1. In this cohort study, a 38% increased risk of stroke was reported amongst black women reporting interpersonal racism in employment, housing, and police interactions.
Evidence Rating Level: 2 (Good)
It is well documented in prior literature that black individuals in the United States face disproportionately higher stroke incidence and mortality rates compared to their White counterparts. This association is most marked in black women, who experience the highest rates and earliest onset of stroke compared to women from other racial groups. Although social determinants of health have been used to determine potential causes of this discrepancy, there has been a lack of literature directly examining the association of interpersonal racism and stroke incidence. The study, conducted within the Black Women’s Health Study (BWHS), initiated in 1995, a prospective cohort study that encompassed 48,375 participants. Participants aged 21-69 at baseline during the study period provided detailed health and psychosocial information through questionnaires and were followed up through 2019. This cohort study sought to identify stroke cases that were gathered through the BWHS questionnaires and medical records review, and characterize their association with perceived interpersonal racism using questions focused on interactions in everyday life and in the workplace, housing market, and with law enforcement. During follow-up from 1997 through 2019, 1664 incident strokes were identified. Women in the highest quartile of perceived interpersonal racism in everyday life had an age-adjusted HR for stroke of 1.28. The multivariable HR was 1.14. For those experiencing racism in employment, housing, and police, the age-adjusted HR for stroke was 1.42, with a multivariable HR of 1.38. Study findings suggest that independent of other risk factors such as smoking, age, etc., the experience of interpersonal racism was associated with a significantly increased stroke risk. Although future studies will be required given the complexities of racism and racial discrimination, findings underscore the significance of racism itself as a social determinant of health and its contribution to stroke risk.
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