Date of Award

January 2016

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Judith Lichtman

Abstract

Background: Perceived discrimination (PD) have been previously linked with multiple physiological and behavioral health risks. However, limited data is available on the association between PD and clinically relevant outcomes, such as the frequency and severity of angina.

Method: This thesis explores the association between PD and angina outcomes using data from the Examining Heart Attacks in Young Women (VIRGO) study, which enrolled 2,670 patients with prior acute myocardial infarction (AMI). The Detroit Area Scale and the Seattle Angina Questionnaire (SAQ) were employed to assess perceived discrimination and angina-related outcomes, including its onset frequency and related physical limitation, treatment dissatisfaction and disease perception. I used logistic regression model to examine the effect of PD on the above outcomes at both 1-month and 12-month post AMI.

Results: The analysis revealed a robust association between PD and increased risk for angina occurrence at 1-month (OR 1.57, 95% CI 1.14-2.15 for high PD) and angina-related physical limitation at 12-month (OR 1.66, 95% CI 1.14-2.42 for high PD). This association remained statistically significant after adjusting for socio-demographic, psychophysical and medical access factors, and appeared to be dose-responsive for the degree of discrimination. Furthermore, PD was associated with a higher risk of depression, which in turn is a strong predictor for worsened angina outcomes. Interestingly, only a small number of participants indicated that the discriminatory cases were of gender or race reason. And the largest proportion of participants did not know the cause for their discriminatory experience.

Conclusions: In AMI survivors sample analyzed in this study, PD is associated with increased risk of angina, and with worsened angina-related outcomes in all domains. This data supports programs for reducing PD as preventative measures for angina in AMI survivors.

Comments

This is an Open Access Thesis.

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