Intersectional effects of racial and gender discrimination on cardiovascular health vary among black and white women and men in the CARDIA study

Abstract

Testing hypotheses from the emerging Identity Pathology (IP) framework, we assessed race-gender differences in the effects of reporting experiences of racial and gender discrimination simultaneously compared with racial or gender discrimination alone, or no discrimination, on future cardiovascular health (CVH). Data were from a sample of 3758 black or white adults in CARDIA, a community-based cohort recruited in Birmingham, AL; Chicago, IL; Minneapolis, MN, and Oakland, CA in 1985–6 (year 0). Racial and gender discrimination were assessed using the Experiences of Discrimination scale. CVH was evaluated using a 12-point composite outcome modified from the Life's Simple 7, with higher scores indicating better health. Multivariable linear regressions were used to evaluate the associations between different perceptions of discrimination and CVH scores two decades later by race and gender simultaneously. Reporting racial and gender discrimination in ≥2 settings were 48% of black women, 42% of black men, 10% of white women, and 5% of white men. Year 30 CVH scores (mean, SD) were 7.9(1.4), 8.1(1.6), 8.8(1.6), and 8.7(1.3), respectively. Compared with those of their race-gender groups reporting no discrimination, white women reporting only gender-based discrimination saw an adjusted score difference of +0.3 (95% CI: 0.0,0.6), whereas white men reporting only racial discrimination had on average a 0.4 (95% CI: 0.1,0.8) higher score, and scores among white men reporting both racial and gender discrimination were on average 0.6 (95% CI: 1.1,-0.1) lower than those of their group reporting no discrimination. Consistent with predictions of the IP model, the associations of reported racial and gender discrimination with future CVH were different for different racially-defined gender groups. More research is needed to understand why reported racial and gender discrimination might better predict deterioration in CVH for whites than blacks, and what additional factors associated with gender and race contribute variability to CVH among these groups.

Health Disparities at the Intersection of Gender and Race: Beyond Intersectionality Theory in Epidemiologic Research

“…For example, a recent study assessing the effect of cumulative unfair treatment on subclinical CVD among a multi-ethnic sample of women found an association only among white women [106]. Such evidence supports the argument that while women and black persons are more likely to experience both structural and interpersonal gendered racial discrimination, men and white persons may be more susceptible to the health consequences of perceiving interpersonal discrimination as a result of group-specific internal resources [29,80,107].…”

“…That is, more cultural elements, whether dress styles or styles of worship, are racialized and gendered than given any other social group categorization. In the context of hierarchical racial and gender structures, the prevalence of these constant reminders of what constitutes blackness and whiteness, or femininity and masculinity, renders race and gender particularly influential on how susceptible individuals are to the health consequences of their groups' perceived inferiority or superiority [17,18,[27][28][29].…”

“…Adherence to these gendered race-specific identity paradigms predisposes black women to automated coping such as emotional eating [90,91], other risk-factors for obesity such as postpartum weight retention [92], and other health-impacting behaviors such as low health services utilization [93]. Furthermore, another form of identity pathology characterized by a failure to acknowledge the existence, or negative psychological impacts, of structural inequity can lead to denial and internalization which may lead to premature disease and mortality [29,94]. Importantly, the IP framework does not assert that compounded inequities necessarily translates to greater likelihood of a specific disease outcome among multiply marginalized groups.…”

“…Given these hypotheses, two studies [29,80] examined the relationship of reported interpersonal discrimination with CVH among black and white women and men using 30 years of longitudinal data from the Coronary Artery Risk Development in Young Adults study. The first study evaluated whether the associations of reported interpersonal experiences of racial and gender discrimination simultaneously compared with racial or gender discrimination alone, or no discrimination, with cardiovascular health 23 years later was stronger among white men than other groups.…”

Race and other sociodemographic categories are differentially linked to multiple dimensions of interpersonal-level discrimination: Implications for intersectional, health research

“…A current gap regarding interpersonal-level discrimination research is that this multidimensional construct is traditionally assessed through emphasis on one aspect or domain of discriminatory experiences [15]. Specifically, while some research does assess several dimensions concurrently [e.g., [16][17][18][19][20][21], most research characterizing discrimination has not considered multiple facets of interpersonal discriminatory acts in a comprehensive manner, including their types (e.g., generic versus status specific [race-or gender-related]), context (e.g., workplace, court setting), frequency (e.g., daily, lifetime), form of threat (e.g., socio-emotional, physical), explicitness (e.g., covert versus overt), and consequences (e.g., posed obstacles, blocked opportunities). This is a particular limitation in descriptive discrimination research.…”