Disparities in Reproductive Aging and Midlife Health between Black and White women: The Study of Women's Health Across the Nation (SWAN).

• Type of Material: Article
• Authors: Siobán D Harlow, University of Michigan, School of Public Health, United States, 1415 Washington Heights, Ann Arbor, MI, 48104-2029, USA. [e-mail].; Sherri-Ann M Burnett-Bowie, Massachusetts General Hospital; Gail A Greendale, University of California at Los Angeles, Los Angeles, USA.; Nancy E Avis, Wake Forest School of Medicine; Alexis N Reeves, University of Michigan, Ann Arbor; Thomas R Richards, University of Michigan, Ann Arbor; Tene Lewis, Emory University
• Language: English
• Date: 2022-02-08
• Publisher: BioMed Central Ltd
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2022
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s40695-022-00073-y
• Title of Journal or Parent Work: Womens Midlife Health
• Volume: 8
• Issue: 1
• Start Page: 3
• End Page: 3
• Grant/Funding Information: The Study of Women's Health Across the Nation (SWAN) has grant support from the National Institutes of Health (NIH), DHHS, through the National Institute on Aging (NIA), the National Institute of Nursing Research (NINR) and the NIH Office of Research on Women’s Health (ORWH) (Grants U01NR004061; U01AG012505, U01AG012535, U01AG012531, U01AG012539, U01AG012546, U01AG012553, U01AG012554, U01AG012495, U01AG017719, and U19AG063720). The content of this article is solely the responsibility of the authors and does not represent the official views of the NIA, NINR, ORWH or the NIH.
• Keywords: Cardiovascular disease; Sleep; Metabolic disease; Midlife; Mental health; Race; Hot flash; Menopause; Discrimination; Racism
• Research Categories: Health Sciences, Epidemiology

Abstract

This paper reviews differences in the experience of the menopause transition and midlife health outcomes between Black and White women who participated in the Study of Women's Health Across the Nation (SWAN), a 25-year, longitudinal, multi-racial/ethnic cohort study. We identify health disparities, i.e., instances in which Black women's outcomes are less favorable than those of White women, and consider whether structural racism may underlie these disparities. Although SWAN did not explicitly assess structural racism, Black women in SWAN grew up during the Jim Crow era in the United States, during which time racism was legally sanctioned. We consider how we might gain insight into structural racism by examining proxy exposures such as socioeconomic characteristics, reports of everyday discrimination, and a range of life stressors, which likely reflect the longstanding, pervasive and persistent inequities that have roots in systemic racism in the US. Thus, this paper reviews the presence, magnitude, and longitudinal patterns of racial disparities observed in SWAN in six areas of women's health - menopause symptoms, sleep, mental health, health related quality of life, cardio-metabolic health, and physical function -and elucidates the contextual factors that are likely influencing these disparities. We review the strengths and weaknesses of SWAN's design and approach to analysis of racial disparities and use this as a springboard to offer recommendations for future cohort studies.