, Volume 60, Issue 11, pp 2221–2225 | Cite as

Perceived racism and incident diabetes in the Black Women’s Health Study

  • Kathryn L. Bacon
  • Sherri O. Stuver
  • Yvette C. Cozier
  • Julie R. Palmer
  • Lynn Rosenberg
  • Edward A. Ruiz-Narváez
Short Communication



Our aim was to assess the association of perceived racism with type 2 diabetes, and the possible mediating influence of diet and BMI.


The Black Women’s Health Study, a follow-up of 59,000 African-American women, began in 1995. Over 16 years 5344 incident cases of diabetes occurred during 576,577 person-years. Cox proportional hazards models were used to estimated HRs and 95% CIs for categories of ‘everyday racism’ (interpersonal racism in daily life) and ‘lifetime racism’ (reporting ever treated unfairly due to race with respect to police, housing or work) and incident type 2 diabetes. Models were adjusted for age, questionnaire cycle, marital status, socioeconomic status, education, family history of diabetes, physical activity, alcohol use and smoking status, with and without inclusion of terms for dietary patterns and adult BMI.


Compared with women in the lowest quartile of exposure, women in the highest quartile of exposure to everyday racism had a 31% increased risk of diabetes (HR 1.31; 95% CI 1.20, 1.42) and women with the highest exposure to lifetime racism had a 16% increased risk (HR 1.16; 95% CI 1.05, 1.27). Mediation analysis estimated that BMI accounted for half of the association between either the everyday or lifetime racism measure and incident diabetes.


Perceived everyday and lifetime racism were associated with increased risk of type 2 diabetes in this cohort of African-American women and appear to be at least partly mediated by BMI.


Black women Diabetes Obesity Racial discrimination Racism Stress 



Black Women’s Health Study


Socioeconomic status



The authors thank the BWHS participants for their continuing participation in this research effort.

Some of these results were included in KLB’s doctoral dissertation (Boston University School of Public Health, 2016).

Data availability

The Boston University Medical Campus IRB has determined that we may not post individual data to a public repository because the IRB judged that the informed consent provided by study participants is incompatible with such posting. However, the IRB has determined that we can share de-identified data with outside investigators under the following conditions: (1) personal identifiers are removed from all data items and (2) a BWHS investigator is involved in review, interpretation and publication of results of the analysed data. See https://www.bu.edu/bwhs/for-researchers/ for information about the procedure for data request.


This work was supported by grants R01 MD007015 from the National Institute on Minority Health and Health Disparities (National Institutes of Health), R01 CA058420 and UM1 CA164974 from the National Cancer Institute and 11SDG7390014 from the American Heart Association. The content is solely the responsibility of the authors and does not necessarily represent the official views of any of the funding agencies.

Duality of interest

The authors declare that there is no duality of interest associated with this manuscript.

Contribution statement

All authors made substantial contributions to one or more of the following: the study conception and design, acquisition of data and analysis and interpretation of the data. All authors contributed to drafting and/or revising the article critically for important intellectual content and all authors provided their final approval of the version to be published. EARN is the guarantor of this work.


  1. 1.
    Cowie CC, Rust KF, Byrd-Holt DD et al (2006) Prevalence of diabetes and impaired fasting glucose in adults in the U.S. population: National Health And Nutrition Examination Survey 1999-2002. Diabetes Care 29:1263–1268CrossRefPubMedGoogle Scholar
  2. 2.
    Signorello LB, Schlundt DG, Cohen SS et al (2007) Comparing diabetes prevalence between African Americans and Whites of similar socioeconomic status. Am J Public Health 97:2260–2267CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Williams DR, Yu Y, Jackson JS, Anderson NB (1997) Racial differences in physical and mental health: socio-economic status, stress and discrimination. J Health Psychol 2:335–351CrossRefPubMedGoogle Scholar
  4. 4.
    Cozier YC, Wise LA, Palmer JR, Rosenberg L (2009) Perceived racism in relation to weight change in the Black Women’s Health Study. Ann Epidemiol 19:379–387CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Cozier YC, Yu J, Coogan PF, Bethea TN, Rosenberg L, Palmer JR (2014) Racism, segregation, and risk of obesity in the Black Womenʼs Health Study. Am J Epidemiol 179:875–883CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Tull ES, Chambers EC (2001) Internalized racism is associated with glucose intolerance among Black Americans in the U.S. Virgin Islands. Diabetes Care 24:1498Google Scholar
  7. 7.
    Tull ES, Cort MA, Gwebu ET, Gwebu K (2007) Internalized racism is associated with elevated fasting glucose in a sample of adult women but not men in Zimbabwe. Ethn Dis 17:731–735PubMedGoogle Scholar
  8. 8.
    Peek ME, Wagner J, Tang H, Baker DC, Chin MH (2011) Self-reported racial discrimination in health care and diabetes outcomes. Med Care 49:618–625CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Rosenberg L, Adams-Campbell L, Palmer JR (1995) The Black Womenʼs Health Study: a follow-up study for causes and preventions of illness. J Am Med Wom Assoc 50:56–58PubMedGoogle Scholar
  10. 10.
    Wise LA, Rosenberg L, Radin RG et al (2011) A prospective study of diabetes, lifestyle factors, and glaucoma among African-American women. Ann Epidemiol 21:430–439CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Vimalananda VG, Palmer JR, Gerlovin H et al (2015) Night-shift work and incident diabetes among African-American women. Diabetologia 58:699–706CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Wise LA, Palmer JR, Spiegelman D et al (2005) Influence of body size and body fat distribution on risk of uterine leiomyomata in U.S. black women. Epidemiology 16:346–354CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Coogan PF, Cozier YC, Krishnan S et al (2010) Neighborhood socioeconomic status in relation to 10-year weight gain in the Black Womenʼs Health Study. Obesity (Silver Spring) 18:2064–2065CrossRefGoogle Scholar
  14. 14.
    Scott KA, Melhorn SJ, Sakai RR (2012) Effects of chronic social stress on obesity. Curr Obes Rep 1:16–25CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Fernandez-Real JM, Pickup JC (2012) Innate immunity, insulin resistance and type 2 diabetes. Diabetologia 55:273–278CrossRefPubMedGoogle Scholar
  16. 16.
    Clark R, Anderson NB, Clark VR, Williams DR (1999) Racism as a stressor for African Americans. A biopsychosocial model. Am Psychol 54:805–816CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • Kathryn L. Bacon
    • 1
  • Sherri O. Stuver
    • 1
  • Yvette C. Cozier
    • 1
    • 2
  • Julie R. Palmer
    • 1
    • 2
  • Lynn Rosenberg
    • 1
    • 2
  • Edward A. Ruiz-Narváez
    • 1
    • 2
  1. 1.Department of EpidemiologyBoston University School of Public HealthBostonUSA
  2. 2.Slone Epidemiology Center at Boston University, Boston University Medical CampusBostonUSA

Personalised recommendations