Gendered Race and Setting Matter: Sources of Complexity in the Relationships Between Reported Interpersonal Discrimination and Cardiovascular Health in the CARDIA Study

From Early Trauma to Cardiovascular Risk Among a Nationally Representative Sample of Young Adults

This study aimed to investigate the connection between childhood abuse history and cardiovascular health indicators among a nationally representative sample of young adults aged 24-32. Using data from waves three and four of the National Longitudinal Study of Adolescent to Adult Health (n = 4, 164) multivariate logistic regression was employed to investigate childhood trauma (i.e., childhood physical abuse, sexual abuse, and neglect) as predictors for cardiovascular disease, hypertension, high cholesterol, diabetes, and obesity. Results showed that adults who reported history of sexual abuse were 4.3 times more likely to report diagnosis of cardiovascular disease and those who reported childhood physical abuse at wave three had 1.4 times the odds of reporting high cholesterol diagnosis. Although trauma history is often calculated as a composite, some forms of childhood abuse may have greater impacts on cardiovascular risk than others.

Do Police Encounters Increase the Risk for Cardiovascular Disease? Police Encounters and Framingham 30-Year Cardiovascular Risk Score

INTRODUCTION

Despite increased attention to the societal consequences of aggressive policing, the focus on rarer instances of deaths/severe injuries fails to fully capture the day-to-day experiences that racially minoritized groups face during police encounters (PEs). We explored differential vulnerability by race/ethnicity in the relationship between PEs and cardiovascular disease (CVD) risk.

METHODS

Using data from the National Longitudinal Study of Adolescent to Adult Health, we regressed the Framingham 30-Year CVD risk score on a high number of lifetime PEs (6 + among men and 2 + among women). To explore differential vulnerability by race, we added an interaction between PEs and race/ethnicity. We also examined sex- and race and sex-stratified models.

RESULTS

We observed no association between PEs and CVD risk in the sample overall, but the interaction between PEs and race/ethnicity was statistically significant. In race stratified models, we found that higher PEs were associated with a lower CVD risk among Black respondents, whereas among White respondents there was no relationship. In the sex-stratified analysis, reporting higher PEs was associated with lower CVD risk among men, while among women there was no relationship. In sex- and race-stratified models, higher PEs was associated with lower CVD risk among Black men and higher CVD risk among White women, while there was no association among Black women and White men.

CONCLUSION

The association between PEs and CVD risk depends on race/ethnicity and sex. More work is needed to understand the counterintuitive finding that high PEs are associated with lower CVD risk among Black men.

Discrimination and bladder health among women in the CARDIA cohort study: Life course and intersectionality perspectives

OBJECTIVE

This study examines whether discriminatory experiences are associated with lower urinary tract symptoms (LUTS) and their impact among 972 women in the Coronary Artery Risk Development in Young Adults (CARDIA) cohort study, which recruited participants from 4 cities in the United States.

METHOD

Exposure to discrimination was assessed 3 times (1992-93, 2000-01, 2010-11) and averaged across assessments. Participants separately reported whether they experienced discrimination on the basis of their gender, race or color, and socioeconomic position or social class. For each social identity, discrimination was assessed in 6-7 settings (e.g., when getting a job, medical care, or housing). At different time points, women who reported discriminatory experiences for a given social identity were asked how frequently the discrimination occurred and how stressful experience(s) were. Following the 2010-11 assessment, data on LUTS and their impact were collected. Women were classified into bladder health versus mild, moderate, or severe symptoms/impact clusters.

RESULTS

More Black than White women reported discriminatory experiences across all social identities and most settings. Perceived stress of discriminatory experiences did not differ between Black and White women. In analyses stratified by race and social identity, White women reported LUTS/impact with discriminatory experiences in more settings, more frequent discriminatory experiences across settings, and each additional social identity for which discrimination was experienced. Black women reported LUTS/impact with more frequent discriminatory experiences across settings. For Black women, greater perceived stress of both gender and race discrimination were associated with LUTS/impact. For White women, only greater perceived stress of race discrimination was associated with LUTS/impact.

CONCLUSIONS

This is one of the first studies to examine discrimination in relation to LUTS/impact. Additional research is needed to better understand differences in how discriminatory experiences based on potentially intersecting identities may be related to bladder health among women.

Statin Eligibility and Prescribing Across Racial, Ethnic, and Language Groups over the 2013 ACC/AHA Guideline Change: a Retrospective Cohort Analysis from 2009 to 2018

BACKGROUND

It is uncertain if the American College of Cardiology/American Heart Association (ACC/AHA) 2013 guidelines for the use of HMGCoA reductase inhibitors (statins) were associated with increased statin eligibility and prescribing across underserved groups.

