The Association Between Perceived Racial Discrimination and Hypertension in a Low-Income, Racially Integrated Urban Community

Gabriel, Angel; Bell, Caryn N.; Bowie, Janice V.; Hines, Anika L; LaVeist, Thomas A.; Thorpe, Roland J.

doi:10.1097/fch.0000000000000254

Cited by 5 publications

(6 citation statements)

References 27 publications

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“…The IOM Report focused on health care disparities and highlighted the role interpersonal racism can have on health outcomes for members of minoritized groups (25). These reports and others (9,(27)(28)(29)(30)(31)(32)(33)(34)(35) have led to a more robust focus on population health over the last few decades that has included a renewed interest in the impact of racism and social factors, such as poverty on clinical outcomes (1,33).…”

Section: Poverty and Health Disparities A Historical Perspectivementioning

confidence: 99%

Poverty, Racism, and the Public Health Crisis in America

Beech

Ford

Thorpe

et al. 2021

Front. Public Health

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The purpose of this article is to discuss poverty as a multidimensional factor influencing health. We will also explicate how racism contributes to and perpetuates the economic and financial inequality that diminishes prospects for population health improvement among marginalized racial and ethnic groups. Poverty is one of the most significant challenges for our society in this millennium. Over 40% of the world lives in poverty. The U.S. has one of the highest rates of poverty in the developed world, despite its collective wealth, and the burden falls disproportionately on communities of color. A common narrative for the relatively high prevalence of poverty among marginalized minority communities is predicated on racist notions of racial inferiority and frequent denial of the structural forms of racism and classism that have contributed to public health crises in the United States and across the globe. Importantly, poverty is much more than just a low-income household. It reflects economic well-being, the ability to negotiate society relative to education of an individual, socioeconomic or health status, as well as social exclusion based on institutional policies, practices, and behaviors. Until structural racism and economic injustice can be resolved, the use of evidence-based prevention and early intervention initiatives to mitigate untoward effects of socioeconomic deprivation in communities of color such as the use of social media/culturally concordant health education, social support, such as social networks, primary intervention strategies, and more will be critical to address the persistent racial/ethnic disparities in chronic diseases.

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Section: Poverty and Health Disparities A Historical Perspectivementioning

confidence: 99%

Poverty, Racism, and the Public Health Crisis in America

Beech

Ford

Thorpe

et al. 2021

Front. Public Health

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“…Our novel results highlighting educational attainment as a potential modifier of RED-hypertension within Black women are plausible when considering prior discrimination literature . Prior studies have demonstrated links between RED and hypertension across multiethnic populations and varying age ranges . Studies have also shown that health benefits related to higher educational attainment are not equitable among Black and Latina compared to White adults, which is likely related to the pervasiveness of structural racism and other forms of discrimination faced by minoritized racial and ethnic groups .…”

Section: Discussionmentioning

confidence: 50%

“…23 Prior studies have demonstrated links between RED and hypertension across multiethnic populations and varying age ranges. 6,18,25,26,30,31,45 Studies have also shown that health benefits related to higher educational attainment are not equitable among Black and Latina compared to White adults, which is likely related to the pervasiveness of structural racism and other forms of discrimination faced by minoritized racial and ethnic groups. 9,[19][20][21][22][23]46,47 Our findings of EM by educational attainment for everyday RED but not major RED add valuable insights into RED's health impacts.…”

Section: Discussionmentioning

confidence: 99%

“…Although relationships between socioeconomic status discrimination and a risk factor for hypertension, C-reactive protein, have been shown only among Black persons in a multiracial sample, to our knowledge, empirical studies in the United States have not yet investigated educational attainment as a modifier of associations between RED specifically and hypertension risk while also considering potential differences within racial and ethnic groups . To overcome these literature gaps, we aimed to investigate race and ethnicity as well as educational attainment as modifiers of associations between RED and hypertension risk among a cohort of Black, Latina, and White US women.…”

Section: Introductionmentioning

confidence: 99%

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Racial and Ethnic Discrimination and Hypertension by Educational Attainment Among a Cohort of US Women

