Black women who reported experiencing racism may be at an increased risk of having a stroke, a new study finds.
Participants who said they experienced racism in employment, housing and interactions with police had an estimated 38% higher chance of experiencing all types of strokes compared to Black women who didn’t perceive experiencing racism, the study found.
The study, published under Boston University’s Black Women’s Health Study (BHWS), followed 48,375 Black women from 1997 to 2019 who were free of cardiovascular disease and cancer at the beginning of the study. Over the 22-year period, the study identified 1,664 cases of Black women who had strokes.
Black adults are 50% more likely to have a stroke compared to white adults, and Black women are two times more likely to have a stroke than white women, according to the U.S. Department of Health and Human Services.
While experts have cited factors like obesity or hypertension as the cause for such high rates, the BWHS aimed to show that potential causes from environmental and social factors that individuals can’t change — like racism — should also be considered, according to Dr. Julie Palmer, director of the Slone Epidemiology Center at Boston University and a co-author of the study.
“Our whole aim is really to provide information that will be useful so that fewer people will have major illnesses,” Palmer said.
Boston University’s BHWS was initiated in 1995 in response to the “very little research” being done on Black women’s health, Palmer said. Inspired by the Nurses’ Health Study, BHWS collected data from 59,000 Black women throughout the country and followed up with them every two years to learn about any changes in their health. While the study did not include other races of women, the fact that the study focuses only on Black women is more of a strength than a limitation, because experiences of discrimination may vary for each group, said Shanshan Sheehy, an assistant professor at the Boston University School of Medicine and a co-author of the study.
This study specifically focused on perceived racism, which relies on participants to report their experiences in the questionnaire. Additional findings in the study revealed that participants who experienced racism in employment, housing and with the police were more likely to live in neighborhoods of high socioeconomic status, have higher education levels, and were less likely to live in the South.
When it comes to the association between racism and higher educational attainment, Palmer said it could stem from educated women being more willing to put a name to racism and “recognize what they’re experiencing as racism or being treated differently.”
Black women who live in regions “with high structural racism may not be aware of it or may not be willing to report it on a questionnaire,” Sheehy added, which may also affect the study’s findings.
What puts Black communities at higher risk of stroke?
Strokes are caused by damaged or blocked blood vessels that starve the brain of oxygen, resulting in brain death, said Dr. Olajide Williams, a professor of neurology and vice dean of community health at the Columbia University Vagelos College of Physicians and Surgeons. Chronic psychosocial stressors like discrimination, he said, can lead to toxic stress, which is dangerous to the body.
Countless research confirms that factors of racism and discrimination have disproportionately affected Black people and cause negative health outcomes. A survey conducted by the Pew Research Center in 2021 found that roughly 79% of Black Americans said they have experienced discrimination due to their race or ethnicity. Another 63% of Black Americans said that racism is an extremely big or a very big problem that they face, additional data from the survey found.
Aside from increasing the likelihood of strokes, Boston University’s study found that racism may act as a psychological stressor, elevating systemic inflammation in the body. Previous findings from Boston University identified associations of perceived interpersonal racism with higher risks of obesity, Type 2 diabetes and even decreased subjective cognitive function, often resulting in frequent confusion and memory loss. Other studies have also linked perceived interpersonal racism with a higher risk of hypertension, hormone dysregulation and unhealthy behaviors and lifestyles, among other health issues.
Having medical conditions like diabetes and hypertension increases the likelihood of experiencing a stroke, which is why it is important for individuals to both identify these conditions and have control long term, said Dr. Carolyn D. Brockington, director of the Stroke Center at Mount Sinai West and Mount Sinai Morningside in New York City. She also said it’s important to recognize the signs of a stroke, known as “BE FAST” like a drooping face, or slurred speech and other symptoms, to get help right away since 1.9 million brain cells are lost per minute during a stroke.
“Those are brain cells that are not going to come back,” Brockington said. “So, we’d like people to be able to recognize the signs and symptoms of stroke, and to understand that stroke is an emergency.”
Reducing health disparities
Palmer said she hopes that policymakers will use the data in her study, which provides more evidence of the harm institutional racism causes Black people, to spark change. There are multiple environmental factors within Black communities, including disproportionately high numbers of fast-food restaurants and of smokers, that increase the likelihood of someone having a stroke, Williams said. He also said that the public health system needs to be held accountable for the “ravaging effects of structural racism.”
Biased housing practices that affect the makeup of neighborhoods are also to blame, Williams said.
“We are still suffering in our communities, not just from those lingering effects of redlining, but from the effects of unconscious bias that still plagues American society,” Williams said.
As for Black women, Palmer said she wants the findings to help them engage in activities to reduce their risks of experiencing a stroke, including exercising regularly and eating a healthy diet. Brockington suggests that patients should partner with their doctor to identify their own risk factors, which “can reduce someone’s risk of stroke significantly,” she said.
“It’s a constant conversation,” she said. “It’s not just you having one meeting with a doctor, and that’s it, right? This is going to be lifestyle changes for your whole life.”
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