Abstract
Objectives
Compared to other racial/ethnic groups, Native Americans (NAs) are more likely to develop health conditions associated with allostatic load (stress-related wear-and-tear). Psychosocial factors (i.e., adverse life events, discrimination, psychological distress) often promote stress and may help explain greater allostatic load in NAs. Moreover, previous research suggests sleep may either mediate or moderate the effects of some psychosocial stressors, like discrimination, on allostatic load. The current study investigated the relationship between adverse life events, discrimination, psychological stress, sleep, and cardiometabolic load.
Methods
Using a sample of 302 healthy, chronic pain-free NAs and non-Hispanic White (NHW) participants, bootstrapped mediation analyses were conducted to determine whether the relationship between NA race/ethnicity and cardiometabolic allostatic load (composite score of body mass index, mean arterial pressure, and heart rate variability) was mediated by psychosocial stressors. Models also assessed whether sleep disturbance served as an additional mediator or a moderator to the effects.
Results
Consistent with prior research, we found that NAs experienced greater discrimination, adverse life events (potentially traumatic events), and cardiometabolic allostatic load than NHWs. Further, discrimination was associated with increased psychological stress for NAs, but this did not explain why NAs experience higher cardiometabolic allostatic load. A moderating effect of sleep on discrimination was found, such that discrimination partially contributed to the relationship between NA race/ethnicity and cardiometabolic allostatic load, but only for participants reporting greater sleep disturbance.
Implications These findings highlight that good sleep can buffer the effect of psychosocial stress on cardiometabolic allostatic load in Native Americans.
Similar content being viewed by others
References
McEwen BS. Stress, adaptation, and disease: allostasis and allostatic load. Ann N Y Acad Sci Wiley Online Library. 1998;840:33–44.
McEwen BS, Stellar E. Stress and the individual. Mechanisms leading to disease. Arch Intern Med. 1993;153:2093–101.
McEwen BS, Bowles NP, Gray JD, Hill MN, Hunter RG, Karatsoreos IN, et al. Mechanisms of stress in the brain. Nat Neurosci Nature Publishing Group. 2015;18:1353–63.
Rodriquez EJ, Kim EN, Sumner AE, Nápoles AM, Pérez-Stable EJ. Allostatic load: importance, markers, and score determination in minority and disparity populations. J Urban Health Springer. 2019;96:3–11.
Seeman TE, McEwen BS, Rowe JW, Singer BH. Allostatic load as a marker of cumulative biological risk: MacArthur studies of successful aging. Proc Natl Acad Sci National Acad Sciences. 2001;98:4770–5.
Cadar D, Abell J, Hackett R, Davies H, Llewellyn D, Batty G, et al. Associations of allostatic load with coronary heart disease and dementia in the English longitudinal study of ageing. Innov Aging Oxford University Press US. 2018;2:271.
Goodson NJ, Smith BH, Hocking LJ, McGilchrist MM, Dominiczak AF, Morris A, et al. Cardiovascular risk factors associated with the metabolic syndrome are more prevalent in people reporting chronic pain: results from a cross-sectional general population study. PAIN®. Elsevier. 2013;154:1595–602.
McEwen B. Physiology and neurobiology of stress and adaptation: central role of the brain. Physiol Rev. 2007;87:873–904.
Duru OK, Harawa NT, Kermah D, Norris KC. Allostatic load burden and racial disparities in mortality. J Natl Med Assoc Elsevier. 2012;104:89–95.
Barnes PM, Adams PF. Powell-Griner E. United States 2004-2008: Health characteristics of the American Indian or Alaska native adult population; 2010.
Jimenez N, Garroutte E, Kundu A, Morales L, Buchwald D. A review of the experience, epidemiology, and management of pain among American Indian, Alaska Native, and Aboriginal Canadian Peoples. J Pain. 2011;12:511–22.
Tiedt JA, Brown LA. Allostatic load: the relationship between chronic stress and diabetes in Native Americans. J Theory Constr Test. Tucker Publications, Inc. 2014;18:22.
Ong AD, Williams DR. Lifetime discrimination, global sleep quality, and inflammation burden in a multiethnic sample of middle-aged adults. Cult Divers Ethn Minor Psychol. Educational Publishing Foundation. 2019;25:82.
