Slone Epidemiology Center, Boston University, Boston, Massachusetts.
Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts.
JAMA Netw Open. 2023 Nov 1;6(11):e2343203. doi: 10.1001/jamanetworkopen.2023.43203.
Black individuals in the US experience stroke and stroke-related mortality at younger ages and more frequently than other racial groups. Studies examining the prospective association of interpersonal racism with stroke are lacking.
To examine the association of perceived interpersonal racism with incident stroke among US Black women.
DESIGN, SETTING, AND PARTICIPANTS: The Black Women's Health Study, a prospective cohort study of 59 000 Black women from across the US, assessed the longitudinal association between perceived interpersonal racism and stroke incidence. Stroke-free participants were followed up from 1997 until onset of stroke, death, loss to follow-up, or the end of the study period (December 31, 2019). Cox models were used to estimate hazard ratios (HRs) and 95% CIs, adjusting for major confounders, including education, neighborhood socioeconomic environment, and cardiometabolic factors. Data analysis was performed from March 2021 until December 2022.
On a questionnaire completed in 1997, participants reported experiences of racism in everyday life and when dealing with situations that involved employment, housing, and interactions with police.
Strokes were identified through self-report on biennial questionnaires, medical records adjudication, and linkage with the National Death Index.
In 1997, 48 375 Black women (mean [SD] age, 41 [10] years) provided information on perceived interpersonal racism and were free of cardiovascular disease and cancer. During the 22 years of follow-up, 1664 incident stroke cases were identified; among them, 550 were definite cases confirmed by neurologist review and/or National Death Index linkage. Multivariable HRs for reported experiences of racism in all 3 domains of employment, housing, and interactions with police vs no such experiences were 1.38 (95% CI, 1.14-1.67), a 38% increase, for all incident cases and 1.37 (95% CI, 1.00-1.88) for definite cases. For comparisons of women in the highest quartile of everyday interpersonal racism score vs women in the lowest quartile, multivariable HRs were 1.14 (95% CI, 0.97-1.35) for analyses that included all incident stroke and 1.09 (95% CI, 0.83-1.45) for analyses that included definite cases only.
In this study, Black women who reported experiences of interpersonal racism in situations involving employment, housing, and interactions with police appeared to have an increased risk of stroke, even after accounting for demographic and vascular risk factors, suggesting that the high burden of racism experienced by Black US women may contribute to racial disparities in stroke incidence.
美国的黑人群体在较年轻时且更频繁地经历中风和与中风相关的死亡，这一比例高于其他种族群体。目前尚缺乏研究检验人际种族主义与中风之间的前瞻性关联。
在美国黑人女性中，研究感知到的人际种族主义与中风发病之间的关联。
设计、地点和参与者：黑人女性健康研究是一项针对来自美国各地的 59000 名黑人女性的前瞻性队列研究，评估了感知到的人际种族主义与中风发病之间的纵向关联。无中风的参与者从 1997 年开始随访，直到中风、死亡、失访或研究期结束（2019 年 12 月 31 日）。使用 Cox 模型估计风险比（HR）和 95%CI，调整了主要混杂因素，包括教育、社区社会经济环境和心血管代谢因素。数据分析于 2021 年 3 月至 2022 年 12 月进行。
在 1997 年完成的一份问卷中，参与者报告了日常生活中以及在处理涉及就业、住房和与警察互动的情况时的种族主义经历。
中风通过每两年一次的问卷、医疗记录审查和与国家死亡指数的关联来确定。
1997 年，48375 名黑人女性（平均[SD]年龄，41[10]岁）提供了人际种族主义感知方面的信息，且无心血管疾病和癌症。在 22 年的随访期间，共确定了 1664 例中风事件；其中，550 例为经过神经病学审查和/或国家死亡指数关联确认为明确的病例。在所有领域（就业、住房和与警察的互动）报告种族主义经历与没有此类经历的情况下，所有发病例和明确病例的多变量 HR 分别为 1.38（95%CI，1.14-1.67）和 1.37（95%CI，1.00-1.88）。对于日常人际种族主义评分最高四分位数的女性与最低四分位数的女性进行比较，包括所有发病例的多变量 HR 为 1.14（95%CI，0.97-1.35），仅包括明确病例的多变量 HR 为 1.09（95%CI，0.83-1.45）。
在这项研究中，报告在涉及就业、住房和与警察互动的情况下经历人际种族主义的黑人女性似乎中风风险增加，即使考虑到人口统计学和血管风险因素也是如此，这表明美国黑人女性经历的高度种族主义负担可能导致中风发病率的种族差异。
