Association between Goal-Striving Stress and Rapid Kidney Function Decline among African Americans: The Jackson Heart Study

Abstract

African Americans (AAs) are disproportionately affected by kidney disease and also report higher psychosocial stressors than other racial groups. Goal-striving stress (GSS) is an understudied psychosocial stressor related to attempting to accomplish one’s life goals. Given the numerous social determinants that contribute to health inequities among AAs, stress from goal striving may also disproportionately affect the health of AAs and in particular kidney disease outcomes. The objective of this study was to explore the association between GSS and rapid kidney function decline (RKFD) in an AA cohort. Using examination 1 (2000–2004) and examination 3 (2009–2013) data from the Jackson Heart Study (n=2630), we examined associations of baseline levels of GSS with RKFD among AAs using multivariable Poisson regression models, adjusting for sociodemographics, health behaviors, chronic disease and discrimination. We also explored baseline cortisol as a mediator. The incidence of RKFD in this sample was 7.34% (mean years of follow-up: 8.06±0.84 years). The mean GSS score was 3.80 (±4.88) and total GSS score ranged from 0 to 36. Those who reported high (vs low) GSS were 1.60 times more likely to experience RKFD after full adjustment (incidence rate ratio (IRR) 1.60; 95% CI 1.11 to 2.14, p=0.01). After confirming cortisol as a mediator and adding it to the model, those who reported high (vs low) GSS had 1.58 times the rate of RKFD (IRR 1.58; 95% CI 1.09 to 2.30, p=0.0153). Stress related to not achieving goals was associated with a greater risk of RKFD in this sample of AAs.

A Scoping Review of Life-Course Psychosocial Stress and Kidney Function

“…Adjei et al reported associations between stress at work/home and increased albuminuria and CKD risk [ 24 ]. Other psychosocial stress such as goal-striving stress (GSS) and stress-related disorders were associated with rapid kidney function decline (RKFD) after adjusting for demographics, health behaviors, risk factors, and the burden of discrimination [ 3 , 25 , 26 ]. In contrast, higher optimism was associated with lower odds of CKD and lower odds of RKFD [ 27 ].…”

“…Articles included n = 2 cross-sectional studies [ 19 , 24 ], n = 1 retrospective cohort [ 20 ], n = 8 prospective cohort studies [ 3 , 19 , 21 , 22 , 23 , 25 , 26 , 27 , 28 ] and n = 8 animal model studies [ 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ]. The epidemiological studies included data for adults with different age distributions, ethnic compositions and who lived in both urban and rural areas.…”

“…The included epidemiological studies used a variety of methodologies to define and assess psychosocial stress as different explanatory variables: global perceived stress [ 33 ], low socioeconomic status [ 19 , 20 , 22 , 23 ], perceived discrimination [ 28 ], four constructs of psychological stress [ 24 ], psychosocial well-being [ 3 ], dispositional optimism [ 27 ], goal-striving stress [ 26 ], and clinical diagnosis of stress-related disorders [ 25 ]. The authors describe the use of self-administered questionnaires, including specific questions within a validated tool (e.g., Psychosocial Well-being Index short-form [ 3 ], 6-item Life Orientation Test-Revised scale LOT-R, INTERHEAR´s psychological stress scale, list of threatening experience—LTE, Patient Health Questionnaire—PHQ 9, 9-item Discrimination Scale of the Experience of Discrimination questionnaire, Socioeconomic Status) [ 3 , 19 , 20 , 21 , 22 , 24 , 27 , 28 ].…”

“…Kidney function among population-based studies included baseline and repeated measures of serum/plasma creatinine and urinary albumin. The primary outcomes were the prevalence or incidence of CKD and CKD progression assessed through the estimated glomerular filtration rate (eGFR) decline [ 3 , 26 , 27 ]. GFR was estimated for using either the “Modification of Diet in Renal Disease (MDRD) Study” [ 19 , 20 , 22 ] or the Chronic Kidney Disease Epidemiology Collaboration equation models [ 3 , 24 , 25 , 26 , 27 , 37 ].…”

“…The primary outcomes were the prevalence or incidence of CKD and CKD progression assessed through the estimated glomerular filtration rate (eGFR) decline [3,26,27]. GFR was estimated for using either the "Modification of Diet in Renal Disease (MDRD) Study" [19,20,22] or the Chronic Kidney Disease Epidemiology Collaboration equation models [3,[24][25][26][27]37].…”