We investigated historical redlining, a government-sanctioned discriminatory policy, in relation to cardiovascular health (CVH) and whether associations were modified by present-day neighborhood ...physical and social environments. Data included 4,779 participants (mean age 62 y; SD = 10) from the baseline sample of the Multi-Ethnic Study of Atherosclerosis (MESA; 2000 to 2002). Ideal CVH was a summary measure of ideal levels of seven CVH risk factors based on established criteria (blood pressure, fasting glucose, cholesterol, body mass index, diet, physical activity, and smoking). We assigned MESA participants' neighborhoods to one of four grades (A: best, B: still desirable, C: declining, and D: hazardous) using the 1930s federal Home Owners' Loan Corporation (HOLC) maps, which guided decisions regarding mortgage financing. Two-level hierarchical linear and logistic models, with a random intercept to account for participants nested within neighborhoods (i.e., census tracts) were used to assess associations within racial/ethnic subgroups (non-Hispanic White, non-Hispanic Black, Hispanic, and non-Hispanic Chinese). We found that Black adults who lived in historically redlined areas had a 0.82 (95% CI -1.54, -0.10) lower CVH score compared to those residing in grade A (best) neighborhoods, in a given neighborhood and adjusting for confounders. We also found that as the current neighborhood social environment improved the association between HOLC score and ideal CVH weakened (
< 0.10). There were no associations between HOLC grade and CVH measures or effect modification by current neighborhood conditions for any other racial/ethnic group. Results suggest that historical redlining has an enduring impact on cardiovascular risk among Black adults in the United States.
Research Highlights • We identified 17 studies on the relationship between discrimination and sleep. • All 17 studies found at least one association between discrimination and worse sleep. • Studies ...with more detailed exposures and outcomes revealed some inconsistencies. • Longitudinal designs and studies using objective sleep assessments are needed.
Over the past two decades, research examining the impact of self-reported experiences of discrimination on mental and physical health has increased dramatically. Studies have found consistent ...associations between exposure to discrimination and a wide range of
Diagnostic and Statistical Manual of Mental Disorders
(DSM)-diagnosed mental disorders as well as objective physical health outcomes. Associations are seen in cross-sectional as well as longitudinal studies and persist even after adjustment for confounding variables, including personality characteristics and other threats to validity. However, controversies remain, particularly around the best approach to measuring experiences of discrimination, the significance of racial ethnic discrimination versus overall mistreatment, the need to account for "intersectionalities," and the importance of comprehensive assessments. These issues are discussed in detail, along with emerging areas of emphasis including cyber discrimination, anticipatory stress or vigilance around discrimination, and interventions with potential to reduce the negative effects of discrimination on health. We also discuss priorities for future research and implications for interventions and policy.
Research examining associations between self-reported experiences of discrimination overall (e.g., potentially due to race, gender, socioeconomic status, age) and health—particularly among African ...Americans—has grown rapidly over the past two decades. Yet recent findings suggest that self-reported experiences of racism alone may be less impactful for the health of African Americans than previously hypothesized. Thus, an approach that captures a broader range of complexities in the study of discrimination and health among African Americans may be warranted. This article presents an argument for the importance of examining intersectionalities in studies of discrimination and physical health in African Americans and provides an overview of research in this area.
Several researchers have argued that racism-related stressors play an important role in adverse cardiovascular outcomes among African American women. However, studies have primarily focused on ...experiences of racism; thus, the role of expectations of racism is insufficiently understood. The current proof-of-concept study was designed to examine associations among expectations of racism, self-reported experiences of racism, and carotid intima-media thickness (IMT), a marker of cardiovascular risk, in African American women.
Participants were 52 healthy African American women, aged 30 to 50 years (M (SD) = 40.8 (4.3)). Expectations of racism were assessed with a modified version of the Race-Based Rejection Sensitivity Questionnaire, experiences of racism were assessed with the Schedule of Racist Events, and carotid IMT was measured using B-mode ultrasound.
In linear regression analyses adjusted for age, expectations of racism were associated with higher levels of carotid IMT (b = .04, SE = .014, p = .013), after adjusting for experiences of racism. Findings remained significant after additional adjustments for cardiovascular risk factors (b = .03, SE = .014, p = .032). Associations were not confounded by additional stressors, hostility, or negative affect (depressive symptoms).