Ramona Beltrán M, Katie Schultz M, Fernandez AR, Evans-Campbell T. From ambivalence to revitalization: Negotiating cardiovascular health behaviors related to environmental and historical trauma in a Northwest American Indian community. Am Indian Alsk Native Ment Health Res Online. UCHSC. 2018;25:103–28.
Chang DA. The color of the land: race, nation, and the politics of landownership in Oklahoma, 1832-1929: Univ of North Carolina Press; 2010.
Ellis C. To change them forever: Indian education at the Rainy Mountain Boarding School: University of Oklahoma Press; 1996.
Fryberg SA, Markus HR, Oyserman D, Stone JM. Of warrior chiefs and Indian princesses: the psychological consequences of American Indian mascots. Basic Appl Soc Psychol Taylor & Francis. 2008;30:208–18.
Urban Indian Health Institute. Missing and murdered Indigenous women & girls. 2018.
Brave Heart MYH, Chase J, Elkins J, Altschul DB. Historical trauma among indigenous peoples of the Americas: concepts, research, and clinical considerations. J Psychoactive Drugs Taylor & Francis. 2011;43:282–90.
Thayer Z, Barbosa-Leiker C, McDonell M, Nelson L, Buchwald D, Manson S. Early life trauma, post-traumatic stress disorder, and allostatic load in a sample of American Indian adults. Am J Hum Biol Wiley Online Library. 2017;29:e22943.
Thayer ZM, Blair IV, Buchwald DS, Manson SM. Racial discrimination associated with higher diastolic blood pressure in a sample of A merican I ndian adults. Am J Phys Anthropol. Wiley Online Library. 2017;163:122–8.
Castor ML, Smyser MS, Taualii MM, Park AN, Lawson SA, Forquera RA. A nationwide population-based study identifying health disparities between American Indians/Alaska Natives and the general populations living in select urban counties. Am J Public Health. American Public Health Association. 2006;96:1478–84.
Deyo RA, Mirza SK, Martin BI. Back pain prevalence and visit rates: estimates from U.S. national surveys, 2002. Spine. 2006;31:2724–7.
Fretts AM, Howard BV, Kriska AM, Smith NL, Lumley T, Lee ET, et al. Physical activity and incident diabetes in American Indians: the Strong Heart Study. Am J Epidemiol Oxford University Press. 2009;170:632–9.
Grossman DC, Krieger JW, Sugarman JR, Forquera RA. Health status of urban American Indians and Alaska Natives: a population-based study. JAMA Am Med Asso. 1994;271:845–50.
Findling MG, Casey LS, Fryberg SA, Hafner S, Blendon RJ, Benson JM, et al. Discrimination in the United States: experiences of Native Americans. Health Serv Res Wiley Online Library. 2019;54:1431–41.
Johansson P, Jacobsen C, Buchwald D. Perceived discrimination in health care among American Indians/Alaska natives. Ethn Dis. 2006;16:766–71.
Williams DR, Mohammed SA. Discrimination and racial disparities in health: evidence and needed research. J Behav Med. 2009;32:20–47 https://pubmed.ncbi.nlm.nih.gov/19030981.
Davis SK, Liu Y, Quarells RC, Din-Dzietham R. Stress-related racial discrimination and hypertension likelihood in a population-based sample of African Americans: the Metro Atlanta Heart Disease Study. Ethn Dis. 2005;15:585–93.
Cuevas AG, Wang K, Williams DR, Mattei J, Tucker KL, Falcon LM. The association between perceived discrimination and allostatic load in the Boston Puerto Rican Health Study. Psychosom Med. NIH Public Access. 2019;81:659.
Van Dyke ME, Baumhofer NK, Slopen N, Mujahid MS, Clark CR, Williams DR, et al. Pervasive discrimination and allostatic load in African American and white adults. Psychosom Med LWW. 2020;82:316–23.
Currie CL, Copeland JL, Metz GA, Chief Moon-Riley K, Davies CM. Past-year racial discrimination and allostatic load among indigenous adults in Canada: the role of cultural continuity. Psychosom Med Lippincott Williams & Wilkins 2020;82:99–107. https://pubmed.ncbi.nlm.nih.gov/31609919
Bowers ME, Yehuda R. Intergenerational transmission of stress in humans. Neuropsychopharmacology Nature Publishing Group. 2016;41:232–44.
