OBJECTIVES:Numerous studies link low objective and subjective socioeconomic status (SES) to chronic activation of the hypothalamic pituitary adrenal (HPA) axis. Here, we examine associations between objective and subjective SES and diurnal salivary cortisol, a primary HPA component, as well as demographic and ecological predictors associated with SES perceptions and changes in diurnal cortisol. METHODS:Participants were residents (age 18-79, n = 61) of Utila, a Honduran island where economic disparities are overt and geographically contained. Objective SES was measured as a composite of income, education, and occupation. Subjective SES was measured with a MacArthur ladder and a perceived lifestyle discrepancy (PLD) scale. Salivary cortisol was collected three times per day for two days. Questions addressing demographic, social, and household characteristics were assessed as predictors of PLD. RESULTS:Assessed independently, objective SES (P = .06) and PLD (P = .003) were associated with the steepness of diurnal cortisol changes, while PLD was also associated with higher cortisol area under the curve (AUC) (P = .036). Modeled together, only PLD predicted diurnal slope and AUC. PLD was associated with household sanitation, immigration status, food scarcity, objective SES, and owing money. Only access to sanitation and owing money had direct associations with cortisol that were not mediated by PLD. CONCLUSIONS:For adults on Utila, perceptions of unmet need outweigh other social and economic status factors in predicting cortisol AUC and slope. In addition, the unmediated effects of access to sanitation and owing money on cortisol suggest that these distinct aspects of inequality are important to consider when seeking to understand how inequality can impact HPA function.

译文

目的:许多研究将低客观和主观的社会经济地位(SES)与下丘脑垂体肾上腺(HPA)轴的慢性激活联系起来。在这里,我们研究了客观和主观SES与昼夜唾液皮质醇(HPA的主要成分)之间的关联,以及与SES感知和昼夜皮质醇变化相关的人口和生态预测因子。
方法:参与者是洪都拉斯岛乌蒂拉岛(Utila)的居民(年龄18-79岁,n =)61),那里的经济差异明显且地理分布有限。客观SES是收入,教育和职业的综合指标。使用MacArthur阶梯和感知的生活方式差异(PLD)量表测量主观SES。每天两次收集唾液皮质醇,持续两天。解决人口,社会和家庭特征的问题被评估为PLD的预测因素。
结果:独立评估,客观SES(P = .06)和PLD(P = .003)与昼夜皮质醇变化的陡度有关,而PLD也与曲线下的高皮质醇面积(AUC)有关(P =)。 036)。一起建模,只有PLD预测日斜率和AUC。 PLD与家庭卫生,移民状况,食物短缺,客观的SES和欠款有关。只有获得卫生条件和欠款才与皮质醇有直接联系,而这种联系不是由PLD调解的。
结论:对于Utila地区的成年人来说,在预测皮质醇AUC和坡度时,未满足需求的感知要超过其他社会和经济状况因素。此外,获得卫生设施和欠款对皮质醇的无中介影响表明,在试图了解不平等如何影响HPA功能时,应考虑到不平等的这些不同方面。

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