Graduation Year

2019

Document Type

Dissertation

Degree

Ph.D.

Degree Name

Doctor of Philosophy (Ph.D.)

Degree Granting Department

Nursing

Major Professor

Carmen Rodriguez, Ph.D., ANP-BC, AOCN

Committee Member

Ponrathi Athilingam, Ph.D., RN, A.C.N.P.F.A.A.N.P

Committee Member

Kevin Kip, Ph.D., F.A.H.A.

Committee Member

Ji Ming, Ph.D.

Keywords

Blacks, Cardiovascular outcomes, Cardiovascular risk factors, Perceived discrimination

Abstract

Despite the consistent reduction in morbidity and mortality associated with cardiovascular disease (CVD) over the last four decades, CVD remains the leading cause of death globally. In the United States, Blacks are disproportionately affected by CVD compared to Whites. Blacks are also more likely to report incidence of perceived discrimination. Perceived discrimination has been linked to cardiovascular risk factors such as smoking, hypertension (HTN), hyperlipidemia, and obesity. However, the relationship between perceived discrimination and cardiovascular outcomes such as stroke, myocardial infarction, acute ischemic syndrome, coronary revascularization, and cardiac death remains unclear. The primary goal of this study was to examine whether there is a relationship between perceived discrimination and cardiovascular events. The specific aims of this study were: (1) to examine the relationship between perceived discrimination and cardiovascular events in Blacks in the Heart SCORE Study, and (2) to evaluate whether age, sex, education, income, smoking, physical activity, and stress moderate the relationship between perceived discrimination and cardiovascular events in Blacks. Cox regression and Kaplan Meier Methods were utilized to model the relationship between perceived discrimination and cardiovascular events among Blacks in the Heart SCORE study. In relation to Aim 1, the study found not enough evidence to indicate a statistically significant association between the predictor of perceived discrimination and cardiovascular health events in Black participants in the Heart SCORE study. Model 2 had the best model fit and included four variables of Everyday Discrimination Scale-1, Everyday Discrimination Scale-2, age, and gender. Model 2 (-2 LL = 646.29) was significantly improved over the baseline model with no predictors [-2LL = 670.39; Χ2 (5) = 27.21, p < .0005]. The second model was also a significant improvement over the first model with 3 predictors ( Χ2 (2) = 22.53, p < .0005). The predictor of age was statistically significant [HR = 1.07; 95% CI for HR [1.03, 1.11], p < .005]. The predictor of gender was also statistically significant [HR = 0.46; 95% CI for HR [0.25, 0.76], p = .003].

For Aim 2, none of the interaction terms tested reached statistical significance. Therefore, age, gender, physical activity, smoking, income, education and stress did not modify the relationship between perceived discrimination and cardiovascular events among Black participants in the Heart SCORE study.

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