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01-01-2014 | Race and Ethnicity (M Albert, Section Editor)

Self-Reported Experiences of Discrimination and Cardiovascular Disease

Authors: Tené T. Lewis, David R. Williams, Mahader Tamene, Cheryl R. Clark

Published in: Current Cardiovascular Risk Reports | Issue 1/2014

Abstract

Researchers have long speculated that exposure to discrimination may increase cardiovascular disease (CVD) risk but compared to other psychosocial risk factors, large-scale epidemiologic and community based studies examining associations between reports of discrimination and CVD risk have only emerged fairly recently. This review summarizes findings from studies of self-reported experiences of discrimination and CVD risk published between 2011–2013. We document the innovative advances in recent work, the notable heterogeneity in these studies, and the considerable need for additional work with objective clinical endpoints other than blood pressure. Implications for the study of racial disparities in CVD and clinical practice are also discussed.

Go AS, Mozaffarian D, Roger VL, et al. Heart disease and stroke statistics–2013 update: a report from the American Heart Association. Circulation. 2013;127(1):e6–e245.PubMed

"Discrimination". Oxford Dictionaries: Oxford University Press.

Armstead CA, Lawler KA, Gorden G, et al. Relationship of racial stressors to blood pressure responses and anger expression in black college students. Health Psychol. 1989;8(5):541–56.PubMed

Everson-Rose SA, Lewis TT. Psychosocial factors and cardiovascular diseases. Annu Rev Public Health. 2005;26:469–500.PubMed

Rozanski A, Blumenthal JA, Kaplan J. Impact of psychological factors on the pathogenesis of cardiovascular disease and implications for therapy. Circulation. 1999;99(16):2192–217.PubMed

Rosenman RH, Brand RJ, Sholtz RI, et al. Multivariate prediction of coronary heart disease during 8.5 year follow-up in the Western Collaborative Group Study. Am J Cardiol. 1976;37(6):903–10.PubMed

Barefoot JC, Dahlstrom WG, Williams Jr RB. Hostility, CHD incidence, and total mortality: a 25-year follow-up study of 255 physicians. Psychosom Med. 1983;45(1):59–63.PubMed

Stout C, Marrow J, Brandt Jr EN, et al. Unusually low incidence of death from myocardial infarction. Study of an Italian American community in pennsylvania. JAMA. 1964;188:845–9.PubMed

Bruhn JG, Chandler B, Miller MC, et al. Social aspects of coronary heart disease in two adjacent, ethnically different communities. Am J Public Health Nation’s Health. 1966;56(9):1493–506.

10.

Syme SL, Hyman MM, Enterline PE. Some social and cultural factors associated with the occurrence of coronary heart disease. J Chronic Dis. 1964;17(3):277–89.PubMed

11.

Williams DR, Mohammed SA. Discrimination and racial disparities in health: evidence and needed research. J Behav Med. 2009;32(1):20–47.PubMed

12.

Pascoe EA, Richman LS. Perceived Discrimination and Health: A Meta-Analytic Review. Psychol Bull. 2009;135(4):531–54.PubMedPubMedCentral

13.

Williams DR, Neighbors HW, Jackson JS. Racial/ethnic discrimination and health: findings from community studies. Am J Public Health. 2003;93(2):200–8.PubMedPubMedCentral

14.

Krieger N, Sidney S. Racial discrimination and blood pressure: the CARDIA Study of young black and white adults. Am J Public Health. 1996;86(10):1370–8.PubMedPubMedCentral

15.•

Albert MA, Cozier Y, Ridker PM, et al. Perceptions of Race/Ethnic Discrimination in Relation to Mortality Among Black Women: Results From the Black Women's Health Study. Arch Intern Med. 2010;170(10):896–904. This study examined clinical CVD endpoints in a large sample of African-American women.PubMedPubMedCentral

16.

Lewis TT, Everson-Rose SA, Powell LH, et al. Chronic exposure to everyday discrimination and coronary artery calcification in African-American women: the SWAN Heart Study. Psychosom Med. 2006;68(3):362–8.PubMed

17.