Gaston,

Forde,

Green

et al. 2023

JAMA Netw Open

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ImportanceAlthough understudied, there are likely within-group differences among minoritized racial and ethnic groups in associations between racial and ethnic discrimination (RED) and hypertension risk, as minoritized individuals with higher educational attainment may more frequently encounter stress-inducing environments (eg, professional workplace settings, higher-income stores and neighborhoods) characterized by, for instance, exclusion and antagonism.ObjectivesTo investigate educational attainment as a potential effect modifier of associations between RED and hypertension risk among US women; the study hypothesis was that the magnitude of associations would be stronger among participants with higher vs lower educational attainment.Design, Setting, and ParticipantsThis is a nested case-control study using Sister Study data collected at enrollment (2003-2009) and over follow-up visits until September 2019. Among eligible US Black or African American (hereafter Black), Latina, and non-Hispanic White women without prior hypertension diagnoses, incidence density sampling was performed to select self-reported hypertension cases that developed over a mean (SD) follow-up 11 (3) years. Data were analyzed August 2022 to February 2023.ExposuresParticipants reported lifetime everyday (eg, unfair treatment at a business) and major (eg, mistreatment by police) RED via a self-administered questionnaire.Main Outcome and MeasuresAdjusting for sociodemographic characteristics, conditional logistic regression was used to estimate odds ratios (ORs) and 95% CIs for associations between RED and hypertension by educational attainment category at baseline (college or higher, some college, and high school or less) within racial and ethnic groups.ResultsAmong 5179 cases (338 [6.5%] Black; 200 [3.9%] Latina; and 4641 [89.6%] non-Hispanic White) and 10:1 race and ethnicity– and age-matched control participants with a mean (SD) age of 55 (9) years at enrollment, half (49.9%) of women reported attaining college or higher education, and Black women with college or greater education had the highest burden of RED (eg, 83% of case participants with college or higher education reported everyday RED compared with 64% of case participants with high school or less education). Everyday RED was associated with higher hypertension risk among Black women with college or higher education (OR, 1.56 [95% CI, 1.06-2.29]) but not among Black women with some college (OR, 0.72 [95% CI, 0.47-1.11]), with evidence of both multiplicative and additive interaction. Results for Black women with high school or less education suggested increased risk, but confidence intervals were wide, and the result was not statistically significant but may be clinically significant (OR, 1.89 [95% CI, 0.83-4.31]). Educational attainment was not a modifier among other racial and ethnic groups or for associations with major RED.Conclusions and RelevanceIn this nested case-control study of RED and hypertension risk, chronic or everyday RED-associated hypertension disproportionately affected Black women with the highest levels of educational attainment.

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“…While some argue that race is a “social construct and not a defining biology [ 122 ],” African Americans and other people of African descent have a higher incidence of hypertension and related comorbidities compared to White individuals, with several identifiable genes helping to potentially account for racial differences regarding hypertension [ 123 ]. Regarding perceived racial discrimination and hypertension, the reported association is variable [ [124] , [125] , [126] , [127] , [128] ], with challenges regarding methodology of analyses, and likely most applicable when examined on an individual basis. Obesity also is also pathogenic among Latine individuals [ 129 ], who have high rates of cardiometabolic risk factors such as obesity, high blood glucose, high blood lipids, and high blood pressure [ 130 ].…”

Section: Genetics Epigenetics Sex Gender Race Ethnicity Obesity and H...mentioning

confidence: 99%

Obesity and hypertension: Obesity medicine association (OMA) clinical practice statement (CPS) 2023

2023

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The Association Between Perceived Racial Discrimination and Hypertension in a Low-Income, Racially Integrated Urban Community

Cited by 5 publications

References 27 publications

Poverty, Racism, and the Public Health Crisis in America

Poverty, Racism, and the Public Health Crisis in America

Racial and Ethnic Discrimination and Hypertension by Educational Attainment Among a Cohort of US Women

Obesity and hypertension: Obesity medicine association (OMA) clinical practice statement (CPS) 2023

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