Psychosocial factors in relation to risk of diabetes and weight gain in African-American women
Bacon, Kathryn L.
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Two serious adverse health effects of obesity are development of cardiovascular disease and type 2 diabetes, which may also lead to stroke, kidney failure, blindness, and non-traumatic amputations. Diabetes and obesity occur more commonly among U.S. African-American women than among white women. One postulated mechanism in the development of obesity and diabetes is disruption of the neuroendocrine system by chronic psychosocial stress. Using data from the Black Women’s Health Study (BWHS), we examined three psychosocial stressors more prevalent in African-American women than white women, and their possible contribution to the incidence of diabetes and obesity among African-American women. Study 1 examined perceived racism and incidence of diabetes over 16 years (1997–2013), among 45,781 women. Women with higher scores for perceived everyday or lifetime racism had greater risk of diabetes compared to women with lesser exposure. Mediation by BMI may have accounted for half of these associations. Study 2 examined abuse victimization with incidence of diabetes in adulthood over eight years (2005–2013), among 29,193 women. Compared to women reporting no abuse in their life span, there was an increased risk of diabetes among women who experienced abuse only during adolescence, or only adolescence and childhood. Higher frequency of sexual abuse or greater severity of abuse increased risk of diabetes. There was some evidence for mediation by BMI, and as a modifier; in stratified analyses overweight women experienced an increased risk of diabetes with childhood sexual abuse. Study 3 evaluated the association of night shift work and weight change over an eight year period (2005–2013), among 28,565 women. Stratified analyses showed BMI modified the association: normal and overweight women who worked a night shift gained significantly more weight than women who did not work a night shift; this was not found among obese women. Younger night shift workers who worked 10 or more years appeared to gain more weight than younger non-night shift workers. In conclusion, there is evidence that perceived racism, abuse, and night shift work may be psychosocial stressors whose downstream effects may contribute to type 2 diabetes and weight gain among African-American women.