title: Racial discrimination & cardiovascular disease risk: my body my story study of 1005 US-born black and white community health center participants (US).
abstract: OBJECTIVE
  To date, limited and inconsistent evidence exists regarding racial discrimination and risk of cardiovascular disease (CVD).
  
  
  METHODS
  Cross-sectional observational study of 1005 US-born non-Hispanic black (n = 504) and white (n = 501) participants age 35-64 randomly selected from community health centers in Boston, MA (2008-2010; 82.4% response rate), using 3 racial discrimination measures: explicit self-report; implicit association test (IAT, a time reaction test for self and group as target vs. perpetrator of discrimination); and structural (Jim Crow status of state of birth, i.e. legal racial discrimination prior 1964).
  
  
  RESULTS
  Black and white participants both had adverse cardiovascular and socioeconomic profiles, with black participants most highly exposed to racial discrimination. Positive crude associations among black participants occurred for Jim Crow birthplace and hypertension (odds ratio (OR) 1.92, 95% confidence interval (CI) 1.28, 2.89) and for explicit self-report and the Framingham 10 year CVD risk score (beta = 0.04; 95% CI 0.01, 0.07); among white participants, only negative crude associations existed (for IAT for self, for lower systolic blood pressure (SBP; beta = -4.86; 95% CI -9.08, -0.64) and lower Framingham CVD score (beta = -0.36, 95% CI -0.63, -0.08)). All of these associations were attenuated and all but the white IAT-Framingham risk score association were rendered null in analyses that controlled for lifetime socioeconomic position and additional covariates. Controlling for racial discrimination, socioeconomic position, and other covariates did not attenuate the crude black excess risk for SBP and hypertension and left unaffected the null excess risk for the Framingham CVD score.
  
  
  CONCLUSIONS
  Despite worse exposures among the black participants, racial discrimination and socioeconomic position were not associated, in multivariable analyses, with risk of CVD. We interpret results in relation to constrained variability of exposures and outcomes and discuss implications for valid research on social determinants of health.
authors.affiliation: Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, United States of America.
authors.forename: Nancy
authors.initials: N
authors.lastname: Krieger
authors.forename: Pamela D
authors.initials: PD
authors.lastname: Waterman
authors.forename: Anna
authors.initials: A
authors.lastname: Kosheleva
authors.forename: Jarvis T
authors.initials: JT
authors.lastname: Chen
authors.forename: Kevin W
authors.initials: KW
authors.lastname: Smith
authors.forename: Dana R
authors.initials: DR
authors.lastname: Carney
authors.forename: Gary G
authors.initials: GG
authors.lastname: Bennett
authors.forename: David R
authors.initials: DR
authors.lastname: Williams
authors.forename: Gisele
authors.initials: G
authors.lastname: Thornhill
authors.forename: Elmer R
authors.initials: ER
authors.lastname: Freeman
mesh_terms: D000328:Adult; D044383:Black People; D001900:Boston / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000208:ethnology / Q000523:psychology*; D003151:Community Health Centers; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011287:Prejudice; D063505:Racism / Q000523:psychology*; D012307:Risk Factors; D012959:Socioeconomic Factors; D044465:White People; D001741:Black or African American