Journal of Racial and Ethnic Health Disparities

, Volume 5, Issue 5, pp 1084–1092 | Cite as

Dimensions of and Responses to Perceived Discrimination and Subclinical Disease Among African-Americans in the Jackson Heart Study

  • Victoria I. Okhomina
  • LáShauntá Glover
  • Herman Taylor
  • Mario SimsEmail author



Although discrimination among African Americans (AAs) has been linked to various health outcomes, few studies have examined associations of multiple measures of discrimination with prevalent subclinical disease in a large sample of AAs.


To examine the associations of measures of discrimination and coping responses to discrimination with prevalent subclinical disease among AAs in the Jackson Heart Study (JHS); and whether this association is modified by sex.


We examined the associations of everyday, lifetime, and burden of lifetime discrimination with carotid intima-media thickness (cIMT), and left ventricular hypertrophy (LVH) among 3029 AAs in the JHS. Prevalence ratios (PR 95% confidence interval—CI) and odds ratios (OR 95% CI) were estimated for above-median cIMT and LVH, respectfully, adjusting for demographic, behavioral, and clinical risk factors.


No significant associations were found between everyday and lifetime discrimination and median cIMT and LVH. Participants who reported high (vs. no) burden of lifetime discrimination had a 48% reduced odds of LVH (OR, 0.52; 95% CI, 0.29, 0.94) after full adjustment. There was evidence of effect modification by sex in the association of coping with everyday discrimination and LVH after full adjustment (p value for interaction < 0.01). Women who actively (vs. passively) coped with everyday discrimination had a greater odds of prevalent LVH (OR, 2.49; 95% CI, 1.39, 4.46).


This study suggests that the manner by which AA women cope with discriminatory events is associated with subclinical disease.


Discrimination Subclinical disease Coping African American Jackson heart study Cardiovascular disease 



The authors thank the staff and participants of the Jackson Heart Study for their important contributions and ongoing support.

Funding Sources

The Jackson Heart Study is supported by contracts HHSN268201300046C, HHSN268201300047C, HHSN268201300048C, HHSN268201300049C, HHSN268201300050C from the National Heart, Lung, and Blood Institute (NHLBI) and the National Institute on Minority Health and Health Disparities (NIMHD). Dr. Sims is supported by the grants P60MD002249 and U54MD008176 from the NIMHD; 15SFDRN26140001 and P50HL120163 from American Heart Association; and 1R01HL116446 from the NHLBI.

Compliance with Ethical Standards

All participants provided informed consent and the study was approved by the institutional review boards of the participating institutions: the University of Mississippi Medical Center, Jackson State University, and Tougaloo College.

Conflict of Interest

The authors declare that they have no conflict of interest.


