Intersectional discrimination from black women, white women, black men, or white men impacts young adult black women’s affective states and risky health cognitions

Introduction: Since the 1980’s, length of stay (LOS) for acute MI (AMI) has declined in the US. However, little is known about trends in LOS for non-white racial groups and whether change in LOS is related to insurance type or hospital complications. Methods: We determined 22 year trends in LOS for nonfatal (definite or probable) AMI among black and white residents age 35–74 in 4 US communities (N=396,514 in 2008 population) under surveillance in the ARIC Study. Events were randomly sampled and independently validated using a standardized algorithm. All analyses accounted for sampling scheme. We excluded MI events which started after admission (n=1,677), events within 28 days for the same person (n=3,817), hospital transfers (n=571), and those with LOS=0 or LOS >66 (top 0.5% of distribution, N= 144) leaving 22,258 weighted events for analysis. The average annual change in log LOS was modeled using weighted linear regression with year as a quadratic term. All models adjusted for age and secondary models adjusted for insurance type (Medicare, Medicaid, private, or other), and complications during admission (cardiac arrest, cardiogenic shock, or heart failure). Results: The average age-adjusted LOS from 1987 to 2008 was reduced by 5 days in black men (9.5 to 4.5 days); 4.6 days in white women (9.4 to 4.8 days); 4 days in white men (8.3 to 4.3 days) and 3.6 days in black women (9.0 to 5.4 days). Between 1987 and 2008, the age-adjusted average annual percent change (with 95% CI) in LOS was largest for white men at −4.40 percent per year (−4.91, −3.89) followed by −3.89 percent (−4.52, −3.26) for white women, −3.72 percent (−4.46, −2.89) for black men, and −2.94 percent (−3.92, −1.96) for black women (see Figure). Adjustment for insurance type, and complications did not change the pattern by race and gender. Conclusions: Between 1987 and 2008, LOS for AMI declined significantly and similarly in men and women, blacks and whites. These changes appear independent of differences in insurance type and hospital complications among race-gender groups.

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Abstract MP32: Race-sex differences in hyperlipidemia awareness, treatment and control in the Reasons for Geographic And Racial Differences in Stroke (REGARDS) study

Circulation ◽

10.1161/circ.129.suppl_1.mp32 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Monika M Safford ◽

Paul Muntner ◽

Raegan Durant ◽

Stephen Glasser ◽

Christopher Gamboa ◽

...

Keyword(s):

Sex Differences ◽

Black Women ◽

Black Men ◽

Racial Differences ◽

White Women ◽

White Men ◽

Risk Category ◽

Chd Risk ◽

And Control ◽

Risk Categories

Introduction: To identify potential targets for eliminating disparities in cardiovascular disease outcomes, we examined race-sex differences in awareness, treatment and control of hyperlipidemia in the REGARDS cohort. Methods: REGARDS recruited 30,239 blacks and whites aged ≥45 residing in the 48 continental US between 2003-7. Baseline data were collected via telephone interviews followed by in-home visits. We categorized participants into coronary heart disease (CHD) risk groups (CHD or risk equivalent [highest risk]; Framingham Coronary Risk Score [FRS] >20%; FRS 10-20%; FRS <10%) following the 3 rd Adult Treatment Panel. Prevalence, awareness, treatment and control of hyperlipidemia were described across risk categories and race-sex groups. Multivariable models examined associations for hyperlipidemia awareness, treatment and control between race-sex groups compared with white men, adjusting for predisposing, enabling and need factors. Results: There were 11,677 individuals at highest risk, 847 with FRS >20%, 5791 with FRS 10-20%, and 10,900 with FRS<10%; 43% of white men, 29% of white women, 49% of black men and 43% of black women were in the highest risk category. More high risk whites than blacks were aware of their hyperlipidemia but treatment was 10-17% less common and control was 5-49% less common among race-sex groups compared with white men across risk categories. After multivariable adjustment, all race-sex groups relative to white men were significantly less likely to be treated or controlled, with the greatest differences for black women vs. white men (Table). Results were similar when stratified on CHD risk and area-level poverty tertile. Conclusion: Compared to white men at similar CHD risk, fewer white women, black men and especially black women who were aware of their hyperlipidemia were treated and when treated, they were less likely to achieve control, even after adjusting for factors that influence health services utilization.

