Abstract P124: Unfair Treatment and Prevalent Hypertension among Women: Data from the Women’s Health Study

Abstract

Background: Discrimination is recognized as a chronic psychological stressor related to poor health outcomes. However, investigations about lifetime discrimination and hypertension (HTN), a major risk factor for cardiovascular disease (CVD) have yielded mixed results. Data are limited by small sample size and lack of studies involving women. Therefore, we assessed the association between unfair treatment (UT), a form of discrimination, and prevalent HTN in women. Methods and Results: In this cross-sectional analysis, we used data from women the Women’s Health Study follow-up cohort who responded to questions about UT (n= 30,873; mean age 69 years). HTN was defined as:a physician’s diagnosis of HTN, the use of anti-hypertensive treatment or self-reported systolic blood pressure (BP) ≥ 140 mmHg, or diastolic BP ≥ 90 mmHg. UT asked about experiences over their lifetime in 4 domains [obtaining housing, getting a job, being fired/not promoted, being stopped/questioned by the police; response (yes/no) to each question was used to compute an UT score (range 0-4; coded in 3 categories: 0 (reference), 1, and 2-4 domains). Logistic regression models estimated the likelihood of HTN if treated unfairly. Among WHS participants, the prevalence of HTN was 67% (20,808 of 30,873); and, 15% (4,614 of 30,873) of women reported UT in at least one domain. In the crude model, increasing UT score was associated with increasing relative odds of HTN (1.01 and 1.26 for 1 and 2-4 domains, vs 0;ptrend=0.03); adjustment for age, race/ethnicity and socioeconomic status (education and income) strengthened the magnitude of observed association (1.00, 1.16, 1.36; ptrend<0.0001). This association was attenuated in a fully adjusted model additionally accounting for factors that may lie in the mechanistic pathway including smoking status, diabetes, physical activity, alcohol use, history of hyperlipidemia, use of hormone replacement therapy, and body mass index (1.00, 1.00, 1.18, ptrend=0.32). Conclusion: These data are hypothesis generating in that they suggest UT is related to hypertension, a potent risk factor for CVD. Additional research is needed to better understand the influence of UT for cardiovascular health disparities in the United States.