NAS Trauma Systems report (2016)
This report by the National Academies of Sciences, Engineering, and Medicine looks at the nation’s health care system in caring for trauma patients – both U.S. service members as well as civilians – across the continuum of care from initial injury and hospitalization to rehabilitation and other care. The report, “A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths,” looks closely at the experience of those who served in the wars in Afghanistan and Iraq. But the Institutes of Medicine panel calls for a joint military-civilian national trauma care system to improve care nationwide. The U.S. Defense Department, the U.S. Department of Homeland Security, the American College of Emergency Physicians and the American College of Surgeons, among others, sponsored the report.
“Weathering” and Age Patterns of Allostatic Load Scores Among Blacks and Whites in the United States
Arline T. Geronimus, Margaret Hicken, Danya Keene, and John Bound, Am J Public Health (2006).
The authors compared African-Americans and whites on measure called “allostatic load,” which is supposed to reflect how well or poorly the cardiovascular, metabolic, nervous, hormonal and immune systems are functioning. The study found that blacks scored worse than whites at all ages, and the racial differences persisted after adjustment for poverty. In fact, nonpoor blacks scored worse than poor whites.
Socio-economic differentials in peripheral biology: Cumulative allostatic load
Teresa Seeman, Elissa Epel, Tara Gruenewald, Arun Karlamangla and Bruce S. McEwen, Annals of the New York Academy of Sciences (2010).
Allostatic load theory attempts to explain how psychological and social experiences “get under the skin” and give rise to disease. The basic idea is that repeated stressful experiences can build up over time, gradually wearing down the body’s regulatory systems, opening the door to the onset and progression of many different diseases. The authors present a helpful review of the evidence behind the theory, and how it might contribute to the development of more evidence-based programs and policies to reduce current social inequalities.
Racial and Ethnic Patterns of Allostatic Load Among Adult Women in the United States: Findings from the National Health and Nutrition Examination Survey 1999–2004
Laura Chyu and Dawn M. Upchurch, J Womens Health (2011).
Allostatic load is an indicator of biological aging, and it reveals a pronounced racial disparity. In this nationally representative study, black women 40–49 years old had allostatic load scores 1.14 times higher than white women 50–59 years old. Meanwhile, Mexican women not born in the United States had lower allostatic load scores than those born in the United States. “The persistent black/white disparity in AL across all age groups observed in this study suggests that black women are already at a significant health disadvantage in early adulthood, and this pattern persists over the life course, with particularly pronounced black/white disparities by midlife,” the authors said.
Sociodemographic Correlates of Allostatic Load Among a National Sample of Adolescents: Findings From the National Health and Nutrition Examination Survey, 1999–2008
Bethany K. Wexler Rainisch and Dawn M. Upchurch, Journal of Adolescent Health (2013).
Using data from 8,000 teenagers, the authors found that by adolescence you can already see racial and socioeconomic inequalities in allostatic load, a measure of biological wear-and-tear (based on a combination of blood pressure, body mass index, blood sugar, and other biomarkers). Average allostatic load was higher for blacks than whites or Mexican-Americans, and was higher among adolescents of lower socioeconomic status.
Association of Lifecourse Socioeconomic Status with Chronic Inflammation and Type 2 Diabetes Risk: The Whitehall II Prospective Cohort Study
Silvia Stringhini, G. David Batty, Pascal Bovet, Martin J. Shipley, Michael G. Marmot, et al.; PLoS Med (2013).
Cumulative exposure to low socioeconomic status over the lifecourse and a downward trajectory from high SES in childhood to low SES in adulthood were associated with an increased risk of developing type 2 diabetes over the study period. Inflammatory processes, measured repeatedly through biomarkers in the blood, explained as much as one third of this association.
Central role of the brain in stress and adaptation: Links to socioeconomic status, health, and disease
Bruce S. McEwen and Peter J. Gianaros; Annals of the New York Academy Of Sciences (2010)
A review of research on chronic stress and how it can lead to a long-term dysregulation of vital systems and make people more vulnerable to a spectrum of illnesses.
Perceived stress as a risk factor for changes in health behaviour and cardiac risk profile: a longitudinal study
N. H. Rod, M. Grønbæk, P. Schnohr, E. Prescott, T. S. Kristensen; Journal of Internal Medicine (2009)
Individuals with high levels of stress compared to those with low levels of stress were less likely to quit smoking, more likely to become physically inactive, less likely to stop drinking above the sensible drinking limits, and stressed women were more likely to become overweight during follow-up. Men and women with high stress were more likely to use antihypertensive medication, and stressed men were more than two times as likely to develop diabetes during follow-up.