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Association between goal-striving stress and rapid kidney function decline among African Americans: the Jackson Heart Study
  1. Loretta Cain-Shields1,
  2. LáShauntá Glover2,
  3. Bessie Young3,4,
  4. Mario Sims5
  1. 1Department of Data Science, John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson, Mississippi, USA
  2. 2Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
  3. 3Division of Nephrology and Kidney Research Institute, University of Washington, Seattle, Washington, USA
  4. 4Veterans Affairs, Hospital and Specialty Medicine and Center for Innovation, Seattle, Washington, USA
  5. 5School of Medicine, Jackson Heart Study, University of Mississippi Medical Center, Jackson, Mississippi, USA
  1. Correspondence to Dr Loretta Cain-Shields, Department of Data Science, John D Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS 39216, USA; lcain{at}


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.

  • kidney diseases
  • stress
  • psychological

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  • Contributors All authors (LCS, LG, BY and MS) have each substantially contributed to the design of the work and interpretation of data for the work, drafted or revised the work critically for important intellectual content, approved the final version to be published and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Additionally, LCS acquired and analyzed the data for the work.

  • Funding The Jackson Heart Study (JHS) is supported and conducted in collaboration with Jackson State University (HHSN268201800013I), Tougaloo College (HHSN268201800014I), the Mississippi State Department of Health (HHSN268201800015I) and the University of Mississippi Medical Center (HHSN268201800010I, HHSN268201800011I, and HHSN268201800012I) contracts from the National Heart, Lung, and Blood Institute (NHLBI) and the National Institute for Minority Health and Health Disparities (NIMHD). MS is supported by grants P60MD002249 and U54MD008176 from NIMHD; 15SFDRN26140001 and P50HL120163 from the American Heart Association. This study was also supported by the National Institute of Diabetes and Digestive and Kidney Diseases grant 1R01DK102134-01 of the National Institutes of Health (NIH) for BY. BY is also supported, in part, by funding from the Veterans Affairs Puget Sound Health Care System. LG is supported by the Genetic Epidemiology of Heart, Lung, and Blood Traits Training Grant (GENHLB) T32 HL129982.

  • Disclaimer The Veterans Affairs does not endorse any of the statements or opinions advocated by this manuscript. The views expressed in this manuscript are those of the authors and do not necessarily represent the views of the National Heart, Lung, and Blood Institute; the National Institutes of Health; or the US Department of Health and Human Services. The funders had no role in the study design, collection, analysis, interpretation of data, writing the report, or the decision to submit the report for publication.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Written informed consent was provided by all participants and participating institutions’ institutional review boards approved the study: Tougaloo College (Tougaloo, MS), Jackson State University (Jackson, MS), and the University of Mississippi Medical Center (Jackson, MS).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available.

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