Troxel WM, Matthews KA, Bromberger JT, et al. Chronic stress burden, discrimination, and subclinical carotid artery disease in African American and Caucasian women. Health Psychol. 2003;22(3):300–9.PubMed

18.

Guthrie BJ, Young AM, Williams DR, et al. African American girls' smoking habits and day-to-day experiences with racial discrimination. Nurs Res. 2002;51(3):183–90.PubMed

19.

Friedman EM, Williams DR, Singer BH, et al. Chronic discrimination predicts higher circulating levels of E-selectin in a national sample: the MIDUS study. Brain Behav Immun. 2009;23(5):684–92.PubMedPubMedCentral

20.

Hunte HE, Williams DR. The association between perceived discrimination and obesity in a population-based multiracial and multiethnic adult sample. Am J Public Health. 2009;99(7):1285–92.PubMedPubMedCentral

21.

Hunte HER. Association Between Perceived Interpersonal Everyday Discrimination and Waist Circumference Over a 9-Year Period in the Midlife Development in the United States Cohort Study. Am J Epidemiol. 2011;173(11):1232–9.PubMedPubMedCentral

22.••

Lewis TT, Kravitz HM, Janssen I, et al. Self-reported Experiences of Discrimination and Visceral Fat in Middle-aged African-American and Caucasian Women. Am J Epidemiol. 2011;173(11):1223–31. This study is the first to document an association between discrimination and computed tomography-assessed visceral fat.PubMedPubMedCentral

23.

Chae DH, Nuru-Jeter AM, Lincoln KD, et al. Racial discrimination, mood disorders, and cardiovascular disease among black americans. Ann Epidemiol. 2012;22(2):104–11.PubMed

24.

Veenstra G. Expressed racial identity and hypertension in a telephone survey sample from Toronto and Vancouver, Canada: do socioeconomic status, perceived discrimination and psychosocial stress explain the relatively high risk of hypertension for Black Canadians? Int J Equity Health. 2012;11:58.PubMedPubMedCentral

25.

Borrell LN, Kiefe CI, Diez-Roux AV, et al. Racial discrimination, racial/ethnic segregation, and health behaviors in the CARDIA study. Ethn Health. 2013;18(3):227–43.PubMed

26.

Alderete E, Monteban M, Gregorich S, et al. Smoking and exposure to racial insults among multiethnic youth in jujuy, Argentina. Cancer Causes Control. 2012;23(1):37–44.PubMedPubMedCentral

27.

Copeland-Linder N, Lambert SF, Chen Y-F, Ialongo NS. Contextual stress and health risk behaviors among African American adolescents. Journal of youth and adolescence. 2011;40(2):158–173.PubMed

28.

Crengle S, Robinson E, Ameratunga S, Clark T, Raphael D. Ethnic discrimination prevalence and associations with health outcomes: Data from a nationally representative cross-sectional survey of secondary school students in New Zealand. BMC public health. 2012;12:45.

29.

Harris R, Cormack D, Tobias M, Yeh LC, Talamaivao N, Minster J, Timutimu R. The pervasive effects of racism: Experiences of racial discrimination in New Zealand over time and associations with multiple health domains. Soc Sci Med. 2012;74(3):408–415.PubMed

30.

Horton KD, Loukas A. Discrimination, religious coping, and tobacco use among White, African American, and Mexican American vocational school students. J Relig Health. 2013;52(1):169–83.PubMedPubMedCentral

31.

Lorenzo-Blanco EI, Unger JB, Ritt-Olson A, et al. Acculturation, gender, depression, and cigarette smoking among US Hispanic youth: the mediating role of perceived discrimination. J Youth Adolesc. 2011;40(11):1519–33.PubMedPubMedCentral

32.

Lorenzo-Blanco EI, Unger JB, Ritt-Olson A, et al. A Longitudinal Analysis of Hispanic Youth Acculturation and Cigarette Smoking: The Roles of Gender, Culture, Family, and Discrimination. Nicotine Tob Res. 2013;15(5):957–68.PubMed

33.

