262743 Evaluating Racism and Cardiovascular Health: A Systematic Review of Epidemiological Evidence

Monday, October 29, 2012

Rachel Gratz, MPH , Health Education Department, San Francisco State University, San Francisco, CA
Background: Racial disparities in high blood pressure (BP) are widely documented in the United States, especially among African Americans who suffer disproportionately from hypertension, a risk factor for heart disease, stroke, and kidney disease. Theories point to physiological impacts of racial discrimination on cardiovascular health, considering racism as a chronic and cumulative stressor triggering elevated cardiovascular responses. This review systematically examines the epidemiological evidence regarding the direct relationship between racism and BP, a critical correlation in addressing racial health disparities.

Methods: Published original studies (n=23) in the PubMed database, investigating the relationship between perceived racism and BP, were reviewed according to their association's direction and strength. Studies were 61% cross-sectional, 30% experimental/quasi-experimental, and adjusted for multiple confounders. All studies investigated African Americans, 13% included Latinos, and 26% included White participants.

Results: Analysis revealed inconclusive evidence where 43% of studies observed no association, 39% showed positive associations correlating higher perceived racism with elevated BP, 9% found negative results, and three exhibited conditional or U-shaped relationships. Thirteen studies showed statistically significant associations (p<.05), though directions were mixed. Experimental and quasi-experimental studies (67%) yielded largely positive results, as did studies measuring ambulatory BP (75%). Associations were strongest for African Americans, followed by Latinos, and Whites.

Conclusions: Limited evidence supported the hypothesis that racism is detrimental to cardiovascular health, however methodological gaps were identified, including small sample sizes, variations in measurement instruments, and inconsistent operational definitions of ‘racism.' Future research should examine longitudinal evidence, clarify the effects of confounders, and consider intersecting oppressions.

Learning Areas:
Chronic disease management and prevention
Epidemiology

Learning Objectives:
1. Evaluate the inconsistent evidence, regarding the association between racism and blood pressure, through an epidemiological framework. 2. Identify both methodological and conceptual issues needing to be addressed in future research assessing the association between racism and blood pressure.

Keywords: Health Disparities, Hypertension

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: As a second year MPHc student, I have dedicated the past year to developing competency in reviewing epidemiological evidence, and have maintained a strong commitment to reducing health disparities through public health research.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 3299.0: Epidemiology & Biostatistics for Health Solutions