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Inequalities in Hypertension and Diabetes in Canada: Intersections between Racial Identity, Gender, and Income

Ethnicity & Disease ◽

10.18865/ed.27.4.371 ◽

2017 ◽

Vol 27 (4) ◽

pp. 371 ◽

Cited By ~ 4

Author(s):

Thierry Gagné ◽

Gerry Veenstra

Keyword(s):

Racial Identity ◽

Black Women ◽

Black Men ◽

White Women ◽

White Men ◽

Canadian Community Health Survey ◽

The United States ◽

Unequal Distribution ◽

Community Health Survey ◽

Using Data

A growing body of research from the United States informed by intersectionality theory indicates that racial identity, gender, and income are often entwined with one another as determinants of health in unexpectedly complex ways. Research of this kind from Canada is scarce, however. Using data pooled from ten cycles (2001- 2013) of the Canadian Community Health Survey, we regressed hypertension (HT) and diabetes (DM) on income in subsamples of Black women (n = 3,506), White women (n = 336,341), Black men (n = 2,806) and White men (n = 271,260). An increase of one decile in income was associated with lower odds of hypertension and diabetes among White men (ORHT = .98, 95% CI (.97, .99); ORDM = .93, 95% CI (.92, .94)) and White women (ORHT = .95, 95% CI (.95, .96); ORDM = .90, 95% CI (.89, .91)). In contrast, an increase of one decile in income was not associated with either health outcome among Black men (ORHT = .99, 95% CI (.92, 1.06); ORDM = .99, 95% CI (.91, 1.08)) and strongly associated with both outcomes among Black women (ORHT = .86, 95% CI (.80, .92); ORDM = .83, 95% CI (.75, .92)). Our findings highlight the complexity of the unequal distribution of hypertension and diabetes, which includes inordinately high risks of both outcomes for poor Black women and an absence of associations between income and both outcomes for Black men in Canada. These results suggest that an intersectionality framework can contribute to uncovering health inequalities in Canada.Ethn Dis.2017;27(4):371-378; doi:10.18865/ ed.27.4.371.

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Identity and the Legislative Decision Making Process: A Case Study of the Maryland State Legislature

Ethnic Studies Review ◽

10.1525/esr.2011.34.1.45 ◽

2011 ◽

Vol 34 (1) ◽

pp. 45-68 ◽

Cited By ~ 1

Author(s):

Nadia Brown

Keyword(s):

Decision Making ◽

Black Women ◽

African American Women ◽

Black Men ◽

White Women ◽

White Men ◽

State Legislature ◽

Men And Women ◽

Women Legislators ◽

Men I

Both politicians and the mass public believe that identity influences political behavior yet, political scientists have failed to fully detail how identity is salient for all political actors not just minorities and women legislators. To what extent do racial, gendered, and race/gendered identities affect the legislation decision process? To test this proposition, I examine how race and gender based identities shape the legislative decisions of Black women in comparison to White men, White women, and Black men. I find that Black men and women legislators interviewed believe that racial identity is relevant in their decision making processes, while White men and women members of the Maryland state legislature had difficulty deciding whether their identities mattered and had even more trouble articulating how or why they did. African American women legislators in Maryland articulate or describe an intersectional identity as a meaningful and significant component of their work as representatives. More specifically, Black women legislators use their identity to interpret legislation differently due to their race/gender identities.

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Age-, sex-, and race-related differences in myoglobin concentrations in the serum of healthy persons.