OBJECTIVE

To analyze, by race, ethnicity, and preferred language, patients with indications for and presence of a statin prescription before and after the guideline change.

DESIGN

Retrospective cohort study.

SETTING

Multistate community health center (CHC) network with linked electronic health records.

PATIENTS

Low-income patients aged ≥ 50 with a primary care visit in 2009-2013 or 2014-2018.

MAIN MEASURES

(1) Odds of each race/ethnicity/language group meeting statin eligibility via the National Cholesterol Education Program Adult Treatment Panel III Guidelines in 2009-2013 or the ACC/AHA guidelines in 2014-2018. (2) Among those eligible, odds of each group in each period with a statin prescription.

KEY RESULTS

In 2009-2013 (n = 109,330), non-English-preferring Latino (OR = 1.10, 95% CI = 1.03, 1.17), White (OR = 1.41, 95% CI = 1.16, 1.72), and Black patients (OR = 1.25, 95% CI = 1.11, 1.42), were more likely than English-preferring non-Hispanic Whites to meet guideline criteria for statins. Non-English-preferring Black patients, when eligible, were no more likely than non-Hispanic Whites to have statin prescriptions (OR = 1.16, 95% CI = 0.88, 1.54). In 2014-2018 (n = 319,904), English-preferring Latino patients (OR = 1.02, 95% CI = 0.96-1.07) and non-English-preferring Black patients (OR = 1.08, 95% CI = 0.98, 1.19) had similar odds of statin prescription to English-preferring non-Hispanic White patients. English-preferring Black patients were less likely (OR = 0.95, 95% CI = 0.91-0.99) to have a prescription than English-preferring non-Hispanic Whites.

CONCLUSION

Across the 2013 ACC/AHA guideline change in CHCs serving low-income patients, non-English-preferring patients were consistently more likely to be eligible for and have been prescribed statins. English-preferring Latino and English-preferring Black patients experienced reduced prescribing, comparatively, after the guideline change. Further work should explore the contextual factors that may influence guideline effectiveness and care equity.

Life Course Cardiovascular Health: Risk Factors, Outcomes, and Interventions

Since it was first defined by the American Heart Association in 2010, cardiovascular health (CVH) has been extensively studied across the life course. In this review, we present the current literature examining early life predictors of CVH, the later life outcomes of child CVH, and the relatively few interventions which have specifically addressed how to preserve and promote CVH across populations. We find that research on CVH has demonstrated that prenatal and childhood exposures are consistently associated with CVH trajectories from childhood through adulthood. CVH measured at any point in life is strongly predictive of future cardiovascular disease, dementia, cancer, and mortality as well as a variety of other health outcomes. This speaks to the importance of intervening early to prevent the loss of optimal CVH and the accumulation of cardiovascular risk. Interventions to improve CVH are not common but those that have been published most often address multiple modifiable risk factors among individuals within the community. Relatively few interventions have been focused on improving the construct of CVH in children. Future research is needed that will be both effective, scalable, and sustainable. Technology including digital platforms as well as implementation science will play key roles in achieving this vision. In addition, community engagement at all stages of this research is critical. Lastly, prevention strategies that are tailored to the individual and their context may help us achieve the promise of personalized prevention and help promote ideal CVH in childhood and across the life course.

A Longitudinal Study of Acculturation in Context and Cardiovascular Health and Their Effects on Cognition Among Older Latino Adults

Background We previously outlined the importance of considering acculturation within the context of older Latino adults' lived experience (ie, acculturation in context) to better capture contributors to cognitive aging. We now examine this conceptual framework as related to level of and change in cardiovascular health, and whether cardiovascular health modifies previously documented associations of acculturation in context with cognition. Methods and Results Acculturation in context data from 192 Latino participants without dementia at baseline (age ~70 years) were compiled into 3 separate composite scores: acculturation-related (nativity, language-, and social-based preferences), contextually related socioenvironmental (experiences of discrimination, social isolation, social networks), and familism-related (Latino-centric family ethos). A modified American Heart Association's Life's Simple 7 (mLS7; ie, smoking, physical activity, body mass index, blood pressure, total cholesterol, blood glucose) was used to measure cardiovascular health. Mixed effects regressions simultaneously tested the association of all 3 composite scores with total mLS7 adjusting for confounders. Separate models tested whether mLS7 modified associations of the 3 composite scores and cognition. The contextually related socioenvironmental composite score reflecting higher discrimination, higher social isolation, and smaller social networks (estimate=0.22, SE=0.10, P=0.02) and the familism score (estimate=0.16, SE=0.07, P=0.02) both significantly associated with change in total mLS7. The acculturation-related composite was not significantly associated with change in mLS7. No composite was significantly associated with level of mLS7. Total mLS7, however, significantly modified associations between the acculturation-related composite and change in working memory (estimate=-0.02, SE=0.01, P=0.043). Conclusions Acculturation within the context of older Latino adults' lived experience is important for maintaining cardiovascular health, relationships that also affect domain-specific cognitive decline.