Cave L, Cooper MN, Zubrick SR, Shepherd CCJ. Racial discrimination and allostatic load among First Nations Australians: a nationally representative cross-sectional study. BMC Public Health. 2020;20:1881.
Rhudy JL, Kuhn BL, Demuth MJ, Huber FA, Hellman N, Toledo TA, et al. Are cardiometabolic markers of allostatic load associated with pronociceptive processes in Native Americans?: a structural equation modeling analysis from the Oklahoma Study of Native American Pain Risk. J Pain Elsevier. 2021. https://doi.org/10.1016/j.jpain.2021.04.014.
Szanton SL, Gill JM, Allen JK. Allostatic load: a mechanism of socioeconomic health disparities? Biol Res Nurs Sage Publications Sage CA: Thousand Oaks, CA. 2005;7:7–15.
Tomfohr L, Pung MA, Edwards KM, Dimsdale JE. Racial differences in sleep architecture: the role of ethnic discrimination. Biol Psychol Elsevier. 2012;89:34–8.
Tomfohr LM, Pung MA, Dimsdale JE. Mediators of the relationship between race and allostatic load in African and White Americans. Health Psychol American Psychological Association. 2016;35:322.
Slopen N, Lewis TT, Williams DR. Discrimination and sleep: a systematic review. Sleep Med. 2016;18:88–95 https://pubmed.ncbi.nlm.nih.gov/25770043.
Kajeepeta S, Gelaye B, Jackson CL, Williams MA. Adverse childhood experiences are associated with adult sleep disorders: a systematic review. Sleep Med. 2015;16:320–30 https://pubmed.ncbi.nlm.nih.gov/25777485.
Cappuccio FP, Cooper D, D’Elia L, Strazzullo P, Miller MA. Sleep duration predicts cardiovascular outcomes: a systematic review and meta-analysis of prospective studies. Eur Heart J Oxford University Press. 2011;32:1484–92.
Hale L, Do DP. Racial differences in self-reports of sleep duration in a population-based study. Sleep Associated Professional Sleep Societies, LLC 2007;30:1096–1103 https://pubmed.ncbi.nlm.nih.gov/17910381
Meerlo P, Sgoifo A, Suchecki D. Restricted and disrupted sleep: effects on autonomic function, neuroendocrine stress systems and stress responsivity. Sleep Med Rev. 2008;12:197–210 https://www.sciencedirect.com/science/article/pii/S1087079207000986.
Hamilton NA, Catley D, Karlson C. Sleep and the affective response to stress and pain. Health Psychol. 2007;26:288–95.
Beatty Moody DL, Brown C, Matthews KA, Bromberger JT. Everyday discrimination prospectively predicts inflammation across 7-years in racially diverse midlife women: study of women’s health across the nation. J Soc Issues Wiley Online Library. 2014;70:298–314.
John-Henderson NA, Palmer CA, Thomas A. Life stress, sense of belonging and sleep in American Indian college students. Sleep Health. 2019;5:352–8.
Rhudy JL, Lannon EW, Kuhn BL, Palit S, Payne MF, Sturycz CA, et al. Assessing peripheral fibers, pain sensitivity, central sensitization, and descending inhibition in Native Americans: main findings from the Oklahoma. Study of Native American Pain Risk Pain. 2020;161:388–404 https://pubmed.ncbi.nlm.nih.gov/31977838.
Bebbington P, Nayani T. The psychosis screening questionnaire. Int J Methods Psychiatr Res. 1995;5:11–9.
Juster R-P, McEwen BS, Lupien SJ. Allostatic load biomarkers of chronic stress and impact on health and cognition. Neurosci Biobehav Rev Elsevier. 2010;35:2–16.
Niskanen J-P, Tarvainen MP, Ranta-Aho PO, Karjalainen PA. Software for advanced HRV analysis. Comput Methods Programs Biomed Elsevier. 2004;76:73–81.
Williams DR, Yu Y, Jackson JS, Anderson NB. Racial differences in physical and mental health: Socio-economic status, stress and discrimination. J Health Psychol Sage Publications Sage CA: Thousand Oaks CA. 1997;2:335–51.