Independent of actual reports of racism, "expectations" of racism may be associated with increased cardiovascular risk in African American women. In addition, although experiences of discrimination were associated with depressive symptoms, expectations of racism were not, suggesting that other negative emotions likely play a role. Future studies are needed to replicate these results in larger samples and to explore the psychological and physiological pathways through which expectations of racism might affect cardiovascular disease risk across a range of populations.
Abstract Self-reported experiences of “everyday” discrimination have been linked to indices of cardiovascular disease and overall mortality and findings have been particularly pronounced for ...African-American populations. However, the biological mechanisms underlying these associations remain unclear. C-reactive protein (CRP), a marker of inflammation, is a known correlate of cardiovascular and other health outcomes and has also been linked to several psychosocial processes. To our knowledge, no studies have examined the association between experiences of discrimination and CRP. We examined the cross-sectional association between self-reported experiences of discrimination and CRP in a sample of 296 older African-American adults (70% female, mean age = 73.1). Experiences of discrimination were assessed with the 9-item everyday discrimination scale and CRP was assayed from blood samples. In linear regression models adjusted for age, sex and education, experiences of discrimination were associated with higher levels of CRP ( B = .10, p = .03). This association remained significant after additional adjustments for depressive symptoms ( B = .10, p = .04), smoking, and chronic health conditions (heart disease, diabetes, hypertension) that might influence inflammation ( B = .11, p = .02). However, results were attenuated when body mass index (BMI) was added to the model ( B = .09, p = .07). In conclusion, self-reported experiences of everyday discrimination are associated with higher levels of CRP in older African-American adults, although this association is not completely independent of BMI.
In their article "COVID-19-Related Discrimination Among Racial/Ethnic Minorities and Other Marginalized Communities in the United States," Strassle et al. (p. 453) provide an excellent descriptive ...analysis ofthe prevalence of COVID-19-related discrimination by race/ethnicity in the United States between December 2020 and February 2021. The authors begin by acknowledging the increasing anti-Asian sentiment driven by references to COVID-19 as the "Chinese flu." However, in contrast to early reports of COVID-19-related discrimination that focused primarily on Asian Americans, Strassle et al. extend this work beyond Asian, Black, Latino, and multiracial groups to also include American Indian/Alaska Native and Native Hawaiian/Pacific Islander groups. The authors also examine Asian subpopulations, highlighting the potential heterogeneity within this population. Using a modified version ofthe Everyday Discrimination Scale explicitly designed to capture discrimination because of COVID-19, more than 22% ofthe sample reported exposure to discriminatory behaviors, and over 42% reported people being afraid of them. Unsurprisingly, every racial/ethnic group reported more discrimination experiences because of COVID-19 than White populations. Asian followed by Latino and American Indian/ Alaska Native populations reported the highest prevalence of discrimination experiences. Although not significantly different from other Asian subpopulations, Vietnamese adults reported the most COVID-19-related discrimination, and Japanese adults reported the least COVID-19-related discrimination. Small sample sizes within Asian subpopulations may have precluded the ability to estimate statistically significant differences. However, the substantial variation in COVID-19-related discrimination reports should encourage future studies to disaggregate within racial/ ethnic subgroups, when possible, for Asian populations, as well as other minoritized populations. In addition to race/ethnicity, other socially disadvantaged groups, namely those with lower levels of education, low income, nonnative English speakers, and individuals living in rural areas, were also significantly more likely to report COVID-19-related discrimination. Notably, these are all groups with higher levels of COVID-19related morbidity and mortality. This article highlights the ubiquity ofCOVID-19related discrimination and the salience of race/ethnicity among minoritized populations.1 Therefore, this editorial aims to discuss how we can expand theory to fully understand the impacts of COVID-19related discrimination and make recommendations for reducing its negative impacts.
BACKGROUND:Mental stress-induced myocardial ischemia (MSIMI) is frequent in patients with coronary artery disease and is associated with worse prognosis. Young women with a previous myocardial ...infarction (MI), a group with unexplained higher mortality than men of comparable age, have shown elevated rates of MSIMI, but the mechanisms are unknown.
METHODS:We studied 306 patients (150 women and 156 men) ≤61 years of age who were hospitalized for MI in the previous 8 months and 112 community controls (58 women and 54 men) frequency matched for sex and age to the patients with MI. Endothelium-dependent flow-mediated dilation and microvascular reactivity (reactive hyperemia index) were measured at rest and 30 minutes after mental stress. The digital vasomotor response to mental stress was assessed using peripheral arterial tonometry. Patients received Tc-sestamibi myocardial perfusion imaging at rest, with mental (speech task) and conventional (exercise/pharmacological) stress.
