Research Highlight:
- A long-term study of more than 48,000 Black women assessed two measures of perceived interpersonal racism with risk of coronary heart disease.
- Experiencing self-reported interpersonal racism in employment, housing and interactions with the police was associated with a 26% higher risk of coronary heart disease, relative to not experiencing interpersonal racism in those areas.
- Self-reported experiences of racism in everyday life were not associated with an increased risk of coronary heart disease.
DALLAS, March 1, 2023 — Self-reported interpersonal racism in employment, housing and interactions with the police was associated with a 26% higher risk of coronary heart disease among Black women, according to preliminary research presented at the American Heart Association’s Epidemiology, Prevention, Lifestyle & Cardiometabolic Health Scientific Sessions 2023. The meeting will be held in Boston, February 28-March 3, 2023, and offers the latest science on population-based health and wellness and implications for lifestyle and cardiometabolic health.
“Many Black adults in the U.S. are already at higher risk of developing heart disease due to high blood pressure or Type 2 diabetes,” said Shanshan Sheehy, Sc.D., lead author of the study and an assistant professor at the Slone Epidemiology Center at Boston University and Boston University’s Chobanian & Avedisian School of Medicine. “Current evidence shows that racism may act as a chronic stressor in the human body, and chronic stress may lead to high blood pressure, which increases the risk of heart attack and stroke.”
Researchers evaluated data for approximately 48,000 individuals enrolled in the Black Women’s Health Study, the largest follow-up study on the health of Black women in the U.S. They reviewed data gathered from 1997, two years after the Black Women’s Health Study began, through 2019 to investigate whether self-perceived interpersonal racism was associated with an increased risk of coronary heart disease. In 1997, the age range of participants in the study was 22-72 years old and by 2019, the age range was 40-90 years old. All participants were free of cardiovascular disease and cancer in 1997; during the 22-year follow-up period, 1,947 women developed coronary heart disease.
In 1997, the participants answered five questions about their experiences related to interpersonal racism in their everyday activities, such as “How often do people act as if they think you are dishonest?” They also answered three questions (for a total of eight) that asked “have you ever been treated unfairly due to your race in any of the following circumstances?” — employment (hiring, promotion, firing), housing (renting, buying, mortgage) or in interactions with police (stopped, searched, threatened).
The researchers calculated a score for self-perceived interpersonal racism in everyday life by averaging participants’ responses to the first set of five questions and divided the participants into quartiles of the score; this analysis found no association with reported experiences of racism in everyday life and increased risk of CHD.
The researchers also calculated a perceived interpersonal racism score for interactions that involved jobs, housing and police interactions by adding up the positive responses to those three additional questions. The self-perceived interpersonal racism scores ranged from 0 (no to all three questions) to 3 (yes to all three questions). The researchers’ analysis of perceived interpersonal racism scores for interactions that involved jobs, housing and police found that women who reported experiencing racism in all three categories had an estimated 26% higher risk of heart disease relative to those who answered no to all three questions.
“Structural racism is real — on the job, in educational circumstances and in interactions with the criminal justice system,” said Michelle A. Albert, M.D., M.P.H., FAHA. Albert is president of the American Heart Association, professor of medicine at the University of California at San Francisco (UCSF), Admissions Dean for UCSF Medical School and an author on the study. “Now we have hard data linking it to cardiovascular outcomes, which means that we as a society need to work on the things that create the barriers that perpetuate structural racism.”
The study’s limitations include that the investigation was limited to self-perceived interpersonal racism, which is subjective by definition and may reflect different perceptions of levels of actual racism for each individual, and this information was collected from study participants only once. Also, despite efforts to adjust the findings based on a comprehensive list of additional factors — age, neighborhood socioeconomic status, education level, body mass index, geographic region, physical activity, smoking, history of diabetes and history of hypertension — the study is observational in nature and may still have some unmeasured factors or other elements that may influence the results that were not included, Sheehy said.
