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Discrimination and Hypertension Risk Among African Americans
Quick Takes
- Lifetime discrimination may increase the risk of hypertension in African Americans.
- To what degree discrimination contributes to overall and specifically cardiovascular health in all persons is an important but difficult question.
- Regardless of the impact of discrimination on health, we owe it to ourselves to rid it from the United States.
Study Questions:
What is the association of everyday and lifetime stress from discrimination with incident hypertension in African Americans compared with other racial or ethnic groups in the United States?
Methods:
The authors utilized participants enrolled in the Jackson Heart Study, a broad-based sample of African Americans (21–95 years of age) who were recruited from the ARIC (Atherosclerosis Risk in the Community) study (31%); a commercially available list (17%); a community random sample of volunteers (30%); and the adult family members of ARIC participants or volunteer participants (22%). Available data included discrimination attribution and coping responses. Participants completed two follow-up study visits from 2005 to 2008 and 2009 to 2013. Cox proportional hazards regression was used to estimate associations of discrimination with incident hypertension.
Results:
Overall, 52% (n = 954) of participants developed hypertension over the follow-up period. After adjustment for age, gender, socioeconomic status, and hypertension risk factors, medium versus low levels of lifetime discrimination (hazard ratio [HR], 1.49; 95% confidence interval [CI], 1.18–1.89), and high versus low levels of lifetime discrimination (HR, 1.34; 95% CI, 1.07–1.68) were associated with a higher incidence of hypertension. No statistically significant interactions with gender, age, attribution, or coping were present. Higher stress from lifetime discrimination was associated with higher hypertension risk after adjustment for demographics (HR for high vs. low, 1.19; 95% CI, 1.01–1.40), but the association was attenuated after adjustment for hypertension risk factors (HR, 1.14; 95% CI, 0.97–1.35).
Conclusions:
Lifetime discrimination may increase the risk of hypertension in African Americans.
Perspective:
Considering the overlap of stress and lifestyle response to stress, locus of control, socioeconomics, and relationship of each with discrimination, identifying to what degree social discrimination of minorities contributes to cardiovascular health and particularly hypertension will always be conflicted. As the authors suggest, findings from this study have important implications for future research on health disparities and are important to the design of interventions and policies aimed at reducing the negative health effects of discrimination in any form.
Clinical Topics: Cardiovascular Care Team, Prevention, Hypertension, Stress
Keywords: African Americans, Ethnic Groups, Hypertension, Life Style, Minority Groups, Primary Prevention, Risk Factors, Social Class, Social Discrimination, Socioeconomic Factors, Stress, Psychological
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