Am J Epidemiol. 2023 Nov 10;192(12):1971-1980. doi: 10.1093/aje/kwad150.
Racial inequities in blood pressure levels have been extensively documented. Experiences of racial discrimination could explain some of this disparity, although findings from previous studies have been inconsistent. To address limitations of prior literature, including measurement error, we implemented instrumental variable analysis to assess the relationship between racial discrimination in institutional settings and blood pressure. Using data from 3,876 Black and White adults with an average age of 32 years from examination 4 (1992-1993) of the Coronary Artery Risk Development in Young Adults Study, our primary analysis examined the relationship between self-reported experiences of racial discrimination in institutional settings and blood pressure using reflectance meter measurement of skin color as an instrument. Findings suggested that an increase in experiences of racial discrimination was associated with higher systolic and diastolic blood pressure (β = 2.23 mm Hg (95% confidence interval: 1.85, 2.61) and β = 1.31 (95% confidence interval: 1.00, 1.62), respectively). Our instrumental variable estimates suggest that experiences of racial discrimination within institutional settings contribute to racial inequities in elevated blood pressure and cardiovascular disease outcomes in a relatively young cohort of adults and may yield clinically relevant differences in cardiovascular health over the life course.
种族间血压水平的不平等现象已被广泛记录。种族歧视的经历可能可以解释其中的一些差异，尽管之前的研究结果并不一致。为了解决先前文献的局限性，包括测量误差，我们实施了工具变量分析，以评估机构环境中的种族歧视与血压之间的关系。我们利用来自 3876 名黑人和白人成年人的数据，这些人在冠状动脉风险发展的年轻人研究的第 4 次检查（1992-1993 年）中的平均年龄为 32 岁，我们的主要分析使用反射计测量皮肤颜色作为工具，研究了机构环境中自我报告的种族歧视经历与血压之间的关系。研究结果表明，种族歧视经历的增加与收缩压和舒张压升高有关（β=2.23mmHg（95%置信区间：1.85，2.61）和β=1.31（95%置信区间：1.00，1.62））。我们的工具变量估计表明，机构环境中的种族歧视经历导致了相对年轻的成年人群体中血压升高和心血管疾病结果的种族不平等，并且可能会在整个生命过程中对心血管健康产生具有临床意义的差异。