“Future research is needed to examine the impacts of structural racism on cardiovascular health,” Sheehy said, “as well as to evaluate the joint impacts of perceived interpersonal racism and structural racism.”
Co-first author is Max Brock, M.D.; additional co-authors include Julie R. Palmer, Sc.D. M.P.H.; Yvette Cozier, D.Sc.; and Lynn Rosenberg, Sc.D. Authors’ disclosures are listed in the abstract.
This study was funded by the National Institutes of Health.
Statements and conclusions of studies that are presented at the American Heart Association’s scientific meetings are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. Abstracts presented at the Association’s scientific meetings are not peer-reviewed, rather, they are curated by independent review panels and are considered based on the potential to add to the diversity of scientific issues and views discussed at the meeting. The findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.
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Additional Resources:
- Multimedia is available on the right column of release link https://newsroom.heart.org/news/higher-levels-of-perceived-racism-linked-to-increased-risk-of-heart-disease-in-black-women?preview=35927364a33d66dfdb64f9bbedbc207e
- Video interview: Shanshan Sheehy, Sc.D., lead author of the study and an assistant professor at the Slone Epidemiology Center at Boston University and Boston University’s Chobanian & Avedisian School of Medicine.
- Video interview: Michelle A. Albert, M.D., M.P.H., FAHA, president of the American Heart Association, professor of medicine at the University of California at San Francisco (UCSF), Admissions Dean for UCSF Medical School and an author on the study.
- AHA news release: Perceived discrimination increased the risk of worse health outcomes after a heart attack (October 2022)
- AHA news release: Representation matters, especially when it comes to your health (October 2022)
- AHA news release: Help for Latinas and Black women at higher risk of out of hospital cardiac arrest death (August 2022)
- For more news from AHA EPI Lifestyle Conference 2023, follow us on Twitter @HeartNews and #EPILifestyle23.
The American Heart Association’s EPI/LIFESTYLE 2023 Scientific Sessions is the world’s premier meeting dedicated to the latest advances in population-based science. The meeting will be held Tuesday-Friday, February 28 – March 3, 2023, at the Omni Boston Seaport in Boston, Massachusetts. The primary goal of the meeting is to promote the development and application of translational and population science to prevent heart disease and stroke and foster cardiovascular health. The sessions focus on risk factors, obesity, nutrition, physical activity, genetics, metabolism, biomarkers, subclinical disease, clinical disease, healthy populations, global health and prevention-oriented clinical trials. The Councils on Epidemiology and Prevention and Lifestyle and Cardiometabolic Health (Lifestyle) jointly planned the EPI/Lifestyle 2023 Scientific Sessions. Follow the conference on Twitter at #EPILifestyle23.
Black women at high risk of breast cancer face a variety of obstacles that may keep them from care that could prevent cancer and increase the chances they’ll survive if they develop the disease, new research has found.
A study from researchers at The Ohio State University provides insights into the factors that contribute to racial disparities in use of preventive measures, including genetic testing, prophylactic mastectomies and medication to thwart breast cancer.
In the new study, which appears today (March 1, 2023) in the journal PLOS ONE, the researchers interviewed 20 Black women and 30 white women at high risk of breast cancer to better understand racial differences in the decision-making process, which hadn’t previously been well-studied.
Among their findings: Black women may be less focused on breast cancer risk as an issue to be addressed proactively, may less frequently possess information to help guide their decisions about prevention, and face more constraints when it comes to making and carrying out health-protective decisions.
“We need to recognize that the personal, interpersonal and social dynamics that Black women are experiencing that influence their ability to cope with their risk are complicated and multilayered and need to be taken into account if we’re going to empower people to do something about their risk,” said Tasleem Padamsee, lead author of the study and an assistant professor in Ohio State’s College of Public Health.
Women with strong family histories of breast cancer, genetic predispositions to the disease or other risk factors can face a 20% to 80% risk of developing the disease within their lifetimes, but can cut that risk in half, or more, by using preventive therapies, research has shown. Black women in the U.S. are diagnosed with breast cancer at about the same rate as white women, although at younger ages and later stages of disease, and with higher breast cancer mortality rates.
