Cross-Sectional Association between Perceived Discrimination and Hypertension in African-American Men and Women The Pitt County Study

Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA.
American journal of epidemiology (Impact Factor: 5.23). 04/2008; 167(5):624-32. DOI: 10.1093/aje/kwm334
Source: PubMed


Few studies have examined the impact of the frequency of discrimination on hypertension risk. The authors assessed the cross-sectional associations between frequency of perceived racial and nonracial discrimination and hypertension among 1,110 middle-aged African-American men (n = 393) and women (n = 717) participating in the 2001 follow-up of the Pitt County Study (Pitt County, North Carolina). Odds ratios were estimated using gender-specific unconditional weighted logistic regression with adjustment for relevant confounders and the frequency of discrimination. More than half of the men (57%) and women (55%) were hypertensive. The prevalences of perceived racial discrimination, nonracial discrimination, and no discrimination were 57%, 29%, and 13%, respectively, in men and 42%, 43%, and 15%, respectively, in women. Women recounting frequent nonracial discrimination versus those reporting no exposure to discrimination had the highest odds of hypertension (adjusted odds ratio = 2.34, 95% confidence interval: 1.09, 5.02). A nonsignificant inverse odds ratio was evident in men who perceived frequent exposure to racial or nonracial discrimination in comparison with no exposure. A similar association was observed for women reporting perceived racial discrimination. These results indicate that the type and frequency of discrimination perceived by African-American men and women may differentially affect their risk of hypertension.

