Heart disease is the leading cause of death in the United States, yet the risk of death from this condition differs by race and ethnicity. Research has shown that Black adults are more likely to have poorer cardiovascular health compared with white adults and other minority groups. They are also more likely to develop risk factors for heart disease, such as obesity and high blood pressure, at an earlier age.
A new study led by Virginia Commonwealth University suggests that chronic stress from discrimination and adverse neighborhood conditions are some of the contributing factors behind this racial disparity. The research also found that the cardiovascular impact of these stressors varied by gender, with Black women more affected by discrimination and Black men more affected by neighborhood safety.
The findings, published in JAMA Network Open, could help providers and community partners better understand how certain stressors impact cardiovascular health within different groups, and thus could aid in the development of interventions.
“Our goal was to understand what types of factors contribute to the stress experiences of Black people. If we can identify certain stressors to target in our mitigation strategies, we can hopefully improve cardiovascular health outcomes and reduce disparities in heart disease,” said Anika L. Hines, Ph.D., an assistant professor in the Department of Health Behavior and Policy at the VCU School of Population Health and lead author of the new study. Hines heads the Equity in Cardiovascular Health Outcomes Lab, which researches cardiovascular health disparities in Black communities.
Chronic stress and stress-related coping mechanisms are associated with increased heart disease. Experts believe that the cumulation of stress from a lifespan of structural and interpersonal racism may cause Black individuals to have differential stress-related health outcomes.
“We have these natural mechanisms in our body which respond to stressful situations, often referred to your fight-or-flight response. However, being persistently exposed to various stressors can throw your system off balance. Over time, the various systems that are supposed to help you during periods of stress can actually deteriorate your organ functioning,” Hines said.
For this study, Hines and her colleagues utilized data from the REGARDS project, a national study focused on better understanding geographic and racial differences in stroke mortality. They examined survey responses and clinical information collected from more than 7,500 participants.
To assess a person’s cardiovascular health, the researchers generated scores based on four health behaviors (cigarette smoking, diet, physical activity and body mass index) and three health indicators (blood pressure, cholesterol and glucose levels).
In their survey responses, participants reported how often they experienced racial discrimination, including at school, while receiving medical care or from the police. Participants were also asked about the condition of their local neighborhood, such as whether they feel safe, what the noise and traffic level is like and whether there is adequate access to grocery stores, parks and playgrounds. They additionally provided information about how connected they feel to their neighborhood, such as whether neighbors get along, trust one another, share the same values and are willing to help one another.
“We wanted to assess the various ways in which social and physical environments could impact an individual to see if we could understand which factors are contributing to the disparity. Social and economic determinants of health may feel so final that they can’t be adjusted, but these are often a result of policies,” Hines said.
The data showed that Black adults, especially Black women, had poorer cardiovascular health compared with white adults. While Black men had 27% lower odds of having better cardiovascular health than white men, Black women had 55% lower odds than white women - more than double the racial gap among men.
Compared with white participants, Black participants reported higher levels of perceived stress and more often reported instances of discrimination. Black participants also reported worse neighborhood conditions and more often reported that their neighborhoods were unsafe.
The data analysis showed that the disproportionate exposure to these stressors accounted for some of the racial disparity in cardiovascular health. According to the researchers’ calculations, stress from discrimination explained 11% of the racial difference in cardiovascular health between Black and white participants. Stress from neighborhood conditions also influenced this racial disparity, specifically the level of safety (6%), physical features (5%) and social connectedness (1%) within a neighborhood.
The research team discovered that the impact of these stressors varied by gender. Their results showed that discrimination explained 14% of the racial differences in cardiovascular health among women, while neighborhood safety attenuated these racial differences by 12% among men.
These findings suggest that public health approaches for reducing heart disease disparities may be more impactful by strategically targeting certain stressors. For example, addressing the unique stressors that tie into coping with discrimination could be more consequential in Black women, whereas addressing the impact of neighborhood violence may be more important for Black men.
“This study shows the importance of intersectional experiences when considering solutions for health disparities,” Hines said. “Marginalized groups aren’t monoliths. Even in the umbrella of marginalization related to race, there can be differential experiences based on gender, socioeconomic status and other factors.”
Hines and her colleagues are currently working with community members to design feasible interventions for young Black women to combat stress from these unique racial, gendered experiences with discrimination.
“We measure things so that we can do something about it. We hope that our findings help inform strategies, both in terms of policies and therapies, for dismantling these health disparities,” Hines said. “The more evidence we build in this field, the more improvements we can hopefully make in terms of structural change.
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