Attributions for Everyday Discrimination and All-Cause Mortality Risk Among Older Black Women: A Latent Class Analysis Approach

BACKGROUND AND OBJECTIVES

This study examined the relationship between number of attributed reasons for everyday discrimination and all-cause mortality risk, developed latent classes of discrimination attribution, and assessed whether these latent classes were related to all-cause mortality risk among US older Black women.

RESEARCH DESIGN AND METHOD

Participants were from the 2006 and 2008 waves of the Health and Retirement Study (N = 1133; 335 deaths). Vital status was collected through the National Death Index through 2013 and key informant reports through 2019. Latent Class Analyses were conducted on discrimination attributions. Weighted Cox proportional hazards model were used to predict all-cause mortality. Analyses controlled for demographic characteristics, socioeconomic status, and health.

RESULTS

Reporting greater attributions for everyday discrimination was associated with higher mortality risk (HR = 1.117; 95% CI: 1.038 - 1.202; p <.01), controlling for demographic characteristics, socioeconomic status, and health as well as health behaviors. A four-class solution of the Latent Class Analysis specified the following attribution classes: No/Low Attribution; Ancestry/Gender/Race/Age; Age/Physical Disability; High on All Attributions. When compared to the No/Low Attribution class, membership in the High on All Attributions class was associated with greater mortality risk (HR = 2.809; CI: 1.458 - 5.412; p < .01).

DISCUSSION AND IMPLICATIONS

Findings underscore the importance of everyday discrimination experiences from multiple sources in shaping all-cause mortality risk among older Black women. Accordingly, this study problematizes the homogenization of Black women in aging research and suggests the need for health interventions that consider Black women's multiplicity of social statuses.

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

Objectives

To examine whether intersections of race with other key sociodemographic categories contribute to variations in multiple dimensions of race- and non-race-related, interpersonal-level discrimination and burden in urban-dwelling African Americans and Whites.

Methods

Data from 2,958 participants aged 30–64 in the population-based Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study were used to estimate up to four-way interactions of race, age, gender, and poverty status with reports of racial and everyday discrimination, discrimination across multiple social statuses, and related lifetime discrimination burden in multiple regression models.

Results

We observed that: 1) African Americans experienced all forms of discrimination more frequently than Whites, but this finding was qualified by interactions of race with age, gender, and/or poverty status; 2) older African Americans, particularly African American men, and African American men living in poverty reported the greatest lifetime discrimination burden; 3) older African Americans reported greater racial discrimination and greater frequency of multiple social status-based discrimination than younger African Americans; 4) African American men reported greater racial and everyday discrimination and a greater frequency of social status discrimination than African American women; and, 5) White women reported greater frequency of discrimination than White men. All p’s < .05.

Conclusions

Within African Americans, older, male individuals with lower SES experienced greater racial, lifetime, and multiple social status-based discrimination, but this pattern was not observed in Whites. Among Whites, women reported greater frequency of discrimination across multiple social statuses and other factors (i.e., gender, income, appearance, and health status) than men. Efforts to reduce discrimination-related health disparities should concurrently assess dimensions of interpersonal-level discrimination across multiple sociodemographic categories, while simultaneously considering the broader socioecological context shaping these factors.

Exploring the Spatial Patterning in Racial Differences in Cardiovascular Health Between Blacks and Whites Across the United States: The REGARDS Study

Background

Cardiovascular health (CVH) disparities between blacks and whites have persisted in the United States for some time, and although there have been remarkable improvements in addressing cardiovascular disease, it still remains the leading cause of death in the United States. In addition, well‐documented disparities are unfortunately widening incidence gaps across certain regions of the United States. Our focus was on answering the following questions: (1) How much spatial heterogeneity exists in the racial differences in CVH between blacks and whites across this country? and (2) Is the spatial heterogeneity in the racial differences significantly explained by living in the Stroke Belt?

Methods and Results

To explore the spatial patterning in the racial differences in CVH between blacks and whites across the country, we used geographically weighted regression methods, which result in local estimates of the racial differences in CVH. Using data from the REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study, we found significant spatial patterning in these racial differences, even beyond the well‐known Stroke Belt and Stroke Buckle. All of the estimated differences indicated blacks consistently having diminishing CVH compared with whites, where this difference was largely noted in pockets of the Stroke Belt and Stroke Buckle, in addition to moderate to large disparities noted in the Great Lakes region, portions of the Northeast, and along the West coast.

Conclusions

Efforts to improve CVH and ultimately reduce disparities between blacks and whites require culturally competent methods, with a strong focus on geography‐based interventions and policies.