Racism Key Social Determinant of Health Linked to 38% Risk of Stroke

Women who have experienced racism have a 38 percent higher risk of stroke than women who have not, according to a new JAMA Network Open study, giving further credence to the weathering hypothesis in medicine.

These findings come as healthcare continues to grapple with the impact that race and racism have on health outcomes. In this latest study, the researchers suggest that the cumulative stress incurred by experiencing racism in situations involving employment, housing, and the police can increase the risk for adverse health outcomes, particularly stroke.

For the study, the researchers looked at data from the Black Women’s Health Study, which surveyed 48,375 Black women about their perceived interpersonal racism in 1997 and then again in 2019. Women included in the survey had no cardiovascular disease or cancer at baseline.

In the 22 years between baseline survey and follow-up, there were 1664 cases of stroke, 550 of which were confirmed by neurologist review and/or National Death Index linkage. Women reporting racist interactions in employment, housing, and with police were 38 percent more likely to have experienced a stroke than those not reporting racist interactions.

This is a significant finding, considering that racist interactions were not uncommon, the researchers found. Around six in 10 women perceived racism in employment, while 35 percent perceived racism in housing and 24 percent perceived racism during police encounters. About one in 10 (11 percent) women reported perceived racism in all three domains, while 30 percent reported no experiences of racism.

These findings are more confirmation of the weathering hypothesis, which states that the chronic stress incurred by a lifetime of facing racism can have health impacts. Race and racism are social determinants of health, the researchers said, and they can ultimately have consequences for patient health outcomes.

“Racism may act as a psychosocial stressor and thereby elevate systemic inflammation, impair endothelial function, and dysregulate the hypothalamic-pituitary-adrenal axis,” the research team explained.

“Previous studies have linked perceived interpersonal racism with worse mental health outcomes, higher risk of hypertension, increased systolic blood pressure, unhealthy behavior and lifestyles, higher allostatic load, higher inflammatory markers, hormone dysregulation, and shorter telomere length,” they added.

More studies are emerging to corroborate the link between racism and poorer health outcomes. An April 2023 American Heart Association Study linked workplace discrimination with high blood pressure. In particular, people who reported moderate workplace discrimination were 22 percent more likely to have high blood pressure by the end of an eight-year study period.

“Scientists have studied the associations among systemic racism, discrimination and health consequences. However, few studies have looked specifically at the health impact of discrimination in the workplace, where adults, on average, spend more than one-third of their time,” Jian Li, MD, PhD, the study’s lead author and a professor of work and health in the Fielding School of Public Health and the School of Nursing at the University of California, Los Angeles, said in a press release.

“To the best of our knowledge, this is the first scientific evidence indicating workplace discrimination may increase people’s long-term risk of developing high blood pressure.”

Studies like Li’s and the one published in JAMA Network Open provide more evidence to explore race and racism as social determinants of health, experts say, and give providers the opportunity to tailor their treatment to promote health equity.