Psychosocial Stress due to COVID-19 and Vascular Aging in African-American Women

PROJECT SUMMARY The novel coronavirus disease 2019 (COVID-19) global pandemic is arguably one of the most devastating Public Health crises of the last century. In the United States, African-Americans have been disproportionately impacted, with overall rates of infection and mortality 2 to 4 times higher than those observed in Whites. Additionally, as a direct result of closings of non-essential businesses and other entities, rates of unemployment and underemployment have also surged, and African-Americans are significantly more likely than Whites to report being underemployed or furloughed due to the pandemic. Unsurprisingly, given racial disparities in COVID-19 mortality, national polls have also found racial differences in reports of COVID-related loss, with African-Americans more frequently reporting personally knowing someone who has died from COVID-19 than Whites. Because of this, it has been argued that, as a result of COVID-19, African- Americans are experiencing a "pandemic of stress" that will have a "dangerous impact" on their health and well-being long after the virus itself has been contained. Leveraging our previously funded cohort that assessed psychosocial stress and vascular aging in early middle-aged African-American women, we have an unprecedented opportunity to examine the degree to which stressors resulting from, and related to, the COVID-19 pandemic might impact vascular disease-the number 1 killer in the US-in this group. Middle-aged African-American women may be a uniquely important group on which to focus, because: 1) they have increasingly high, but poorly understood, rates of vascular disease relative to other race-gender groups; and 2) the long-term impact of the widespread financial, employment and social stressors resulting from COVID-19 might be particularly deleterious for African-American women, largely due to structural and contextual inequalities that pre-dated the pandemic itself. The proposed project will examine linkages between overall psychosocial stressors (debt, financial stress, job stress, interpersonal incivilities and mistreatment, loneliness), COVID-specific stressors (COVID-related financial difficulties, COVID-specific parenting stressors, COVID-related loss) and prospective changes in vascular aging (ambulatory blood pressure, arterial stiffness, inflammation) over 24 months in a cohort of 350 middle-aged African-American women. Because we have pre-COVID assessments of a range of psychosocial stressors, a major innovation of the proposed work is our ability to examine how pre- versus post-COVID changes in exposure to overall psychosocial stress might prospectively impact vascular aging. Importantly, we will capitalize on the considerable within-group heterogeneity in our cohort, to examine whether any of our hypothesized associations are moderated by pre- COVID assessed sociodemographic factors that might increase vulnerability (socioeconomic status, single parenthood, marital status) or resilience (e.g., purpose in life, optimism, mastery, social support) to psychosocial stress, in order to inform short- and long-term prevention efforts.