Racial Discrimination and the Incidence of Hypertension in US Black 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.
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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
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This work was supported by grant no. CA58420 from the National Cancer Institute.