Shin SS, Wan X, Wang Q, Raymond HF, Liu H, Ding D, et al. Perceived discrimination and smoking among rural-to-urban migrant women in china. Journal of immigrant and minority health / Center for Minority Public Health. 2013;15(1):132–140.

34.

Zuckerman RB, Tinsley LJ, Hawk H, Cohen B. Perceived reactions to race and health status in the Massachusetts Behavioral Risk Factor Surveillance System survey. Ethn Dis Autumn. 2012;22(4):492–496.

35.

Nguyen KH, Subramanian SV, Sorensen G, et al. Influence of experiences of racial discrimination and ethnic identity on prenatal smoking among urban black and Hispanic women. J Epidemiol Community Health. 2012;66(4):315–21.PubMed

36.

Ornelas IJ, Eng E, Perreira KM. Perceived barriers to opportunity and their relation to substance use among Latino immigrant men. J Behav Med. 2011;34(3):182–91.PubMed

37.

Purnell JQ, Peppone LJ, Alcaraz K et al.: Perceived Discrimination, Psychological Distress, and Current Smoking Status: Results From the Behavioral Risk Factor Surveillance System Reactions to Race Module, 2004–2008. Journal Information 2012, 102(5)

38.

Krieger N, Waterman PD, Kosheleva A, et al. Exposing racial discrimination: implicit & explicit measures–the My Body, My Story study of 1005 US-born black & white community health center members. PLoS One. 2011;6(11):e27636.PubMedPubMedCentral

39.

Johnson P, Risica PM, Gans KM, et al. Association of perceived racial discrimination with eating behaviors and obesity among participants of the SisterTalk study. J Natl Black Nurses' Assoc JNBNA. 2012;23(1):34–40.

40.

Corral I, Landrine H. Racial discrimination and health-promoting vs damaging behaviors among African-American adults. J Health Psychol. 2012;17(8):1176–82.PubMed

41.

Knutson KL, Van Cauter E, Rathouz PJ, et al. Association Between Sleep and Blood Pressure in Midlife: The CARDIA Sleep Study. Arch Intern Med. 2009;169(11):1055–61.PubMedPubMedCentral

42.

King CR, Knutson KL, Rathouz PJ, et al. Short sleep duration and incident coronary artery calcification. Jama. 2008;300(24):2859–66.PubMedPubMedCentral

43.

Patel SR, Zhu X, Storfer-Isser A, et al. Sleep duration and biomarkers of inflammation. Sleep. 2009;32(2):200–4.PubMedPubMedCentral

44.

Hall MH, Muldoon MF, Jennings JR, et al. Self-reported sleep duration is associated with the metabolic syndrome in midlife adults. Sleep. 2008;31(5):635–43.PubMedPubMedCentral

45.

Ikehara S, Iso H, Date C, et al. Association of sleep duration with mortality from cardiovascular disease and other causes for Japanese men and women: the JACC study. Sleep. 2009;32(3):295–301.PubMedPubMedCentral

46.

Ayas NT, White DP, Manson JE, et al. A prospective study of sleep duration and coronary heart disease in women. Arch Intern Med. 2003;163(2):205–9.PubMed

47.

Grandner MA, Hale L, Jackson N, et al. Perceived racial discrimination as an independent predictor of sleep disturbance and daytime fatigue. Behav Sleep Med. 2012;10(4):235–49.PubMedPubMedCentral

48.

Tomfohr L, Pung MA, Edwards KM, et al. Racial differences in sleep architecture: the role of ethnic discrimination. Biol Psychol. 2012;89(1):34–8.PubMed

49.•

Lewis TT, Troxel WM, Kravitz HM, et al. Chronic exposure to everyday discrimination and sleep in a multiethnic sample of middle-aged women. Health Psychol. 2013;32(7):810–9. This study documents an association between chronic exposure to discrimination and polysomnography-assessed sleep.PubMed

50.

Beatty DL, Hall MH, Kamarck TA, et al. Unfair treatment is associated with poor sleep in African American and Caucasian adults: Pittsburgh SleepSCORE project. Health Psychol. 2011;30(3):351–9.PubMedPubMedCentral

51.

