Black women with high levels of educational attainment are disproportionately affected by racial and ethnic discrimination (RED) associated hypertension, according to a recent study published in JAMA Network Open.
Takeaways
- The study reveals that Black women with higher levels of educational attainment are disproportionately affected by hypertension linked to racial and ethnic discrimination (RED).
- Non-Hispanic Black women in the United States experience the highest rates of hypertension, and the study suggests that intersectionality, specifically the overlap of racial and ethnic discrimination, is likely a significant risk factor for hypertension in this population.
- The research highlights that educational attainment plays a role in the association between RED and hypertension. Black individuals with higher educational levels may work in settings with increased odds of discrimination, potentially leading to a higher incidence of RED-associated hypertension.
- The study distinguishes between everyday RED and major RED, showing that both types are associated with increased hypertension risk.
- Given the observed increased association between RED and hypertension risk among highly educated Black women, the study suggests the importance of implementing multilevel interventions to address racism and alleviate the disproportionate burden of hypertension in this demographic.
Hypertension is a significant risk factor for cardiovascular disease, which is the leading cause of death among US women. Non-Hispanic Black women experience the highest rates of hypertension in the United States, with intersectionality indicated as a likely risk factor of hypertension in this population.
Educational attainment influences the association between RED and hypertension, and RED is reported more often among minoritized racial and ethnic groups, especially Black individuals. As Black individuals with higher levels of educational attainment are more likely to work in settings with increased odds of discrimination, they may experience increased RED-associated hypertension.
Investigators conducted a study to evaluate the impact of educational attainment on RED-associated hypertension. Data from the Sister Study, a cohort study of US women aged 35 to 74 years with a sister diagnosed with breast cancer but not a breast cancer diagnosis themselves, was used.
There were 26,846 eligible participants without previous hypertension during RED assessment. RED data was obtained using a self-administered questionnaire between 2008 and 2012. Everyday RED and major RED were reported.
Everyday RED included unfair treatment at a place of business, treated as less intelligent, honest, or worthy, and experienced people acting afraid because of race or ethnicity. Major RED included unfair treatment in home renting, unfair treatment by police, and being fired because of race or ethnicity.
Participants were asked, “Has a doctor or other health professional told you that you had hypertension or high blood pressure?” Patients who responded yes, were considered cases and reported the month and year of diagnosis.
Covariates included age, race and ethnicity, longest resided region as an adult, educational attainment, marital status, annual household income, current employment, sleep, diet, physical activity, menopausal status, and body mass index.
Participants were aged a mean 55 years at baseline, and 5179 cases of hypertension were observed across a mean 11-year follow-up period, 6.5% of which were among Black women, 3.9% Hispanic women, and 89.6% White women. Incidences in these populations were 265, 178, and 174 cases per 10,000 person years respectively.
Increased rates of high education level were observed among Black women, followed by White women and Hispanic women. RED was also most commonly reported by Black women, with all forms of RED more common among women with a higher education level. All forms of RED were associated with increased hypertension risk in the general population.
Compared to Black women with college level education or higher without everyday RED experience, those with RED experience had an odds ratio for hypertension of 1.56. However, everyday RED experience did not impact hypertension risk among Black women with some college education nor those with high school education or less.
These results indicated an increased association between RED and hypertension risk among Black women with a college level education or higher. Investigators recommended multilevel interventions be implemented to address racism and disproportionate hypertension burdens.
Reference
Gaston SA, Forde AT, Green M, Sandler DP, Jackson CL. Racial and ethnic discrimination and hypertension by educational attainment among a cohort of US women. JAMA Netw Open. 2023;6(11):e2344707. doi:10.1001/jamanetworkopen.2023.44707