“I walked away from these conversations feeling like many of these women have experienced horrible things with cancer over and over again, and that they just have an overriding sense that cancer is this thing that comes at you, upends your life and the life of everyone around you, and it’s up to God what happens from there,” said Padamsee, who is a member of The Ohio State University Comprehensive Cancer Center’s Cancer Control Research Program.
“Being in a cutting-edge cancer center, we have ways, and are finding new ones, to head the disease off at the pass and — if we can’t — to catch it earlier, when the prognosis is much better. And we want all high-risk women to have those advantages.”
The researchers found several differences based on race, all of which pointed to potentially worse outcomes for the high-risk Black women.
Overall, the Black women in the study described feeling less ready and equipped to consider and cope with their risk and less informed about their options. They also reported facing more obstacles in availing themselves of those options and having less access to detailed information to help them make decisions about managing their risk.
Previous research using data from the same interviews with this group of women found that experiences with family members had a profound influence on perceptions of their own risk and prevention options. Though Black women generally reported having more up-close experiences with family members who had cancer, that didn’t seem to be associated with awareness of measures they might take to protect themselves, Padamsee said.
The Black women in the study were more likely to describe cancers as a collective group of diseases for which they have an equally high risk, rather than recognizing a particular predisposition to breast cancer. Women who thought this way did not generally believe anything specific could be done to prevent their increased risk, instead viewing a healthy lifestyle and regular health screenings as their sole tools to mitigate risk.
Many white women in the study who were more inclined to pursue preventive medication, such as Tamoxifen, or prophylactic mastectomies, told the researchers they perceived themselves to be at specific risk of breast cancer and that they worried a lot about its impact on them and their families.
In contrast, Black women in the study who worried about their cancer risk were more likely to talk about their faith.
“We’re just a really spiritual family, we believe in God. … I put my faith in God in that everything will be alright,” said one of the middle-aged Black women interviewed for the study.
While worrying less and having a stronger spiritual connection could have mental health benefits for Black women, it also could serve as a barrier to seeking out risk-management options, Padamsee said.
Black women in the study were also more likely to describe other priorities in their lives — including family and work demands and other health struggles — that were top of mind. About 20% of white women in the study had a major health concern besides the high risk of breast cancer, compared to 40% of the Black women.
Access to care from specialists, including genetic counselors, was also uneven. About 15% of the Black women reported access to specialists, compared to 70% of the white women.
That disparity likely has a significant influence on another key finding — that Black women were less likely to know about preventive measures and were much less likely to undergo genetic testing even when they’d heard of it.
Black women’s ability to manage their breast cancer risk also is more significantly impacted by financial barriers, the study suggests. Of the Black women in the study, 40% had experienced a time without insurance, compared to just 3% of the white women. And 40% of the Black women also described significant financial difficulties coping with health challenges, compared to 3% of whites.
These new findings could provide a foundation for building equity within health care, Padamsee said. Among the possibilities she suggests: Find better ways to acknowledge and incorporate patients’ spirituality and religious perspectives into discussions about prevention, ensure that women have access to good insurance coverage or other ways of paying for specialist care, and improve training for primary care physicians who are often the sole source of medical counsel for high-risk Black women.
“There’s a lot of hand waving when it comes to talking about health equity problems, and discrimination and disadvantage in general,” she said. “One of the things that’s really important in equity work is that we have clear documentation of where the differences are and where they’re coming from, and this study helps provide that.”
Other Ohio State researchers who worked on the study are Anna Muraveva, Megan Hils, Celia Wills and Electra Paskett.
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CONTACT: Tasleem Padamsee, Padamsee.1@osu.edu
Written by Misti Crane, 614-292-3739; Crane.11@osu.edu
SUBJECT OF RESEARCH
People
ARTICLE PUBLICATION DATE
1-Mar-2023
