Hypertension Among Black Women—College-Educated But More at Risk?

Abstract

In this issue of JAMA Network Open, Gaston and colleagues 1 used a nested case-control design to examine associations among self-reported experiences of racial and ethnic discrimination, education, and hypertension risk in a cohort of Black, Latina, and White women from the Sister Study. Interestingly, while reports of racial and ethnic discrimination were associated with hypertension risk in women from all racial and ethnic backgrounds, education only modified associations among Black women.Consistent with findings from other large-scale cohort studies such as the Coronary Artery Disease in Young Adults (CARDIA) Study 2 and the My Body My Story cohort, 3 reports of discrimination were actually highest in college-educated Black women. This is in direct contrast to other forms of psychosocial stress (eg, negative life events, perceived stress, financial strain), which are typically lowest in college-educated adults. However, as argued by Gaston et al 1 and others, 4 college-educated Black women may be more likely than Black women without a college degree to live, work, and socialize in environments where they are exposed to individuals from other racial and ethnic groups. Consequently, their exposure to intergroup tensions and racial and ethnic discrimination is likely greater than that of their lower-educated counterparts. In support of this hypothesis, studies have found that Black women