  1. 1.
    Mozaffarian D, Benjamin EJ, Go AS, et al. Executive summary: heart disease and stroke Statistics-2016 update: a report from the American Heart Association. Circulation. 2016;133(4):447–54. Scholar
  2. 2.
    Wyatt SB, Williams DR, Calvin R, Henderson FC, Walker ER, Winters K. Racism and cardiovascular disease in African Americans. Am J Med Sci. 2003;325(6):315–31.CrossRefPubMedGoogle Scholar
  3. 3.
    Paradies Y, Ben J, Denson N, Elias A, Priest N, Pieterse A, et al. Racism as a determinant of health: a systematic review and meta-analysis. PLoS One. 2015;10(9):e0138511. Scholar
  4. 4.
    Williams DR, Mohammed SA. Discrimination and racial disparities in health: evidence and needed research. J Behav Med. 2009;32(1):20–47. Scholar
  5. 5.
    Williams DR, Yu Y, Jackson JS, Anderson NB. Racial differences in physical and mental health socio-economic status, stress and discrimination. J Health Psychol. 1997;2(3):335–51. Scholar
  6. 6.
    Lewis TT, Williams DR, Tamene M, Clark CR. Self-reported experiences of discrimination and cardiovascular disease. Curr Cardiovasc Risk Rep. 2014;8(1):365. Scholar
  7. 7.
    Krieger N. Racial and gender discrimination: risk factors for high blood pressure? Soc Sci Med. 1990;30(12):1273–81. Scholar
  8. 8.
    Krieger N, Sidney S. Racial discrimination and blood pressure: the CARDIA study of young black and white adults. Am J Public Health. 1996;86(10):1370–8. Scholar
  9. 9.
    Sims M, Diez-Roux AV, Dudley A, Gebreab S, Wyatt SB, Bruce MA, et al. Perceived discrimination and hypertension among African Americans in the Jackson Heart Study. Am J Public Health. 2012;102(S2):S258–65. Scholar
  10. 10.
    Everson-Rose SA, Lutsey PL, Roetker NS, et al. Perceived discrimination and incident cardiovascular events the multi-ethnic study of atherosclerosis. Am J Epidemiol. 2015:kwv035.Google Scholar
  11. 11.
    Dunlay SM, Lippmann SJ, Greiner MA, O’Brien EC, Chamberlain AM, Mentz RJ, et al. Perceived discrimination and cardiovascular outcomes in older African Americans: insights from the Jackson Heart Study. In Mayo Clinic Proceedings. 2017;92(5):699–709 Elsevier. Scholar
  12. 12.
    Troxel WM, Matthews KA, Bromberger JT, Sutton-Tyrrell K. Chronic stress burden, discrimination, and subclinical carotid artery disease in African American and Caucasian women. Health Psychol. 2003;22(3):300–9. Scholar
  13. 13.
    Lewis TT, Everson-Rose SA, Powell LH, Matthews KA, Brown C, Karavolos K, et al. Chronic exposure to everyday discrimination and coronary artery calcification in African-American women: the SWAN Heart Study. Psychosom Med. 2006;68(3):362–8. Scholar
  14. 14.
    Bhattacharyya MR, Steptoe A. Emotional triggers of acute coronary syndromes: strength of evidence, biological processes, and clinical implications. Prog Cardiovascular Dis. 2007;49(5):353–65. Scholar
  15. 15.
    Krieger N, Sidney S. Racial discrimination and blood pressure: the CARDIA Study of young black and white adults. Am J Public Health. 1996 Oct;86(10):1370–8. Scholar
  16. 16.
    Taylor HA Jr, Wilson JG, Jones DW, et al. Toward resolution of cardiovascular health disparities in African Americans: design and methods of the Jackson Heart Study. Ethn Dis. 2005;15(4 Suppl 6):S6–4.PubMedGoogle Scholar
  17. 17.
    Nunez E, Arnett DK, Benjamin EJ, Liebson PR, Skelton TN, Taylor H, et al. Optimal threshold value for left ventricular hypertrophy in blacks the atherosclerosis risk in communities study. Hypertension. 2005;45(1):58–63. Scholar
  18. 18.
    Carpenter MA, Crow R, Steffes M, Rock W, Skelton T, Heilbraun J, et al. Laboratory, reading center, and coordinating center data management methods in the Jackson Heart Study. Am J Med Sci. 2004;328(3):131–44. Scholar
  19. 19.
    Hurst RT, Ng DW, Kendall C, Khandheria B. Clinical use of carotid intima-media thickness: review of the literature. J Am Soc Echocardiogr. 2007;20(7):907–14. Scholar
  20. 20.
    Mohan A, Sada S, Kumar BS, Sarma KV, Devi BV, Rao PV, et al. Subclinical atherosclerosis in patients with rheumatoid arthritis by utilizing carotid intima-media thickness as a surrogate marker. Indian J Med Res. 2014;140(3):379–86.PubMedPubMedCentralGoogle Scholar
  21. 21.
    Tosetto A, Prati P, Baracchini C, Manara R, Rodeghiero F. Age-adjusted reference limits for carotid intima-media thickness as better indicator of vascular risk: population-based estimates from the VITA project. J Thromb Haemost. 2005;3(6):1224–30. Scholar
  22. 22.
    Sims M, Wyatt SB, Gutierrez ML, Taylor HA, Williams DR. Development and psychometric testing of a multidimensional instrument of perceived discrimination among African Americans in the Jackson heart study. Ethn Dis. 2009;19(1):56–64.PubMedPubMedCentralGoogle Scholar
  23. 23.
    Dubbert PM, Robinson JC, Hye Sung J, et al. Physical activity and obesity in African Americans: the Jackson Heart Study. Ethn Dis. 2010;20(4):383–9.PubMedPubMedCentralGoogle Scholar
  24. 24.
    Smitherman TA, Dubbert PM, Grothe KB, Sung JH, Kendzor DE, Reis JP, et al. Validation of the Jackson Heart Study physical activity survey in African Americans. J Phys Act Health. 2009;6(1):S124–32. Scholar
  25. 25.
    Coutinho L, Scazufca M, Menezes PR. Methods for estimating prevalence ratios in cross-sectional studies. Rev Saúde Pública. 2008;42(6):992–8. Scholar
  26. 26.
    SAS 9.4. Cary, NC; 2013.Google Scholar
  27. 27.
    StataCorp. Stata statistical software: release 14. College Station, TX: StataCorp LP; 2015.Google Scholar
  28. 28.
    Cooper DC, Thayer JF, Waldstein SR. Coping with racism: the impact of prayer on cardiovascular reactivity and post-stress recovery in African American women. Ann of Behav Med. 2014;47(2):218–30. Scholar
  29. 29.
    Everson-Rose SA, Lewis TT. Psychosocial factors and cardiovascular diseases. Annu Rev Public Health. 2005;26(1):469–500. Scholar
  30. 30.
    Matthews DD, Hammond WP, Nuru-Jeter A, Cole-Lewis Y, Melvin T. Racial discrimination and depressive symptoms among African-American men: the mediating and moderating roles of masculine self-reliance and John Henryism. Psychol Men Masc. 2013;14(1):35–46. Scholar
  31. 31.
    Pascoe EA, Richman LS. Perceived discrimination and health: a meta-analytic review. Psychol Bull. 2009;135(4):531–54. Scholar
  32. 32.
    Woods-Giscombé CL. Superwoman schema: African American women’s views on stress, strength, and health. Qual Health Res. 2010;20(5):668–83. Scholar
  33. 33.
    Hamer M, Malan L. Psychophysiological risk markers of cardiovascular disease. Neurosci Biobehav Rev. 2010 Sep 30;35(1):76–83. Scholar
  34. 34.
    Williams RB. Patterns of reactivity and stress. Handbook of stress, reactivity, and cardiovascular disease. 1986.Google Scholar

Copyright information

© W. Montague Cobb-NMA Health Institute 2018

Authors and Affiliations

  • Victoria I. Okhomina
    • 1
  • LáShauntá Glover
    • 2
  • Herman Taylor
    • 3
  • Mario Sims
    • 2
    Email author
  1. 1.Department of BiostatisticsVirginia Commonwealth UniversityRichmondUSA
  2. 2.Department of MedicineUniversity of Mississippi Medical Center, Jackson Heart StudyJacksonUSA
  3. 3.Cardiovascular Research Institute, Morehouse School of MedicineAtlantaUSA

Personalised recommendations