Hicken M, Lee H, Ailshire J, et al. “Every Shut Eye, Ain’t Sleep”: The Role of Racism-Related Vigilance in Racial/Ethnic Disparities in Sleep Difficulty. Race Soc Probl. 2013;5(2):100–12.PubMedPubMedCentral

52.

Lenfant C, Chobanian AV, Jones DW, et al. Seventh report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) resetting the hypertension sails. Circulation. 2003;107(24):2993–4.

53.

Mezuk B, Kershaw KN, Hudson D, et al. Job Strain, Workplace Discrimination, and Hypertension among Older Workers: The Health and Retirement Study. Race Social Probl. 2011;3(1):38–50.

54.

Trevino B, Ernst FA. Skin tone, racism, locus of control, hostility, and blood pressure in Hispanic college students. Hispanic Journal of Behavioral Sciences. 2012;34(2):340–348.

55.•

Chae DH, Nuru-Jeter AM, Adler NE. Implicit Racial Bias as a Moderator of the Association Between Racial Discrimination and Hypertension: A Study of Midlife African American Men. Psychosom Med. 2012;74(9):961–4. This study examined the role of internalized racial bias as an effect modifier of the association between racism and hypertension in African-American men.PubMedPubMedCentral

56.

Eliezer D, Townsend SSM, Sawyer PJ, et al. System-justifying beliefs moderate the relationship between perceived discrimination and resting blood pressure. Soc Cogn. 2011;29(3):303–21.

57.

Gregoski MJ, Buxbaum SG, Gaston Kapuku MD et al.: Interactive Influences of Ethnicity, Endothelin-1 Gene, and Everyday Discrimination Upon Nocturnal Ambulatory Blood Pressure. Annals of Behavioral Medicine 2013:1–10.

58.

Neblett EW, Carter SE. The protective role of racial identity and Africentric worldview in the association between racial discrimination and blood pressure. Psychosom Med. 2012;74(5):509–16.PubMed

59.•

Sims M, Diez-Roux AV, Dudley A et al.: Perceived discrimination and hypertension among African Americans in the Jackson Heart Study. American Journal of Public Health 2012, 102(S2). This is one of the first studies of discrimination and health from the Jackson Heart Study, which utilizes a comprehensive assessment of various forms of discrimination and examines them in relation to hypertension prevalence

60.

Moore-Greene GM, Gross SM, Silver KD, Perrino CS. Chronic stress and decreased physical exercise: Impact on weight for African American women. Ethn Dis Spring 2012;22(2):185–191.

61.

Subramanyam MA, Diez-Roux AV, Hickson DA, Sarpong DF, Sims M, Taylor HA, Jr., et al. Subjective social status and psychosocial and metabolic risk factors for cardiovascular disease among African Americans in the Jackson Heart Study. Soc Sci Med. Feb 14 2012.

62.

Mwendwa DT, Gholson G, Sims RC, Levy S-A, Ali M, Harrell CJ, et al. Coping with perceived racism: A significant factor in the development of obesity in African American women? J Natl Med Assoc. 2011;103(7):602–608.PubMed

63.••

Brondolo E, Love EE, Pencille M, et al. Racism and hypertension: a review of the empirical evidence and implications for clinical practice. Am J Hypertens. 2011;24(5):518–29. This systematic review critically evaluates the broad literature documenting associations between discrimination and blood pressure across a wide range of study designs.PubMed

64.

Kaholokula JK, Grandinetti A, Keller S, et al. Association between perceived racism and physiological stress indices in Native Hawaiians. J Behav Med. 2012;35(1):27–37.PubMed

65.

Klimentidis YC, Dulin-Keita A, Casazza K, et al. Genetic admixture, social-behavioural factors and body composition are associated with blood pressure differently by racial-ethnic group among children. J Hum Hypertens. 2012;26(2):98–107.PubMed

66.

Hickson DA, Lewis TT, Liu J, et al. The associations of multiple dimensions of discrimination and abdominal fat in African American adults: the Jackson Heart Study. Ann Behav Med. 2012;43(1):4–14.PubMed

67.

