Dataset Information

Structural inequities contribute to racial/ethnic differences in neurophysiological tone, but not threat reactivity, after trauma exposure.

ABSTRACT: Considerable racial/ethnic disparities persist in exposure to life stressors and socioeconomic resources that can directly affect threat neurocircuitry, particularly the amygdala, that partially mediates susceptibility to adverse posttraumatic outcomes. Limited work to date, however, has investigated potential racial/ethnic variability in amygdala reactivity or connectivity that may in turn be related to outcomes such as post-traumatic stress disorder (PTSD). Participants from the AURORA study (n = 283), a multisite longitudinal study of trauma outcomes, completed functional magnetic resonance imaging and psychophysiology within approximately two-weeks of trauma exposure. Seed-based amygdala connectivity and amygdala reactivity during passive viewing of fearful and neutral faces were assessed during fMRI. Physiological activity was assessed during Pavlovian threat conditioning. Participants also reported the severity of posttraumatic symptoms 3 and 6 months after trauma. Black individuals showed lower baseline skin conductance levels and startle compared to White individuals, but no differences were observed in physiological reactions to threat. Further, Hispanic and Black participants showed greater amygdala connectivity to regions including the dorsolateral prefrontal cortex (PFC), dorsal anterior cingulate cortex, insula, and cerebellum compared to White participants. No differences were observed in amygdala reactivity to threat. Amygdala connectivity was associated with 3-month PTSD symptoms, but the associations differed by racial/ethnic group and were partly driven by group differences in structural inequities. The present findings suggest variability in tonic neurophysiological arousal in the early aftermath of trauma between racial/ethnic groups, driven by structural inequality, impacts neural processes that mediate susceptibility to later PTSD symptoms.

SUBMITTER: Harnett NG

PROVIDER: S-EPMC10615735 | biostudies-literature | 2023 Jul

REPOSITORIES: biostudies-literature

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Structural inequities contribute to racial/ethnic differences in neurophysiological tone, but not threat reactivity, after trauma exposure.

Harnett Nathaniel G NG Fani Negar N Carter Sierra S Sanchez Leon D LD Rowland Grace E GE Davie William M WM Guzman Camilo C Lebois Lauren A M LAM Ely Timothy D TD van Rooij Sanne J H SJH Seligowski Antonia V AV Winters Sterling S Grasser Lana R LR Musey Paul I PI Seamon Mark J MJ House Stacey L SL Beaudoin Francesca L FL An Xinming X Zeng Donglin D Neylan Thomas C TC Clifford Gari D GD Linnstaedt Sarah D SD Germine Laura T LT Bollen Kenneth A KA Rauch Scott L SL Haran John P JP Storrow Alan B AB Lewandowski Christopher C Hendry Phyllis L PL Sheikh Sophia S Jones Christopher W CW Punches Brittany E BE Swor Robert A RA Hudak Lauren A LA Pascual Jose L JL Harris Erica E Chang Anna M AM Pearson Claire C Peak David A DA Merchant Roland C RC Domeier Robert M RM Rathlev Niels K NK Bruce Steven E SE Miller Mark W MW Pietrzak Robert H RH Joormann Jutta J Barch Deanna M DM Pizzagalli Diego A DA Harte Steven E SE Elliott James M JM Kessler Ronald C RC Koenen Karestan C KC McLean Samuel A SA Jovanovic Tanja T Stevens Jennifer S JS Ressler Kerry J KJ

Molecular psychiatry 20230201 7

Considerable racial/ethnic disparities persist in exposure to life stressors and socioeconomic resources that can directly affect threat neurocircuitry, particularly the amygdala, that partially mediates susceptibility to adverse posttraumatic outcomes. Limited work to date, however, has investigated potential racial/ethnic variability in amygdala reactivity or connectivity that may in turn be related to outcomes such as post-traumatic stress disorder (PTSD). Participants from the AURORA study ( ...[more]

PMID: 36725899

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Project description:ImportanceIndividuals of racial and ethnic minority groups may be less likely to use telemedicine in part due to lack of access to technology (ie, digital divide). To date, some studies have found less telemedicine use by individuals of racial and ethnic minority groups compared with White individuals, and others have found the opposite. What explains these different findings is unclear.ObjectiveTo quantify racial and ethnic differences in the receipt of telemedicine and total visits with and without accounting for demographic and clinical characteristics and geography.Design, setting, and participantsThis cross-sectional study included individuals who were continuously enrolled in traditional Medicare from March 2020 to February 2022 or until death.ExposureRace and ethnicity, which was categorized as Black non-Hispanic, Hispanic, White non-Hispanic, other (defined as American Indian/Pacific Islander, Alaska Native, and Asian), and unknown/missing.Main outcomes and measuresTotal telemedicine visits (audio-video or audio); total visits (telemedicine or in-person) per individual during the study period. Multivariable models were used that sequentially adjusted for demographic and clinical characteristics and geographic area to examine their association with differences in telemedicine and total visit utilization by documented race and ethnicity.ResultsIn this national sample of 14 305 819 individuals, 7.4% reported that they were Black, 5.6% Hispanic, and 4.2% other race. In unadjusted results, compared with White individuals, Black individuals, Hispanic individuals, and individuals of other racial groups had 16.7 (95% CI, 16.1-17.3), 32.9 (95% CI, 32.3-33.6), and 20.9 (95% CI, 20.2-21.7) more telemedicine visits per 100 beneficiaries, respectively. After adjustment for clinical and demographic characteristics and geography, compared with White individuals, Black individuals, Hispanic individuals, and individuals of other racial groups had 7.9 (95% CI, -8.5 to -7.3), 13.2 (95% CI, -13.9 to -12.6), and 9.2 (95% CI, -10.0 to -8.5) fewer telemedicine visits per 100 beneficiaries, respectively. In unadjusted and fully adjusted models, and in 2019 and the second year of the COVID-19 pandemic, Black individuals, Hispanic individuals, and individuals of other racial groups continued to have fewer total visits than White individuals.Conclusions and relevanceThe results of this cross-sectional study of US Medicare enrollees suggest that although nationally, Black individuals, Hispanic individuals, and individuals of other racial groups received more telemedicine visits during the pandemic and disproportionately lived in geographic regions with higher telemedicine use, after controlling for geographic region, Black individuals, Hispanic individuals, and individuals of other racial groups received fewer telemedicine visits than White individuals.

Dataset Information

Structural inequities contribute to racial/ethnic differences in neurophysiological tone, but not threat reactivity, after trauma exposure.

Publications

Structural inequities contribute to racial/ethnic differences in neurophysiological tone, but not threat reactivity, after trauma exposure.

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