Elsevier

Annals of Epidemiology

Volume 16, Issue 9, September 2006, Pages 681-687
Annals of Epidemiology

Racial Discrimination and the Incidence of Hypertension in US Black Women

https://doi.org/10.1016/j.annepidem.2005.11.008Get rights and content

Purpose

Unique experiences associated with “race,” such as racism, may adversely affect health. Our goal is to assess whether racism is associated with the occurrence of hypertension in African-American women.

Methods

In the first prospective examination of perceived experiences of racism in relation to the incidence of hypertension, we used data from the Black Women's Health Study, a follow-up study of US black women that began in 1995. The 1997 follow-up questionnaire contained eight questions designed to measure personally mediated racism and institutionalized racism. Cox proportional hazard models were used to estimate incidence rate ratios (IRRs), with control for age, body mass index, and questionnaire period.

Results

There were 2316 incident cases of hypertension reported during 104,574 person-years of observation from 1997 to 2001. Most women reported experiences of racism. In the total sample, IRRs for the association of racism with incident hypertension were close to the null. However, some positive associations were observed for personally mediated racism in women born outside the United States.

Conclusions

There may be an increase in hypertension associated with experiences of racism in certain subgroups of African-American women.

Introduction

African-American women have greater morbidity and mortality rates than white women for nearly every major illness 1, 2. Hypertension is a key contributor to this excess (2). The rate of hypertension in black women is two to three times that of white women, and age-specific rates for black women are similar to those of the next age decade of white women. As a result, black women have a substantially greater prevalence of such hypertension-related illness as cardiovascular disease and end-stage renal disease 3, 4. Established risk factors, including family history, cigarette smoking, sedentary lifestyle, and obesity, do not adequately explain the observed differences in hypertension between black and white women 2, 5.

Several emerging hypotheses to explain the excess burden of hypertension in black women concern psychosocial and environmental factors. Recently, there has been recognition that “race” is a social construct, rather than a biologic concept 6, 7, and investigators are seeking to understand the ways in which unique experiences associated with race, such as racism, may adversely affect health. Several studies suggested there may be increases in blood pressure associated with experiences of racism 8, 9, 10, 11, 12, 13. Two of these studies assessed the relation of racism to hypertension, and results are conflicting 12, 13.

Previous studies of racism and hypertension were small, and analyses were cross-sectional. The goal of the present study is to prospectively examine the influence of perceptions of racism and discrimination on risk for hypertension in a large cohort of US black women enrolled in the Black Women's Health Study (BWHS). Specifically, we examined whether perceptions and experiences of racism are associated positively with increased risk for hypertension in black women and whether associations were modified by other characteristics, such as place of birth and neighborhood racial composition.

Section snippets

Establishment of the Cohort and Follow-up

The human subjects protocol for this study was approved by the Boston University Medical Center and the Howard University Cancer Center Institutional Review Boards. The BWHS is a follow-up study of US black women that began in 1995 when 64,500 women aged 21 to 69 years enrolled through postal health questionnaires, which were sent mainly to subscribers of Essence magazine, members of selected black women's professional organizations, and friends and relatives of early respondents. The 59,000

Results

Characteristics of study participants in 1997 are listed in Table 3. Median age was 37 years and 60% had a BMI of 25 kg/m2 or greater. Personally mediated racism was related inversely to age, and the prevalence was slightly greater in women with a BMI 30 kg/m2 or higher, women who were born in the United States, and those who grew up in predominantly white neighborhoods. Institutionalized racism was greater among the most well-educated women, women born in the United States, and women who grew

Discussion

Several studies examined whether exposure to racist or discriminatory incidents may be an important risk factor for elevated blood pressure in African Americans 8, 9, 10, 11, 12, 13. The findings are mixed. Results in a group of African-American college students indicated greater increases in resting blood pressure in response to racist stimuli than in response to either anger or neutral stimuli (8). A subsequent analysis of black and white adults enrolled in the Coronary Artery Risk

References (29)

  • N. Moss

    What are the underlying sources of racial differences in health?

    Ann Epidemiol

    (1997)
  • N. Krieger

    Racial and gender discrimination: Risk factors for high blood pressure?

    Soc Sci Med

    (1990)
  • National Center for Health Statistics

    Health, United States, 2004, With Chartbook on Trends in the Health of Americans

    (2004)
  • R.F. Gillum

    Epidemiology of hypertension in African-American women

    Am Heart J

    (1996)
  • D.T. Lackland et al.

    Epidemiology of hypertension in African Americans

    Semin Nephrol

    (1996)
  • C.E. Grim et al.

    High blood pressure in blacks: Salt, slavery, survival, stress, and racism. In Hypertension: Pathophysiology, Diagnosis, and Management

    (1995)
  • J. Cornoni-Huntley et al.

    Race and sex differentials in the impact of hypertension in the United States: The National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study

    Arch Intern Med

    (1989)
  • A. Goodman

    Why genes don't count (for racial differences in health)

    Am J Public Health

    (2000)
  • C.A. Armstead et al.

    Relationship of racial stressors to blood pressure responses and anger expression in black college students

    Health Psychol

    (1989)
  • N. Krieger et al.

    Racial discrimination and blood pressure: The CARDIA Study of young black and white adults

    Am J Public Health

    (1996)
  • K. James et al.

    Social identity correlates of minority workers' health

    Acad Manage J

    (1994)
  • S.A. James et al.

    John Henryism and blood pressure differences among black men. II. The role of occupational stressors

    J Behav Med

    (1984)
  • C. Broman

    The health consequences of racial discrimination: A study of African Americans

    Ethn Dis

    (1996)
  • D.R. Williams et al.

    Racial differences in physical and mental health: Socio-economic status, stress and discrimination

    J Health Psychol

    (1997)
  • Cited by (0)

    This work was supported by grant no. CA58420 from the National Cancer Institute.

    View full text