Perceived racism and incident diabetes in the Black Women’s Health Study
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.
KeywordsBlack women Diabetes Obesity Racial discrimination Racism Stress
Black Women’s Health Study
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).
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.
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.
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