Intersectional effects of racial and gender discrimination on cardiovascular health vary among black and white women and men in the CARDIA study.

B. Jesdale,C. Kiefe,G.S. Bey,S. Forrester,S.D. Person

doi:10.1016/j.ssmph.2019.100446

B. Jesdale, C. Kiefe + Show 3 more

Open Access

https://doi.org/10.1016/j.ssmph.2019.100446

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Abstract

Testing hypotheses from the emerging Identity Pathology (IP) framework, we assessed race-gender differences in the effects of reporting experiences of racial and gender discrimination simultaneously compared with racial or gender discrimination alone, or no discrimination, on future cardiovascular health (CVH). Data were from a sample of 3758 black or white adults in CARDIA, a community-based cohort recruited in Birmingham, AL; Chicago, IL; Minneapolis, MN, and Oakland, CA in 1985–6 (year 0). Racial and gender discrimination were assessed using the Experiences of Discrimination scale. CVH was evaluated using a 12-point composite outcome modified from the Life's Simple 7, with higher scores indicating better health. Multivariable linear regressions were used to evaluate the associations between different perceptions of discrimination and CVH scores two decades later by race and gender simultaneously. Reporting racial and gender discrimination in ≥2 settings were 48% of black women, 42% of black men, 10% of white women, and 5% of white men. Year 30 CVH scores (mean, SD) were 7.9(1.4), 8.1(1.6), 8.8(1.6), and 8.7(1.3), respectively. Compared with those of their race-gender groups reporting no discrimination, white women reporting only gender-based discrimination saw an adjusted score difference of +0.3 (95% CI: 0.0,0.6), whereas white men reporting only racial discrimination had on average a 0.4 (95% CI: 0.1,0.8) higher score, and scores among white men reporting both racial and gender discrimination were on average 0.6 (95% CI: 1.1,-0.1) lower than those of their group reporting no discrimination. Consistent with predictions of the IP model, the associations of reported racial and gender discrimination with future CVH were different for different racially-defined gender groups. More research is needed to understand why reported racial and gender discrimination might better predict deterioration in CVH for whites than blacks, and what additional factors associated with gender and race contribute variability to CVH among these groups.

Highlights

Due to prominent disparities in cardiovascular outcomes between black and white women and men in the United States (Mensah & Brown, 2007; Pool, Ning, Lloyd-Jones, & Allen, 2017), researchers have examined social group-specific exposures as potential contributors to these inequities (Wyatt et al, 2003)
Analyses were conducted using Stata 14.0 (StataCorp, Texas). Exclusion of those missing data on race or gender discrimination at year 7, cardiovascular health (CVH) score, or included covariates resulted in an analytic sample of 3758 participants
There was considerable variation in the prevalence of each level and type of discrimination reported by each gendered race group, and in CVH scores across categories of discrimination (Table 1)

Summary

Introduction

Due to prominent disparities in cardiovascular outcomes between black and white women and men in the United States (Mensah & Brown, 2007; Pool, Ning, Lloyd-Jones, & Allen, 2017), researchers have examined social group-specific exposures as potential contributors to these inequities (Wyatt et al, 2003). Previous studies have linked reported racial discrimination to sedentary behavior, smoking, hypertension, obesity, and incident cardiovascular disease (CVD) within black and white populations (Borrell et al, 2010; Hunte & Willaims, 2009; Sims et al, 2012; Udo & Grilo, 2017; Womack et al, 2014). Because the prevalence of reported interpersonal racial discrimination is substantially higher among black persons than whites (Bey et al, under review; Krieger & Sidney, 1996; Shariff-Marco, Klassen, & Bowie, 2010; Williams, Yu, Jackson, & Anderson, 1997), these findings have generally been interpreted through the lens of differential exposure rather than vulnerability (Lewis, Williams, Tamene, & Clark, 2014). Consensus has leaned toward an association of what has been conceptualized as “perceived” but measured as “reported” racial discrimination with the disproportionate rate of cardiovascular morbidity and mortality among blacks (Brewer & Cooper, 2014; Krieger, 2014; Wyatt et al, 2003)

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