Clinical Chemistry ◽

10.1093/clinchem/26.13.1864 ◽

1980 ◽

Vol 26 (13) ◽

pp. 1864-1868 ◽

Cited By ~ 28

Author(s):

I W Chen ◽

R David ◽

H R Maxon ◽

M Sperling ◽

E A Stein

Keyword(s):

Black Women ◽

Black Men ◽

White Women ◽

Age Groups ◽

White Men ◽

Reference Intervals ◽

Creatinine Ratio ◽

Healthy Individuals ◽

Female Population ◽

Serum Myoglobin

Abstract A radioimmunoassay was used to study the relation of race, sex, and age to serum myoglobin concentrations in ostensibly healthy individuals: 75 white men, 76 white women, 75 black men, and 66 black women, ranging in age from 20 to 85 years. Mean serum myoglobin values were significantly higher in men than in women in both races (35 vs 31 microgram/L for whites and 44 vs 29 microgram/L for blacks). Black men had higher values than white men, but no corresponding difference was observed in the female population. Except for the group of black men, which consistently had the highest values for serum myoglobin, values were always higher for the older groups (greater than or equal to 50 years) than the younger, irrespective of race or sex. Serum myoglobin and age were significantly and directly correlated only among white men (r = 0.3408 p < 0.01, n = 75). If results were expressed as a myoglobin/creatinine ratio, the distinctions by race, sex, and age were partly eliminated. Reference intervals for serum myoglobin, expressed both ways, are given for different race, sex, and age groups.

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Association of Resting Heart Rate With Blood Pressure and Incident Hypertension Over 30 Years in Black and White Adults

Hypertension ◽

10.1161/hypertensionaha.120.15233 ◽

2020 ◽

Vol 76 (3) ◽

pp. 692-698 ◽

Cited By ~ 1

Author(s):

Laura A. Colangelo ◽

Yuichiro Yano ◽

David R. Jacobs ◽

Donald M. Lloyd-Jones

Keyword(s):

Black Women ◽

Black Men ◽

Young Adulthood ◽

White Women ◽

Middle Age ◽

White Men ◽

Resting Heart Rate ◽

Incident Hypertension ◽

Black And White ◽

Hazard Ratios

Few studies have assessed the association of resting heart rate (RHR) through young adulthood with incident hypertension by middle age. We investigated the association between RHR measured over 30 years with incident hypertension in a cohort of young Black and White men and women. A joint longitudinal time-to-event model consisting of a mixed random effects submodel, quadratic in follow-up time, and a survival submodel adjusted for confounders, was used to determine hazard ratios for a 10 bpm higher RHR. Race-sex specific effects were examined in a single joint model that included interactions of race-sex groups with longitudinal RHR. Out of 5115 participants enrolled in year 0 (1985–1986), after excluding prevalent cases of hypertension at baseline, 1615 men and 2273 women were included in the analytic cohort. Hypertension event rates per 1000 person-years were 42.5 and 25.7 in Black and White men, respectively, and 36.2 and 15.3 in Black and White women, respectively. The hazard ratios for a 10 bpm higher RHR were 1.47 (95% CI, 1.23–1.75), 1.51 (95% CI, 1.28–1.78), 1.48 (95% CI, 1.26–1.73), and 1.02, (95% CI, 0.89–1.17) for Black men, White men, White women, and Black women, respectively. Higher RHR during young adulthood is associated with a greater risk of incident hypertension by middle age. The association is similarly strong in Black men, White men, and White women, but absent in Black women, which may suggest racial differences in the effect of sympathetic nervous activity on hypertension among women.

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Initial Screening Transferrin Saturations, Serum Ferritin Concentrations, and HFE Genotypes in Whites and Blacks in the Hemochromatosis and Iron Overload Screening (HEIRS) Study.

Blood ◽

10.1182/blood.v104.11.3202.3202 ◽

2004 ◽

Vol 104 (11) ◽

pp. 3202-3202

Author(s):

James C. Barton ◽

Ronald T. Acton ◽

Fitzroy W. Dawkins ◽

Paul C. Adams ◽

Laura Lovato ◽

...

Keyword(s):

