Perceived racism leads to greater risk of stroke among Black women

Black U.S. individuals are especially vulnerable to stroke, with a two-to-threefold higher stroke incidence and 1.2 times higher stroke mortality than white U.S. individuals. Black women in particular, experience stroke and stroke-related mortality at higher rates and earlier onset than women in any other racial group.

A new study using data from Boston University's Black Women's Health Study (BWHS)—the largest follow-up study on the health of Black women in the U.S.—has found that Black women who reported experiencing racism in situations such as employment, housing and interactions with the police, had an estimated 38% increased risk of stroke compared with women who reported no such experiences.

The researchers believe racism may act as a psychosocial stressor and thereby elevate systemic inflammation, impair endothelial function and dysregulate the hypothalamic-pituitary-adrenal axis. Previous studies have linked perceived interpersonal racism with worse mental health outcomes, higher risk of hypertension, increased systolic blood pressure and unhealthy behavior and lifestyles.

"Our findings suggest that the high burden of racism experienced by Black U.S. women may contribute to racial disparities in stroke incidence," explains corresponding author Shanshan Sheehy, MD, MSc, ScD, assistant professor of medicine at Boston University Chobanian & Avedisian School of Medicine.

In an effort to examine whether self-perceived interpersonal racism was associated with an increased risk of stroke, the researchers reviewed BWHS data gathered from 1997 through 2019. All participants were free of cardiovascular disease and cancer in 1997. During the same year, the participants answered questions about their experiences related to interpersonal racism in their everyday activities, including being treated unfairly due to race in employment (hiring, promotion, firing), housing (renting, buying, mortgage) or in interactions with police (stopped, searched, threatened).

At the 22-year follow-up period, the researchers identified 1,664 incidents of stroke in the 48,375 participants included in the analysis. After further research, they found Black women who reported experiences of interpersonal racism in situations involving employment, housing, and interactions with police appeared to have an increased risk of stroke, even after accounting for demographic and vascular risk factors.

According to the researchers, while several large studies have investigated stroke risk factors among U.S. Black individuals, direct evidence about perceived racism and stroke incidents is very limited. "Our study provides direct evidence on perceived racial discrimination at the interpersonal level in relation to subsequent occurrence of stroke," said Sheehy.

The researchers wish to thank the participants in the BWHS for their generous contributions and dedication to the study.

The findings are published in the journal JAMA Network Open.