Black Women Bear the Brunt of Racism’s Effect on Hypertension Risk

November 28, 2023 - Racial discrimination is linked with increased hypertension risk, illustrating the concept of weathering in healthcare, and for Black women with college degrees or higher, it’s even worse, according to research in JAMA Network Open.

The data also showed an adverse relationship between everyday discrimination and hypertension risk among Black women with a high school degree but not Black women with some college education.

These findings come as healthcare researchers further investigate the concept of weathering and the social determinants of health that exacerbate or attenuate it. Weathering describes the adverse health outcomes incurred due to the chronic stress experienced by those who have faced a lifetime of racism or discrimination.

Weathering has previously been linked to cardiovascular disease, hypertension, and adverse childhood experiences.

This latest study confirms the effect everyday racism has on women managing hypertension and adds that everyday racism’s impacts can be heightened based on the educational attainment of an individual.

Using data from the Sister Study from between 2003 and 2009, the researchers looked at the development of hypertension among more than 5,000 Black, Hispanic, and White women without a prior history of the disease. The team also surveyed participants about their experiences with everyday racism, like unfair treatment at work or at a business, and major racism, like mistreatment by the police.

Overall, educational attainment had no impact on racism or racism-linked hypertension risk among any racial or ethnic groups except Black people, who had the overall highest risk for hypertension regardless of educational attainment.

College-educated Black women were the most likely to report everyday racism, with 83 percent reporting such compared to 64 percent of Black women with high school degrees or less. Moreover, everyday racism was linked with higher hypertension risk more so for college-educated Black women than for Black women with some college.

The link between everyday racism and hypertension risk was about the same for college-educated Black women as Black women with high school degrees, which the researchers said indicated a U-shaped relationship between racism and hypertension risk by educational attainment.

“Highly educated Black women may encounter everyday discriminatory acts, such as microaggressions and unfair treatment, more frequently due to residing, working, and participating in environments where minoritized groups were historically excluded and are currently sometimes unwelcomed,” the researchers explained.

“The chronic nature of the exposure may contribute to exacerbated risk of hypertension associated with experiencing [racial and ethnic discrimination] by contributing to daily stress, vigilance, denial of resources despite perceived increased access, loneliness, isolation, and internalized racism.”

Findings about everyday racism and hypertension risk mirror other studies corroborating the weathering hypothesis, the team added. Chronic exposure to racism and discrimination can trigger stress response pathways, the researchers said, and can cause victims to develop unhealthy coping mechanisms, disrupt sleep, and add to overall “psychological wear-and-tear.”

The researchers did note that their findings countered their hypothesis that Hispanic women would likewise see changes in racism-linked hypertension risk by educational attainment. This may have been the byproduct of surveying many Latina women in Puerto Rico, meaning respondents experienced limited geographic and ethnic diversity.

“This may be related to our assessment not adequately capturing the complexity of colorism or skin color discrimination that has previously been associated with health and well-being among Latino populations,” the researchers added.

This study is notable in that it provides key insights into how racism impacts different people within a single racial or ethnic group, but experts say it is too early to make recommendations about interventions. In an invited commentary, Tené T. Lewis, PhD, of the departments of epidemiology and behavioral sciences and health education sciences at the Rollins School of Public Health at Emory University, noted that more data is necessary.

“Future research is needed to fully understand whether and how additional race-related stressors (eg, tokenism, code-switching, vigilance, providing support for less-educated Black community members) might enhance college-educated Black women’s risk for hypertension and other forms of adverse cardiovascular outcomes,” Lewis wrote in the commentary.

“Examining the role of negative affect (ie, depression, anxiety), along with emotional and/or instrumental support, as well as self-compassion, will also be an important direction for future studies. Ultimately, additional research is needed to inform interventions that provide further supports for college-educated Black women across the range of environments where they live, work, and play.”