Black Women ◽

Iron Overload ◽

Allele Frequency ◽

Black Men ◽

Serum Ferritin ◽

White Women ◽

Transferrin Saturation ◽

White Men ◽

P Value ◽

Initial Screening

Abstract We compared initial screening data of 44,149 whites (17,043 men; 27,106 women) and 26,947 blacks (9,788 men; 17,159 women) who reported no previous diagnosis of hemochromatosis or iron overload from a primary care-based sample of ~100,000 adults ≥25 years recruited from 5 Field Centers. Each underwent transferrin saturation (TfSat) and serum ferritin (SF) measurements without regard to fasting, and HFE C282Y and H63D genotyping. We observed these mean TfSat and SF values and percentages of participants with elevated biochemical measurements (TfSat >50% and SF >300 ng/mL, men; TfSat >45% and SF >200 ng/mL, women): Participants Mean % TfSat (95% CI) Elevated TfSat, % Participants Mean SF, ng/mL (95% CI) Elevated SF, % Participants White men 32.4 (32.3, 32.6) 7.05 150.9 (149.1, 152.8) 19.49 Black men 29.3 (29.1, 29.5) 4.03 178.4 (175.5, 181.3) 25.95 p Value <0.0001 <0.0001 <0.0001 <0.0001 White women 27.5 (27.3, 27.6) 6.62 63.0 (62.3, 63.7) 8.74 Black women 23.3 (23.1, 23.4) 3.04 68.3 (67.2, 69.4) 15.43 p Value <0.0001 <0.0001 <0.0001 <0.0001 In participants grouped by decade, mean TfSat was greater in white men than in black men, and in white women than in black women (all p<0.0001). Mean SF was greater in black men than in white men in all decades except 25–34 years, and in black women than in white women in decades ≥45 years. SF increased with age to ~45 years in white men and ~50 years in black men, and then decreased. In white women, SF rose with age until ~62 years and less rapidly to age ≥80. In black women, SF rose with age until ~62 years and then decreased. C282Y allele frequency was 0.0700 (95% CI: 0.0683, 0.0717) in whites and 0.0119 (0.0110, 0.0129) in blacks. H63D allele frequency was 0.1532 (0.1509, 0.1556) in whites and 0.0299 (0.0284, 0.0313) in blacks. Frequencies of genotypes with C282Y or H63D were greater in whites than in blacks (all p<0.0001). The prevalence of elevated TfSat and SF plus genotype C282Y/C282Y was 0.003 in whites and 0.00004 in blacks (p<0.0001). The prevalence of elevated TfSat and SF plus genotype C282Y/C282Y, C282Y/H63D, or H63D/H63D was 0.006 in whites and 0.0003 in blacks (p<0.0001). We conclude that: 1) the prevalence of elevated TfSat is higher in whites and the prevalence of elevated SF is higher in blacks; 2) SF levels increase with age; 3) HFE C282Y and H63D alleles occur more frequently in whites than in blacks; and 4) the prevalence of elevated TfSat and SF plus genotypes with two common HFE mutations is greater in whites than in blacks.

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Job Characteristics and Well-Being at Midlife: Ethnic and Gender Comparisons

Psychology of Women Quarterly ◽

10.1111/j.1471-6402.1989.tb00998.x ◽

1989 ◽

Vol 13 (2) ◽

pp. 223-235 ◽

Cited By ~ 39

Author(s):

Susan E. Crohan ◽

Toni C. Antonucci ◽

Pamela K. Adelmann ◽

Lerita M. Coleman

Keyword(s):

Life Satisfaction ◽

Black Women ◽

Black Men ◽

Perceived Control ◽

White Women ◽

Occupational Status ◽

White Men ◽

Well Being ◽

Role Stress ◽

And Gender

Lacking in the research on work and well-being is a focus on the characteristics of the employment role that contribute to well-being and their differential relations across ethnicity and gender. White and Black women and men at midlife (ages 40–64) were studied. The samples were drawn from two national surveys and included 186 White women, 202 White men, 254 Black women, and 169 Black men. Multiple regression analyses were conducted to assess the relation of work commitment, job satisfaction, role stress, occupational status and personal income to perceived control, life satisfaction, and happiness. Marital status, age, and hours worked were included as control variables. Results indicate that job satisfaction is positively related to life satisfaction for all four groups, and to happiness for White women and Black men. Personal income is positively related to perceived control for Black women and White men, and to life satisfaction for White women. Occupational status is positively related to perceived control for White and Black women; role stress is negatively related to life satisfaction among White men, and to happiness among Black women. Among the control variables, being married is positively related to well-being for all four race-sex groups.

