title: Black-white disparities in the association between posttraumatic stress disorder and chronic illness.
abstract: Non-Latino blacks experience a higher proportion of chronic illness and associated disabilities than non-Latino whites. Posttraumatic stress disorder (PTSD) is associated with a greater risk of chronic illness, although few studies have investigated whether the interaction of PTSD with racial disparities may lead to a greater risk of chronic illness among blacks with PTSD than among whites with PTSD.
  
  
  
  We evaluated data from the population-based National Survey of American Life and the National Comorbidity Survey Replication to investigate the association between race, lifetime PTSD and self-reported chronic illness. Weighted linear and Poisson regression models assessed differences in the magnitude of association between PTSD and chronic illness by race on both the additive and multiplicative scales.
  
  
  
  The magnitude of the association between lifetime PTSD and diabetes was greater among blacks (RD 0.07, 95% CI 0.02, 0.11; RR 1.9, 95% CI 1.4, 2.5) than whites (RD 0.004, 95% CI -0.02, 0.03; RR 1.2, 95% CI 0.7, 1.9) on the additive (p=0.017) scale. The magnitude of the association between lifetime PTSD and heart disease was greater among blacks (RD 0.09, 95% CI 0.05, 0.13) than whites (RD 0.04, 95% CI 0.01, 0.07) on the additive scale at a level approaching significance (p=0.051).
  
  
  
  A lifetime history of PTSD was associated with a significantly greater risk of diabetes among blacks as compared to whites. These findings suggest that continuous exposure to racial inequalities may be associated with a greater risk of PTSD-related health sequela.
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, 70 Everett Ave. Suite 516, Chelsea, MA 02150, USA; Harvard Medical School, USA. Electronic address: cnobles@mgh.harvard.edu.
authors.forename: Carrie J
authors.initials: CJ
authors.lastname: Nobles
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, 70 Everett Ave. Suite 516, Chelsea, MA 02150, USA; Harvard Medical School, USA.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Valentine
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, 70 Everett Ave. Suite 516, Chelsea, MA 02150, USA; Harvard Medical School, USA.
authors.forename: Christina P C
authors.initials: CP
authors.lastname: Borba
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, 70 Everett Ave. Suite 516, Chelsea, MA 02150, USA.
authors.forename: Monica W
authors.initials: MW
authors.lastname: Gerber
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, 70 Everett Ave. Suite 516, Chelsea, MA 02150, USA; Harvard Medical School, USA.
authors.forename: Derri L
authors.initials: DL
authors.lastname: Shtasel
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, 70 Everett Ave. Suite 516, Chelsea, MA 02150, USA; Harvard Medical School, USA.
authors.forename: Luana
authors.initials: L
authors.lastname: Marques
mesh_terms: D000328:Adult; D001741:Black or African American / Q000523:psychology* / Q000706:statistics & numerical data; D002908:Chronic Disease / Q000208:ethnology*; D003430:Cross-Sectional Studies; D005260:Female; D054624:Health Status Disparities; D006306:Health Surveys; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D016012:Poisson Distribution; D057566:Self Report; D013313:Stress Disorders, Post-Traumatic / Q000208:ethnology*; D014481:United States / Q000453:epidemiology; D044465:White People / Q000523:psychology* / Q000706:statistics & numerical data
keywords: Chronic illness; Health disparities; Heart disease; Posttraumatic stress disorder; Race/ethnicity; Type 2 diabetes