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    • "Interviewers asked fifteen questions pertaining to experiences of discrimination. The items were adapted from the Major Experiences of Discrimination scale and the Everyday Discrimination Scale created by Williams and colleagues [22] and utilized by numerous others e.g., [23-25]. The items are intended to measure major experiences of unfair treatment as well as chronic, routine experiences of unfair treatment in everyday life. "
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    ABSTRACT: Introduction Canadian research on racial health inequalities that foregrounds socially constructed racial identities and social factors which can explain consequent racial health inequalities is rare. This paper adopts a social typology of salient racial identities in contemporary Canada, empirically documents consequent racial inequalities in hypertension in an original survey dataset from Toronto and Vancouver, Canada, and then attempts to explain the inequalities in hypertension with information on socioeconomic status, perceived experiences with institutionalized and interpersonal discrimination, and psychosocial stress. Methods Telephone interviews were conducted in 2009 with 706 randomly selected adults living in the City of Toronto and 838 randomly selected adults living in the Vancouver Census Metropolitan Area. Bivariate analyses and logistic regression modeling were used to examine relationships between racial identity, hypertension, socio-demographic factors, socioeconomic status, perceived discrimination and psychosocial stress. Results The Black Canadians in the sample were the most likely to report major and routine discriminatory experiences and were the least educated and the poorest. Black respondents were significantly more likely than Asian, South Asian and White respondents to report hypertension controlling for age, immigrant status and city of residence. Of the explanatory factors examined in this study, only educational attainment explained some of the relative risk of hypertension for Black respondents. Most of the risk remained unexplained in the models. Conclusions Consistent with previous Canadian research, socioeconomic status explained a small portion of the relatively high risk of hypertension documented for the Black respondents. Perceived experiences of discrimination both major and routine and self-reported psychosocial stress did not explain these racial inequalities in hypertension. Conducting subgroup analyses by gender, discerning between real and perceived experiences of discrimination and considering potentially moderating factors such as coping strategy and internalization of racial stereotypes are important issues to address in future Canadian racial inequalities research of this kind.
    International Journal for Equity in Health 10/2012; 11(1):58. DOI:10.1186/1475-9276-11-58 · 1.71 Impact Factor
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    • "Scientific literature has shown that perceived experiences of discrimination have a negative effect on the health of people affected. In this sense, studies conducted in various countries have found associations between discrimination and mental health [35,36], physical health [37,38] and access to health-related services [39,40]. In Spain, two recent studies have observed that the perceived discrimination due to belonging to a certain social class, gender or ethnicity, among other causes, is associated with the affected population's poor physical and mental health [41,42]. "
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    ABSTRACT: Discrimination is an important determinant of health inequalities, and immigrants may be more vulnerable to certain types of discrimination than the native-born. This study analyses the relationship between immigrants' perceived discrimination and various self-reported health indicators. A cross-sectional survey was conducted (2008) amongst a non-random sample of 2434 immigrants from Ecuador, Morocco, Romania and Colombia in four Spanish cities: Barcelona, Huelva, Madrid and Valencia. A factorial analysis of variables revealed three dimensions of perceived discrimination (due to immigrant status, due to physical appearance, and workplace-related). The association of these dimensions with self-rated health, mental health (GHQ-12), change in self-rated health between origin and host country, and other self-reported health outcomes was analysed. Logistic regression was used adjusting for potential confounders (aOR-95%CI). Subjects with worsening self-reported health status potentially attributable to perceived discrimination was estimated (population attributable proportion, PAP %). 73.3% of men and 69.3% of women immigrants reported discrimination due to immigrant status. Moroccans showed the highest prevalence of perceived discrimination. Immigrants reporting discrimination were at significantly higher risk of reporting health problems than those not reporting discrimination. Workplace-related discrimination was associated with poor mental health (aOR 2.97 95%CI 2.45-3.60), and the worsening of self-rated health (aOR 2.20 95%CI 1.73- 2.80). 40% (95% CI 24-53) PAP of those reporting worse self-rated health could be attributable to discrimination due to immigrant status. Discrimination may constitute a risk factor for health in immigrant workers in Spain and could explain some health inequalities among immigrant populations in Spanish society.
    BMC Public Health 08/2011; 11(1):652. DOI:10.1186/1471-2458-11-652 · 2.26 Impact Factor
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    • "For some African Americans, failure to report racial discrimination may reflect a racial identity schema characterized by a denial of racism. In tandem with negative racial group evaluations, reporting no or low levels of racial discrimination may be associated with worse health outcomes (Chae & Yoshikawa, 2008; Krieger, 1990; Roberts et al., 2008). Other researchers have theorized that interpreting negative life experiences as instances of systematic discrimination might be protective via the minimization of internal or personal causes (Crocker & Major, 1989; Major, Kaiser, & McCoy, 2003; Weiner, 1985). "
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    ABSTRACT: Studies examining associations between racial discrimination and cardiovascular health outcomes have been inconsistent, with some studies finding the highest risk of hypertension among African Americans who report no discrimination. A potential explanation of the latter is that hypertension and other cardiovascular problems are fostered by internalization and denial of racial discrimination. To explore this hypothesis, the current study examines the role of internalized negative racial group attitudes in linking experiences of racial discrimination and history of cardiovascular disease among African American men. We predicted a significant interaction between reported discrimination and internalized negative racial group attitudes in predicting cardiovascular disease. Weighted logistic regression analyses were conducted among 1216 African American men from the National Survey of American Life (NSAL; 2001-2003). We found no main effect of racial discrimination in predicting history of cardiovascular disease. However, agreeing with negative beliefs about Blacks was positively associated with cardiovascular disease history, and also moderated the effect of racial discrimination. Reporting racial discrimination was associated with higher risk of cardiovascular disease among African American men who disagreed with negative beliefs about Blacks. However, among African American men who endorsed negative beliefs about Blacks, the risk of cardiovascular disease was greatest among those reporting no discrimination. Findings suggest that racial discrimination and the internalization of negative racial group attitudes are both risk factors for cardiovascular disease among African American men. Furthermore, the combination of internalizing negative beliefs about Blacks and the absence of reported racial discrimination appear to be associated with particularly poor cardiovascular health. Steps to address racial discrimination as well as programs aimed at developing a positive racial group identity may help to improve cardiovascular health among African American men.
    Social Science [?] Medicine 09/2010; 71(6):1182-8. DOI:10.1016/j.socscimed.2010.05.045 · 2.89 Impact Factor
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