Increased stroke risks for US Black women reporting experiences of racism

Key takeaways:

• Experiencing racism in employment, housing and police interactions was associated with increased incident stroke risk.
• Interpersonal racism in these three domains also was linked to increased stroke risk.

Black women in the U.S. who reported experiencing interpersonal racism in employment, housing and police interactions had increased stroke risks, according to findings published in JAMA Network Open.

“Black women, in particular, experience stroke and stroke-related mortality at higher rates and earlier onset than women in any other racial group,” Shanshan Sheehy, ScD, assistant professor in the Slone Epidemiology Center at Boston University, and colleagues wrote. “Racism in the U.S., both interpersonal racism and structural racism, disproportionally affects Black individuals. Racism is a complex construct and exists in multiple forms and at multiple levels. Direct evidence linking racism with incident stroke is quite limited.”

Sheehy and colleagues conducted the Black Women’s Health Study, a prospective cohort study of 48,375 Black women (mean age, 41 years) in the U.S. The study evaluated the association between perceived interpersonal racism and stroke incidence in this cohort. Participants completed a questionnaire in 1997 reporting on experiences of racism in everyday life and in situations involving employment, housing and police interactions. Every 2 years, all participants updated their health information on follow-up via mailed or web-based questionnaires. Follow-up continued through 2019.

The primary outcome was stroke identified through self-reported, medical records and linkage with the National Death Index.

During 22 years of follow-up, researchers identified 1,664 incident strokes. Of these, 550 were definite and confirmed by neurologist review and/or linkage with the National Death Index. Black women who reported experiencing racism in employment, housing and police interactions had a 38% increase for incident stroke (HR = 1.38; 95% CI, 1.14-1.67; P < .001) and a 37% increase for definite stroke (HR = 1.37; 95% CI, 1-1.88; P = .05) compared with Black women who did not report experiencing racism in these domains.

The HRs for incident stroke and definite stroke were 1.14 (95% CI, 0.97-1.35) and 1.09 (95% CI, 0.83-1.45), respectively, when comparing Black women in the highest quartile of experiencing interpersonal racism in their everyday life with those in the lowest quartile.

“The elevated stroke risk was present in analyses of all incident strokes, as well as in analyses restricting to definite strokes,” the researchers wrote. “For perceived interpersonal racism in everyday life, stroke risk was elevated in an analysis that included all stroke cases, but there was no evidence of an increased risk of stroke based on analyses of the smaller number of definite cases.”