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COPD in a Population-Based Sample of Never-Smokers: Interactions among Sex, Gender, and Race

International Journal of Chronic Diseases ◽

10.1155/2016/5862026 ◽

2016 ◽

Vol 2016 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Esme Fuller-Thomson ◽

Rachel S. Chisholm ◽

Sarah Brennenstuhl

Keyword(s):

Black Women ◽

Black Men ◽

Racial Differences ◽

White Women ◽

Insurance Coverage ◽

White Men ◽

Population Based ◽

Behavioral Risk ◽

Gender And Race ◽

Never Smokers

This observational epidemiological study investigates sex/gender and racial differences in prevalence of COPD among never-smokers. Data were derived from the 2012 Center for Disease Control’s Behavioral Risk Factor Surveillance System. The sample consisted of 129,535 non-Hispanic whites and blacks 50 years of age and older who had never smoked. Descriptive and multivariable analyses were conducted, with the latter using a series of logistic regression models predicting COPD status by sex/gender and race, adjusting for age, height, socioeconomic position (SEP), number of household members, marital status, and health insurance coverage. Black women have the highest prevalence of COPD (7.0%), followed by white women (5.2%), white men (2.9%), and black men (2.4%). Women have significantly higher odds of COPD than men. When adjusting for SEP, black and white women have comparably higher odds of COPD than white men (black women OR = 1.66; 99% CI = 1.46, 1.88; white women OR = 1.49; 99% CI = 1.37, 1.63), while black men have significantly lower odds (OR = 0.62; 99% CI = 0.49, 0.79). This research provides evidence that racial inequalities in COPD (or lack thereof) may be related to SEP.

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Abstract P257: The Association of Metabolic Risk and Physical Activity Trajectories: CARDIA

Circulation ◽

10.1161/circ.125.suppl_10.ap257 ◽

2012 ◽

Vol 125 (suppl_10) ◽

Author(s):

Sarah M Camhi ◽

Peter T Katzmarzyk ◽

Stephanie Broyles ◽

Timothy S Church ◽

Arlene L Hankinson ◽

...

Keyword(s):

Physical Activity ◽

Young Adults ◽

Black Women ◽

Black Men ◽

Repeated Measures ◽

White Women ◽

Smoking Status ◽

White Men ◽

Metabolic Risk ◽

Linear Modeling

Purpose: To determine whether baseline metabolic risk in young adults is associated with physical activity (PA) trajectories over 20 years. Methods: The sample included young adults from the Coronary Artery Risk Development in Young Adults (CARDIA) study, baseline ages 18–30 years (n= 4161). PA was determined from self-reported questionnaire at baseline and at years 2,5,7,10,15 and 20 of follow-up. Baseline metabolic risk was calculated using age-adjusted principal components analysis (elevated=top 10% of first factor), within sex-by-race groups, from mean arterial pressure (1/3(SBP-DBP)+DBP), glucose, waist circumference, triglycerides, and high-density lipoprotein cholesterol. Repeated measures general linear modeling was used to generate PA trajectories over 20 years, separately in black men, white men, black women and white women, adjusting for age and smoking status. Time by metabolic risk interaction terms did not contribute significantly to any model for any sex-by-race group and were therefore not included in final models. Results: In black men, white men, and white women, PA (in exercise units) at baseline was significantly lower among those with elevated metabolic risk (elevated risk vs. normal risk: black men 473.0 ± 27.0 vs. 572.0 ± 22.7; white men: 498.0 ±20.6 vs. 568.7 ± 17.3; white women: 402.4 ± 17.0 vs. 481.1 ± 14.3), and these differences persisted over 20 years (black men: −98.9 ± 16.4, white men: −70.8 ± 12.5 , white women: −78.7 ± 10.2; all p<0.0001). There were no significant differences in PA by metabolic risk in black women (307.2 ± 15.5 vs. 317.4 ± 13.1, difference: −10.1 ± 9.3, p =0.27). Conclusion: Elevated metabolic risk is associated with lower levels of PA in early adulthood, and these differences persist over 20 years. Despite these lower levels at baseline, the PA trajectory declines at similar rates for those with and without elevated metabolic risk. Young adults with elevated metabolic risk are important to identify early, in order to prevent PA level gap which remains over 20 years between those with and without elevated metabolic risk.

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