RESULTS:The mean age of the sample was 50 years (range, 22–61). In the MI group but not among controls, women had a more adverse socioeconomic and psychosocial profile than men. There were no sex differences in cardiovascular risk factors, and among patients with MI, clinical severity tended to be lower in women. Women in both groups showed a higher peripheral arterial tonometry ratio during mental stress but a lower reactive hyperemia index after mental stress, indicating enhanced microvascular dysfunction after stress. There were no sex differences in flow-mediated dilation changes with mental stress. The rate of MSIMI was twice as high in women as in men (22% versus 11%, P=0.009), and ischemia with conventional stress was similarly elevated (31% versus 16%, P=0.002). Psychosocial and clinical risk factors did not explain sex differences in inducible ischemia. Although vascular responses to mental stress (peripheral arterial tonometry ratio and reactive hyperemia index) also did not explain sex differences in MSIMI, they were predictive of MSIMI in women only.
CONCLUSIONS:Young women after MI have a 2-fold likelihood of developing MSIMI compared with men and a similar increase in conventional stress ischemia. Microvascular dysfunction and peripheral vasoconstriction with mental stress are implicated in MSIMI among women but not among men, perhaps reflecting women’s proclivity toward ischemia because of microcirculatory abnormalities.
To investigate the association of psychosocial distress with risk of stroke mortality and incident stroke in older adults.
Data were from the Chicago Health and Aging Project, a longitudinal ...population-based study conducted in 3 contiguous neighborhoods on the south side of Chicago, IL. Participants were community-dwelling black and non-Hispanic white adults, aged 65 years and older (n=4120 for stroke mortality; n=2649 for incident stroke). Psychosocial distress was an analytically derived composite measure of depressive symptoms, perceived stress, neuroticism, and life dissatisfaction. Cox proportional hazards models examined the association of distress with stroke mortality and incident stroke over 6 years of follow-up.
Stroke deaths (151) and 452 incident strokes were identified. Adjusting for age, race, and sex, the hazard ratio (HR) for each 1-SD increase in distress was 1.47 (95% confidence interval CI=1.28-1.70) for stroke mortality and 1.18 (95% CI=1.07-1.30) for incident stroke. Associations were reduced after adjustment for stroke risk factors and remained significant for stroke mortality (HR=1.29; 95% CI=1.10-1.52) but not for incident stroke (HR=1.09; 95% CI=0.98-1.21). Secondary analyses of stroke subtypes showed that distress was strongly related to incident hemorrhagic strokes (HR=1.70; 95% CI=1.28-2.25) but not ischemic strokes (HR=1.02; 95% CI=0.91-1.15) in fully adjusted models.
Increasing levels of psychosocial distress are related to excess risk of both fatal and nonfatal stroke in older black and white adults. Additional research is needed to examine pathways linking psychosocial distress to cerebrovascular disease risk.
BACKGROUND:Limited information exists on the lifetime risk of atrial fibrillation (AF) in African Americans and by socioeconomic status.
METHODS:We studied 15 343 participants without AF at baseline ...from the ARIC (Atherosclerosis Risk in Communities) cohort recruited in 1987 to 1989 from 4 communities in the United States when they were 45 to 64 years of age. Participants have been followed through 2014. Incidence rates of AF were calculated dividing the number of new cases by person-years of follow-up. Lifetime risk of AF was estimated by a modified Kaplan-Meier method considering death as a competing risk. Participants’ family income and education were obtained at baseline.
RESULTS:We identified 2760 AF cases during a mean follow-up of 21 years. Lifetime risk of AF was 36% (95% confidence interval, 32%–38%) in white men, 30% (95% confidence interval, 26%–32%) in white women, 21% (95% confidence interval, 13%–24%) in African American men, and 22% (95% confidence interval, 16%–25%) in African American women. Regardless of race and sex, incidence rates of AF decreased from the lowest to the highest categories of income and education. In contrast, lifetime risk of AF increased in individuals with higher income and education in most sex-race groups. Cumulative incidence of AF was lower in those with higher income and education compared with their low socioeconomic status counterparts through earlier life but was reversed after age 80.
CONCLUSIONS:Lifetime risk of AF in the ARIC cohort was ≈1 in 3 among whites and 1 in 5 among African Americans. Socioeconomic status was inversely associated with cumulative incidence of AF before the last decades of life.
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