Perceived racism and incident diabetes in the Black Women’s Health Study

Abstract

Aims To assess the association of perceived racism with type 2 diabetes, and the possible mediating influence of diet and body mass index (BMI). Methods The Black Women’s Health Study, a follow-up of 59,000 African-American women, begun in 1995. Over 16 years 5,344 incident cases of diabetes occurred during 576,577 person-years. Cox proportional hazards models were used to estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for categories of “everyday” racism (interpersonal racism in daily life) and “lifetime” racism (reporting ever treated unfairly due to race with respect to police, housing or on the job) and incident type 2 diabetes. Models were adjusted for age, questionnaire cycle, marital status, socioeconomic status, education, family history of diabetes, physical activity, alcohol use, and smoking status, with and without inclusion of terms for dietary patterns and adult BMI. Results Compared to women in the lowest quartile of exposure women in the highest quartile of exposure to everyday racism had a 31% increased risk of diabetes, (HR=1.31, 95% CI=1.20, 1.42), and women with the highest exposure to lifetime racism had a 16% increased risk (HR=1.16, 95% CI=1.05, 1.27). Mediation analysis estimated that BMI accounted for half of the association between either the everyday or lifetime racism measure and incident diabetes. Conclusions Perceived everyday and lifetime racism were associated with increased risk of type 2 diabetes in this cohort of African-American women, and appear to be at least partly mediated by BMI.

The Next Generation of Diabetes Translation: A Path to Health Equity

“…Other studies found that perceived discrimination impacted health behaviors (64) and that American Indian women with diabetes who reported perceived discrimination completed fewer diabetes services, which placed them at increased risk for comorbidities of diabetes (55); these findings support the notion that discrimination is associated with an increased risk of incident diabetes (147). Thus, chronic stress due to racism and discrimination can affect diabetes outcomes (12,71,144). However, there is a dearth of interventions that include strategies to address racism or discrimination as factors related to diabetes outcomes.…”

“…The For the Sake of All project described the impact of various policies (including financial and housing) and their link to discriminatory practices and negative health and diabetes outcomes of the black population in St. Louis (110). The Black Women's Health Study, a follow-up of 59,000 African American women, found that women who perceived a high level of everyday racism had a 31% increased risk of diabetes; those reporting exposures to the highest levels of lifetime racism had a 16% increased risk of T2DM (12). Other studies found that perceived discrimination impacted health behaviors (64) and that American Indian women with diabetes who reported perceived discrimination completed fewer diabetes services, which placed them at increased risk for comorbidities of diabetes (55); these findings support the notion that discrimination is associated with an increased risk of incident diabetes (147).…”

Social Relationships and Risk of Type 2 Diabetes Among Postmenopausal Women

“…Some investigations have been conducted of the health effects of racism or discrimination. These findings suggest that racism or discrimination experienced by African Americans may lead to higher levels of social strain and contribute to higher inflammation and diabetes risk (Bacon et al, 2017).…”

Experiences of racism and subjective cognitive function in African American women

“…The Black Women's Health Study (BWHS), a follow‐up study of 59,000 black women, has queried participants on experiences of racism and subjective cognitive function (SCF). In prior analyses in the BWHS, greater experiences of racism were associated with increases in incidence of breast cancer, 20 asthma, 21 type 2 diabetes, 14 and obesity, 22 and with the prevalence of insomnia 13 . We hypothesized that greater experiences of racism would be associated with lower levels of SCF.…”

“…Experiences of racism are common among African Americans, with 50% or more respondents to a 2017 nationally representative survey reporting experiences of institutional racism (eg, having been discriminated against in pay or promotions in the workplace) and daily interpersonal racism (eg, having experienced racial slurs) 11 . These institutional and daily forms of racism have been associated with increased risks of various conditions that can impair cognition, including depression, 12 poor sleep, 13 type 2 diabetes, 14 and hypertension 15 . Two experimental studies have reported immediate adverse effects on cognition when African American subjects were exposed to fictional vignettes describing discrimination, 16 or when cognitive tests were administered by a white person and levels of perceived discrimination were high 17 .…”