Race and Medicine

Race and Medicine

Perspective from Paul Underwood, MD
Disclosures: The authors report no relevant financial disclosures.
July 01, 2020
4 min read
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Discrimination increases hypertension risk among African American adults

Perspective from Paul Underwood, MD
Disclosures: The authors report no relevant financial disclosures.
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Lifetime discrimination increased the risk for hypertension among African American participants from the Jackson Heart Study, researchers found.

“There is a growing body of evidence from prior studies that shows that discrimination affects the health of African Americans,” Allana T. Forde, PhD, MPH, postdoctoral research fellow at the Urban Health Collaborative at Drexel University in Philadelphia, told Healio. “However, our study is one of the first, large community-based longitudinal studies to show a link between discrimination over one’s lifetime and the development of hypertension among a large sample of African American men and women.”

Graphical depiction of data presented in article
Risk for hypertension among individuals who experienced medium compared with high lifetime discrimination.

In the study published in Hypertension, researchers analyzed data from 1,845 participants (mean age, 49 years; 61% women) from the Jackson Heart Study who did not have hypertension at baseline. Discrimination was measured using the Everyday Discrimination Scale and the Lifetime Discrimination Scale. Researchers also assessed how participants coped with discrimination and what was the main reason for the discrimination. Potential confounders included sex, age and socioeconomic status, in addition to hypertension risk factors.

Among the cohort, 52% developed hypertension. Participants who developed hypertension were older (51.9 years vs. 46.4 years; P < .0001), had a higher BMI (31.5 kg/m2 vs. 29.8 kg/m2), engaged in less physical activity (< 150 minutes of moderate activity and < 75 minutes of vigorous activity, 80.5% vs. 73.6%), less likely to be college educated (68.5% vs. 76.8%) and more likely to be former (14.8% vs. 12.7%) or current smokers (15.4% vs. 10.3%) compared with those who did not develop hypertension.

Compared with low levels of lifetime discrimination, medium (HR = 1.49; 95% CI, 1.18-1.89) and high levels (HR = 1.34; 95% CI, 1.07-1.68) of lifetime discrimination were associated with incident hypertension after adjusting for sex, age, hypertension risk factors and socioeconomic status. There were no statistically significant interactions associated with age, sex, coping or attribution.

Participants who experienced higher stress associated with lifetime discrimination had a higher risk for hypertension compared with those with low stress after adjusting for demographics (HR = 1.19; 95% CI, 1.01-1.4). Further adjustment for hypertension risk factors attenuated the association (HR = 1.14; 95% CI, 0.97-1.35).

Allana T. Forde

“Discrimination was found to have a significant impact on hypertension among African Americans, which has important implications for clinical practice and population health,” Forde said in an interview. “Discrimination should be recognized as an important social determinant of health and be included in clinical practice. Our study emphasized the unfair treatment experienced by African Americans and highlights the need to seriously consider how discrimination affects their health and contributes to health disparities.”

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For more information:

Allana T. Forde, PhD, MPH, can be reached at atf45@drexel.edu.