource
ISSN:
0009-7322
,
1524-4539
DOI:
10.1161/circ.147.suppl_1.MP40
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2023
detail.hit.zdb_id:
1466401-X
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