Blake DD, Weathers FW, Nagy LM, Kaloupek DG, Gusman FD, Charney DS, et al. The development of a clinician-administered PTSD scale. J Trauma Stress US: John Wiley & Sons. 1995;8:75–90.
Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index (PSQI): a new instrument for psychiatric research and practice. Psychiatry Res. 1989;28:193–213.
Bastien CH, Vallières A, Morin CM. Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Med Elsevier. 2001;2:297–307.
Morin CM, Belleville G, Bélanger L, Ivers H. The Insomnia Severity Index: psychometric indicators to detect insomnia cases and evaluate treatment response. Sleep J Sleep Sleep Disord Res. 2011;34:601–8.
Krupp LB, LaRocca NG, Muir-Nash J, Steinberg AD. The fatigue severity scale: application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol American Medical Association. 1989;46:1121–3.
Lichstein KL, Means MK, Noe SL, Aguillard RN. Fatigue and sleep disorders. Behav Res Ther. 1997;35:733–40 https://www.sciencedirect.com/science/article/pii/S0005796797000296.
Valko PO, Bassetti CL, Bloch KE, Held U, Baumann CR. Validation of the fatigue severity scale in a Swiss cohort. Sleep Associated Professional Sleep Societies, LLC 2008;31:1601–1607 https://pubmed.ncbi.nlm.nih.gov/19014080
Riedel BW, Lichstein KL. Insomnia and daytime functioning. Sleep Med Rev. 2000;4:277–98 https://www.sciencedirect.com/science/article/pii/S1087079299900746.
Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24:385–96.
Derogatis LR. SCL-90-R : symptom checklist-90-R : administration, scoring & procedures manual. [Minneapolis, Minn.]: [National Computer Systems, Inc.] 1994.
Crimmins EM, Johnston M, Hayward M, Seeman T. Age differences in allostatic load: an index of physiological dysregulation. Exp Gerontol Elsevier. 2003;38:731–4.
Shiels PG, Stenvinkel P, Kooman JP, McGuinness D. Circulating markers of ageing and allostatic load: a slow train coming. Pract Lab Med Elsevier. 2016;7:49–54 https://pubmed.ncbi.nlm.nih.gov/28856219.
Kinnunen M-L, Kaprio J, Pulkkinen L. Allostatic load of men and women in early middle age. J Individ Differ Germany: Hogrefe & Huber Publishers. 2005;26:20–8.
Hayes AF. Introduction to mediation, moderation, and conditional process analysis: a regression-based approach: Guilford publications; 2017.
Wilcox RR. Understanding and applying basic statistical methods using R: John Wiley & Sons; 2016.
Jöreskog KG, Sörbom D. LISREL 8.80. Chic Sci Softw Int. 2006.
Kingsbury JH, Buxton OM, Emmons KM, Redline S. Sleep and its relationship to racial and ethnic disparities in cardiovascular disease. Curr Cardiovasc Risk Rep Springer. 2013;7:387–94.
Ehlers CL, Wills DN, Lau P, Gilder DA. Sleep quality in an adult American Indian Community sample. J Clin Sleep Med JCSM Off Publ Am Acad Sleep Med. 2017;13:385–91 https://pubmed.ncbi.nlm.nih.gov/27998373.
Sabanayagam C, Shankar A, Buchwald D, Goins RT. Insomnia symptoms and cardiovascular disease among older American Indians: the Native Elder Care Study. J Environ Public Health Hindawi Publishing Corporation. 2011;2011:964617.
Nuyujukian DS, Anton-Culver H, Manson SM, Jiang L. Associations of sleep duration with cardiometabolic outcomes in American Indians and Alaska Natives and other race/ethnicities: results from the BRFSS. Sleep Health. 2019;5:344–51.
Stamatakis KA, Kaplan GA, Roberts RE. Short sleep duration across income, education, and race/ethnic groups: population prevalence and growing disparities during 34 years of follow-up. Ann Epidemiol Elsevier. 2007;17:948–55.
Zizi F, Pandey A, Murrray-Bachmann R, Vincent M, McFarlane S, Ogedegbe G, et al. Race/ethnicity, sleep duration, and diabetes mellitus: analysis of the National Health Interview Survey. Am J Med Elsevier. 2012;125:162–7.
