Perceived Discrimination and Hypertension Risk Among Participants in the Multi-Ethnic Study of Atherosclerosis

• Authors: Allana T Forde, National Institute on Minority Health and Health Disparities; Tene Lewis, Emory University; Kiarri N Kershaw, Northwestern University; Scarlett L Bellamy, Drexel University; Ana V Diez Roux, Drexel University
• Journal Title: JOURNAL OF THE AMERICAN HEART ASSOCIATION
• Volume: Volume 10, Number 5
• Publisher: WILEY | 2021-03-02, Pages 1-17
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1161/JAHA.120.019541
• Keywords: Science & Technology; Life Sciences & Biomedicine; Cardiac & Cardiovascular Systems; Cardiovascular System & Cardiology; blood pressure; discrimination; ethnicity; hypertension; multiethnic study of atherosclerosis; race; racial residential segregation; RACIAL/ETHNIC RESIDENTIAL SEGREGATION; RACIAL-DISCRIMINATION; AFRICAN-AMERICANS; CARDIOVASCULAR-DISEASE; HEALTH BEHAVIORS; DISPARITIES; NEIGHBORHOOD; PERCEPTIONS; ASSOCIATION; STRESS

Abstract

BACKGROUND: Black Americans have a higher risk of hypertension compared with White Americans. Perceived discrimination is a plausible explanation for these health disparities. Few studies have examined the impact of perceived discrimination on the incidence of hypertension among a racially diverse sample. Our study examined associations of everyday and lifetime discrimination with incidence of hypertension and whether these associations varied by sex, discrimination attribution, and racial residential segregation. METHODS AND RESULTS: The study included 3297 Black, Hispanic, Chinese, and White participants aged 45 to 84 years from the Multi-Ethnic Study of Atherosclerosis who were without hypertension at exam 1 (2000–2002) and who completed at least 1 of 5 follow-up exams (2002–2018). Cox proportional hazards regression was used to estimate associations of perceived discrimination with incident hypertension. Over the follow-up period, 49% (n=1625) of participants developed hypertension. After adjustment for age, sex, socioeconomic status, hypertension risk factors, and study site, Black participants reporting any lifetime discrimination (compared with none) were more likely to develop hypertension (hazard ratio [HR], 1.35; 95% CI, 1.07–1.69). In fully adjusted models, everyday discrimination (high versus low) was associated with a lower risk for hypertension among Hispanic participants (HR, 0.73; 95% CI, 0.55–0.98). Statistically significant interactions of perceived discrimination (everyday and lifetime) with sex, discrimination attribution, and racial residential segregation were not observed. CONCLUSIONS: This study suggests that lifetime, but not everyday discrimination is associated with incident hypertension in Black Americans.