Psychosocial stress and socioeconomic differences

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Migration can be associated with maladjustment or isolation and stress on the one hand, but also with acculturation and integration on the other. It has been suggested that increased corticosteroid and cytokine activation may be potential links between stress and the metabolic syndrome (Yudkin etal., 2000; Brunner etal., 2002). In a study of 509 subjects in India there was evidence of an interaction between cortisol and adiposity in determining fasting glucose concentration (P=0.045) and insulin resistance (P=0.006), suggesting that increased glucocorticoid action may contribute to ethnic differences in the prevalence of the metabolic syndrome, particularly among men and women with a higher BMI (Ward etal., 2003). However, such studies have not been replicated in other ethnic groups or by other research groups, leaving a gap in our understanding of the potential role of glucocorticoids.

Although socio-economic factors are unequivocally associated with coronary risk within ethnic groups, their role in the pathobiology of ethnic differences in the metabolic syndrome or coronary risk are not clear. In the Whitehall Study of civil servants of three ethnic groups (European, South Asian, African-Caribbean) in the UK, socio-economic status was an important confounder of the association of ethnicity and metabolic risk, but adjustment for socio-economic status did not abolish the ethnic differences in adverse metabolic outcomes (diabetes, hypertension, dyslipidaemia) (Whitty etal., 1999). The associations of socio-economic factors with disease risk are complex because they can affect not only disease prevalence but also disease presentation, access to healthcare and management within healthcare systems. No conclusive evidence on these associations with ethnicity and migration yet exists and is an area for future study.

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