El-Sheikh M, Tu KM, Saini EK, Fuller-Rowell TE, Buckhalt JA. Perceived discrimination and youths’ adjustment: sleep as a moderator. J Sleep Res. 2016;25:70–7 https://pubmed.ncbi.nlm.nih.gov/26260026.
De Castro A, Voss JG, Ruppin A, Dominguez CF, Seixas NS. Stressors among Latino day laborers: a pilot study examining allostatic load. AAOHN J SAGE Publications Sage CA: Los AngelesCA. 2010;58:185–96.
Mays VM, Cochran SD, Barnes NW. Race, race-based discrimination, and health outcomes among African Americans. Annu Rev Psychol Annual Reviews. 2007;58:201–25.
Massey D, Wagner B, Major B, Dovidio J. Link B. Discrimination, and Health: The Oxford Handbook of Stigma; 2016.
McEwen BS. Protective and damaging effects of stress mediators: the good and bad sides of the response to stress. Metabolism. 2002;51:2–4.
Howard BV, Lee ET, Cowan LD, Devereux RB, Galloway JM, Go OT, et al. Rising tide of cardiovascular disease in American Indians: the Strong Heart Study. Circulation Am Heart Assoc. 1999;99:2389–95.
Danese A, McEwen BS. Adverse childhood experiences, allostasis, allostatic load, and age-related disease. Physiol Behav Elsevier. 2012;106:29–39.
Cohen S, Kessler RC, Gordon LU. Measuring stress: a guide for health and social scientists: Oxford University Press on Demand; 1997.
Ross E, Huber F, Kuhn B, Lannon E, Sturycz C, Payne M, et al. (232) Assessing chronic pain onset in Native Americans: follow-up results from the Oklahoma Study of Native American Pain Risk (OK-SNAP). J Pain Elsevier. 2019;20:S33.
Nolan CJ, Damm P, Prentki M. Type 2 diabetes across generations: from pathophysiology to prevention and management. The Lancet Elsevier. 2011;378:169–81.
Dabelea D, Hanson RL, Lindsay RS, Pettitt DJ, Imperatore G, Gabir MM, et al. Intrauterine exposure to diabetes conveys risks for type 2 diabetes and obesity: a study of discordant sibships. Diabetes Am Diabetes Assoc. 2000;49:2208–11.
Franks PW, Looker HC, Kobes S, Touger L, Tataranni PA, Hanson RL, et al. Gestational glucose tolerance and risk of type 2 diabetes in young Pima Indian offspring. Diabetes Am Diabetes Assoc. 2006;55:460–5.
Steptoe A, Hackett RA, Lazzarino AI, Bostock S, La Marca R, Carvalho LA, et al. Disruption of multisystem responses to stress in type 2 diabetes: investigating the dynamics of allostatic load. Proc Natl Acad Sci National Acad Sciences. 2014;111:15693–8.
Data and Materials Availability
Means, standard deviations, and intercorrelations necessary to replicate the analyses are provided in the manuscript. Deidentified raw data are available upon request.
Funding
This research was supported by the National Institute on Minority Health and Health Disparities of the National Institute of Health under award number R01MD007807. Edward Lannon was supported by a National Science Foundation Graduate Research Fellowship Program.
Author information
Authors and Affiliations
Contributions
J.O.S. served as one of the primary investigators, designed the study, and wrote most of the manuscript. P.A.K. helped write the manuscript. T.A.T., F.A.H., B.L.K., E.W.L., N.H., C.A.S., and E.N.R. collected data and provided revisions to the manuscript. J.L.R. served as the primary investigator, designed the study, analyzed the data, and helped write the manuscript. All authors read and approved the final manuscript.
Corresponding author
Ethics declarations
Ethics Approval
The study was approved by IRBs of The University of Tulsa, Cherokee Nation, and the Indian Health Service Oklahoma City Area Office.
Conflicts of Interest
The authors declare no competing interests.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Shadlow, J.O., Kell, P.A., Toledo, T.A. et al. Sleep Buffers the Effect of Discrimination on Cardiometabolic Allostatic Load in Native Americans: Results from the Oklahoma Study of Native American Pain Risk. J. Racial and Ethnic Health Disparities 9, 1632–1647 (2022). https://doi.org/10.1007/s40615-021-01103-7
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40615-021-01103-7