Cunningham TJ, Seeman TE, Kawachi I, et al. Racial/ethnic and gender differences in the association between self-reported experiences of racial/ethnic discrimination and inflammation in the CARDIA cohort of 4 US communities. Soc Sci Med. 2012;75(5):922–31.PubMedPubMedCentral

68.

Lewis TT, Aiello AE, Leurgans S, et al. Self-reported experiences of everyday discrimination are associated with elevated C-reactive protein levels in older African-American adults. Brain Behav Immun. 2010;24(3):438–43.PubMed

69.••

Ayotte BJ, Hausmann LR, Whittle J, et al. The relationship between perceived discrimination and coronary artery obstruction. Am Heart J. 2012;163(4):677–83. This is one of the first studies to examine the relationship between discrimination and CVD risk in a clinical sample.PubMed

70.

Shah AJ, Veledar E, Hong Y, et al. Depression and history of attempted suicide as risk factors for heart disease mortality in young individuals. Arch Gen Psychiatry. 2011;68(11):1135–42.PubMedPubMedCentral

71.

Vaccarino V, McClure C, Johnson BD, et al. Depression, the metabolic syndrome and cardiovascular risk. Psychosom Med. 2008;70(1):40–8.PubMed

72.

Lewis TT, Guo H, Lunos S, et al. Depressive symptoms and cardiovascular mortality in older black and white adults: evidence for a differential association by race. Cir Cardiovasc Qual outcomes. 2011;4(3):293–9.

73.

Henderson KM, Clark CJ, Lewis TT, et al. Psychosocial distress and stroke risk in older adults. Stroke. 2013;44(2):367–72.PubMed

74.

Schulz AJ, Israel BA, Gravlee CC, et al. Discrimination, Symptoms of Depression, and Self-Rated Health Among African American Women in Detroit: Results From a Longitudinal Analysis. Am J Public Health. 2006;96(7):1265–70.PubMedPubMedCentral

75.

Everage NJ, Gjelsvik A, McGarvey ST, et al. Inverse associations between perceived racism and coronary artery calcification. Ann Epidemiol. 2012;22(3):183–90.PubMedPubMedCentral

76.

Williams DR, Yu Y, Jackson JS, et al. Racial Differences in Physical and Mental Health. J of Health Psychol. 1997;2(3):335–51.

77.

Albert MA, Williams DR. Invited Commentary: Discrimination–An Emerging Target for Reducing Risk of Cardiovascular Disease? Am J Epidemiol. 2011;173(11):1240–3.PubMed

78.

Smedley BD, Stith AY, Nelson AR. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: National Academy Press; 2003.

79.

Williams DR, Williams-Morris R. Racism and mental health: the African American experience. Ethn Health. 2000;5(3–4):243–68.PubMed

80.

Sabin JA, Nosek BA, Greenwald AG, et al. Physicians' Implicit and Explicit Attitudes About Race by MD Race, Ethnicity, and Gender. J Health Care Poor Underserved. 2009;20(3):896–913.PubMedPubMedCentral

81.

Cooper LA, Roter DL, Carson KA, et al. The Associations of Clinicians’ Implicit Attitudes About Race With Medical Visit Communication and Patient Ratings of Interpersonal Care. Am J Public Health. 2012;102(5):979–87.PubMedPubMedCentral

82.

van Ryn M, Burgess DJ, Dovidio JF, et al. The impact of racism on clinician cognition, behavior, and clinical decision making. Du Bois Rev. 2011;8(1):199–218.PubMedPubMedCentral

Title: Self-Reported Experiences of Discrimination and Cardiovascular Disease
Authors: Tené T. Lewis
David R. Williams
Mahader Tamene
Cheryl R. Clark
Publication date: 01-01-2014
Publisher: Springer US
Published in: Current Cardiovascular Risk Reports / Issue 1/2014
Print ISSN: 1932-9520
Electronic ISSN: 1932-9563
DOI: https://doi.org/10.1007/s12170-013-0365-2

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