Discrimination Experiences and All-Cause and Cardiovascular Mortality: Multi-Ethnic Study of Atherosclerosis.

Pubmed ID: 37017086

Pubmed Central ID: PMC10106108

Journal: Circulation. Cardiovascular quality and outcomes

Publication Date: April 1, 2023

Affiliation: Division of Intramural Research (K.P.F., J.N.J., A.T.F.), National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD.

MeSH Terms: Humans, Aged, Aged, 80 and over, Cardiovascular Diseases, Middle Aged, Proportional Hazards Models, Atherosclerosis, Ethnicity, Hispanic or Latino, Black or African American, White, Social Discrimination

Grants: UL1 TR001079, N01HC95163, N01HC95161, N01HC95167, N01HC95159, N01HC95162, N01HC95166, N01HC95169, N01HC95165, N01HC95164, N01HC95160, UL1 TR000040, N01HC95168, UL1 TR001420, HHSN268201500003I, Z99 CA999999, R01 HL071759

Authors: Johnson JA, Shiels MS, Lawrence WR, Jones GS, Ferrell KP, Johnson JN, Diez Roux AV, Forde AT

Cite As: Lawrence WR, Jones GS, Johnson JA, Ferrell KP, Johnson JN, Shiels MS, Diez Roux AV, Forde AT. Discrimination Experiences and All-Cause and Cardiovascular Mortality: Multi-Ethnic Study of Atherosclerosis. Circ Cardiovasc Qual Outcomes 2023 Apr;16(4):e009697. Epub 2023 Apr 5.

Studies:

Multi-Ethnic Study of Atherosclerosis (MESA)

Abstract

BACKGROUND: Epidemiologic studies have documented the associations between experiences of discrimination and adverse health outcomes. However, the relationship between discrimination and mortality, and the factors that may moderate this relationship are not well understood. This study examined whether lifetime and everyday discrimination were associated with all-cause and cardiovascular mortality and whether these associations differed by race and ethnicity, gender, and racial and ethnic residential segregation. METHODS: The study included 1633 Black, 1403 Hispanic/Latino, and 2473 White participants aged 45 to 84 years from the Multi-Ethnic Study of Atherosclerosis, enrolled from 2000 to 2002 and followed across 5 exams (2002-2018). Discrimination was measured using the lifetime discrimination (major experiences of unfair treatment) and everyday discrimination (day-to-day experiences of unfair treatment) scales. Racial and ethnic residential segregation was measured using the <i>Gi*</i> statistic. Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% CIs, adjusting for sociodemographic characteristics, health behaviors, and clinical risk factors. RESULTS: Each increase in reports of lifetime discrimination was associated with increased all-cause (HR, 1.06 [95% CI, 1.00-1.11]) and cardiovascular (HR, 1.15 [95% CI, 1.04-1.27]) mortality, adjusting for sociodemographic factors, health behaviors, and clinical risk factors. Associations between lifetime discrimination and cardiovascular mortality were observed across all racial and ethnic groups but were strongest and only statistically significant among Black participants (HR, 1.18 [95% CI, 1.02-1.37]). Additionally, in the fully adjusted model, each increase in reports of everyday discrimination was strongly associated with increased cardiovascular mortality (HR, 1.21 [95% CI, 1.03-1.43]). Associations for lifetime and everyday discrimination with all-cause and cardiovascular mortality were not modified by race and ethnicity, gender, or racial and ethnic residential segregation. CONCLUSIONS: These findings suggest that experiences of discrimination are associated with increased all-cause and cardiovascular mortality.