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Twitter-Characterized Sentiment Towards Racial/Ethnic Minorities and Cardiovascular Disease (CVD) Outcomes


Sentiments towards racial/ethnic minorities may impact cardiovascular disease (CVD) through direct and indirect pathways. In this study, we assessed the association between Twitter-derived sentiments towards racial/ethnic minorities at state-level and individual-level CVD-related outcomes from the 2017 Behavioral Risk Factor Surveillance System (BRFSS). Outcomes included hypertension, diabetes, obesity, stroke, myocardial infarction (MI), coronary heart disease (CHD), and any CVD from BRFSS 2017 (N = 433,434 to 433,680 across outcomes). A total of 30 million race-related tweets were collected using Twitter Streaming Application Programming Interface (API) from 2015 to 2018. Prevalence of negative and positive sentiment towards racial/ethnic minorities were constructed at the state level and merged with CVD outcomes. Poisson regression was used, and all the models adjusted for individual-level demographics as well as state-level demographics. Individuals living in states with the highest level of negative sentiment towards racial/ethnic minorities had 11% higher prevalence of hypertension (PR 1.11, 95% CI 1.08, 1.14), 15% higher prevalence of diabetes (PR 1.15, 95% CI 1.08, 1.22), 14% higher prevalence of obesity (PR 1.14, 95% CI 1.10, 1.18), 30% higher prevalence of stroke (PR 1.30, 95% CI 1.16, 1.46), 14% higher prevalence of MI (PR 1.14, 95% CI 1.03, 1.25), 9% higher prevalence of CHD (PR 1.09, 95% CI 1.00, 1.19), and 16% higher prevalence of any CVD outcomes (PR 1.16, 95% CI 1.09, 1.24). Conversely, Twitter-derived positive sentiment towards racial/ethnic minorities was associated with a lower prevalence of CVD outcomes. Programs and policies that promote racially inclusive environments may improve population health.

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This study was supported by grants from the National Institutes of Health’s Big Data to Knowledge Initiative (BD2K) (award number: 5K01ES025433) and the National Library of Medicine (award number: R01LM012849 (Dr. Nguyen, Q.C., PI). Research reported in this publication was also supported by the National Institute On Minority Health And Health Disparities of the National Institutes of Health under Award Number R00MD012615 (Dr. Nguyen T, PI). 

Collection and storage of the Twitter data used in this publication was supported by the National Drug Early Warning System Coordinating Center housed at the Center for Substance Abuse Research (CESAR) at the University of Maryland, College Park. The content is solely the responsibility of the authors and does not necessarily represent the official views of the CESAR or the University of Maryland.

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Authors and Affiliations



Conceptualization: Quynh C. Nguyen; Data Curation: Nikki Adams, Thu T. Nguyen, Dina Huang; Investigation: Nikki Adams, Thu T. Nguyen; Methodology: Quynh C. Nguyen, Dina Huang; Formal analysis: Dina Huang; Writing—original draft preparation: Dina Huang, Yuru Huang; Writing—review and editing: Dina Huang, Yuru Huang, Thu T. Nguyen, Nikki Adams, Quynh C. Nguyen; Visualization: Dina Huang; Funding acquisition: Quynh C. Nguyen.

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Correspondence to Quynh C. Nguyen.

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Ethnic Statement

The study is original research and was not published in any form elsewhere. The study has been approved by University of Maryland Institutional Review Board. Informed consent was exempt because this study utilized publically available Twitter data and BRFSS data for secondary data analyses.

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The authors declare that they have no conflict of interest.

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Huang, D., Huang, Y., Adams, N. et al. Twitter-Characterized Sentiment Towards Racial/Ethnic Minorities and Cardiovascular Disease (CVD) Outcomes. J. Racial and Ethnic Health Disparities 7, 888–900 (2020).

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  • Racial sentiment
  • Racial/ethnic minorities
  • Twitter
  • CVD outcomes