Experiences of Racism and the Incidence of Adult-Onset Asthma in the Black Women's Health Study

doi:10.1378/chest.13-0665

Chest

Volume 145, Issue 3, March 2014, Pages 480-485

https://doi.org/10.1378/chest.13-0665 Get rights and content

Background

Chronic stress resulting from experiences of racism may increase the incidence of adult-onset asthma through effects on the immune system and the airways. We conducted prospective analyses of the relation of experiences of racism with asthma incidence in the Black Women's Health Study, a prospective cohort of black women in the United States followed since 1995 with mailed biennial questionnaires.

Methods

Among 38,142 participants followed from 1997 to 2011, 1,068 reported incident asthma. An everyday racism score was created based on five questions asked in 1997 and 2009 about the frequency in daily life of experiences of racism (eg, poor service in stores), and a lifetime racism score was based on questions about racism on the job, in housing, and by police. We used Cox regression models to derive multivariable incidence rate ratios (IRRs) and 95% CIs for categories of each racism score in relation to incident asthma.

Results

The IRRs were 1.45 (95% CI, 1.19-1.78) for the highest compared with the lowest quartile of the 1997 everyday racism score (P for trend <.0001) and 1.44 (95% CI, 1.18-1.75) for the highest compared with the lowest category of 1997 lifetime racism. Among women who reported the same levels of racism in 1997 and 2009, the IRRs for the highest categories of everyday and lifetime racism were 2.12 (95% CI, 1.55-2.91) and 1.66 (95% CI, 1.20-2.30), respectively.

Conclusions

Given the high prevalence of experiences of racism and asthma in black women in the United States, a positive association between racism and asthma is of public health importance.

Section snippets

Establishment of the Black Women's Health Study

The Black Women's Health Study (BWHS) is a prospective cohort study established in 1995, when 59,000 black women aged 21 through 69 years enrolled by completing health questionnaires.²⁷ The baseline questionnaire elicited information on demographic and lifestyle factors, reproductive history, and medical conditions. The cohort is followed biennially by mailed questionnaires to update exposures and ascertain incident disease. Follow-up of the original cohort through seven completed questionnaire

Results

Women in the analytic cohort were followed for an average of 13 years, for a total of 227,651 person-years. At baseline in 1997, compared with women in the lowest quartile of the everyday racism score, those in the highest quartile were younger, more highly educated, and heavier; had greater exposure to secondhand smoke; and were more likely to have used female hormones, to be current drinkers, and to report more pack-years of smoking (Table 1). Women who answered “yes” to all three lifetime

Discussion

In this large population of black women, experiences of everyday and lifetime racism were associated with an increased incidence of adult-onset asthma. The associations were stronger when we confined the analyses to women who reported the same level of everyday and lifetime racism in 1997 and 2009; these women may have had more consistent experiences of racism over time.

Previous studies, none reporting on racism, have found associations between a variety of types of stress and asthma incidence.

Conclusions

Experiences of racism were positively associated with adult-onset asthma in this large cohort of black women, suggesting that the chronic stress associated with such racism contributes to the onset of asthma in adults. Given the high prevalence of this stressor in the lives of black women,⁴⁵ the association is of significant public health importance. Our observations contribute to a growing body of evidence indicating that experiences of racism can have adverse health effects. School- and

Acknowledgments

Author contributions: Dr Coogan takes responsibility for the content of the manuscript, including the data and analysis.

Dr Coogan: contributed to the idea for this study, study design conceptualization, analysis and interpretation of the data, and writing of the manuscript.

Mr Yu: contributed to the study design conceptualization, analysis and interpretation of the data, and critical rewriting and approval of the final version of the manuscript.

Dr O'Connor: contributed to the study design

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Citation Excerpt :
In addition to age at blood draw, we considered a number of variables potentially associated with racism and RTL. We selected factors that have been shown to be related to telomere length in other studies, including body mass index (BMI) (kg/m2; <25, 25–29, 30–34, ≥35), geographic region of residence (Northeast, South, Midwest, West), alcohol use (never, past, current: 1–3, ≥4 drinks/week), cigarette smoking (pack-years), vigorous physical activity (hours/week), neighborhood socioeconomic status [17] (quintiles), and depression diagnosis with medication (yes/no). These items were measured on the baseline (1995) and most follow-up questionnaires; the data on these variables were taken from the biennial questionnaire most proximal to the date of blood collection.
Telomere length is considered a biomarker of human aging and premature morbidity and mortality which has been associated with chronic stress.
We assessed the relation between perceived racism and telomere length in the Black Women's Health Study, a follow-up study of U.S. black women begun in 1995. Participants were asked about frequency of “everyday racism” (e.g., “people act as if they think you are not intelligent”) and “institutional racism” (e.g., “ever treated unfairly due to race by police”). Using quantitative real-time polymerase chain reaction assay, relative telomere lengths (RTL) were measured as the copy number ratio of telomere repeat to a single control gene in 997 participants. Associations of racism variables with log-RTL were estimated by multivariable linear regression, with adjustment for age at blood draw and potential confounders.
Participants were aged 40–70 years (mean = 55.6 years), and mean telomere length was 0.77 (range 0.21–1.38). In stratified analyses, there was an inverse association between everyday racism and log-RTL among women who did not discuss their experiences of racism with others (β = −0.1104; 95% CI = −0.2140 to −0.0067; P = .045).
Everyday racism was associated with shorter telomere length among women who reported not discussing those experiences with others.
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Funding/Support: This work was funded by grants from the National Heart, Lung, and Blood Institute [R01 HL107314] and the National Cancer Institute [R01 CA058420].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

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Chest

Original Research: AsthmaExperiences of Racism and the Incidence of Adult-Onset Asthma in the Black Women's Health Study

Background

Methods

Results

Conclusions

Section snippets

Establishment of the Black Women's Health Study

Results

Discussion

Conclusions

Acknowledgments

J Allergy Clin Immunol

J Allergy Clin Immunol

Immunol Allergy Clin North Am

Respir Med

J Allergy Clin Immunol

Ann Epidemiol

Immunol Allergy Clin North Am

Respir Med

J Neuroimmunol

Immunol Lett

Prev Med

Ann Epidemiol

Soc Sci Med

Ann Epidemiol

Complement Ther Clin Pract

Asthma incidence among children and adults: findings from the Behavioral Risk Factor Surveillance system asthma call-back survey—United States, 2006-2008

J Asthma

Asthma is associated with weight gain in females but not males, independent of physical activity

Am J Respir Crit Care Med

Risk factors for asthma in US adults: results from the 2000 Behavioral Risk Factor Surveillance System

J Asthma

Prospective study of postmenopausal hormone use and newly diagnosed asthma and chronic obstructive pulmonary disease

Arch Intern Med

Prospective study of acetaminophen use and newly diagnosed asthma among women

Am J Respir Crit Care Med

Prospective study of short stature and newly diagnosed asthma in women

J Asthma

War-related stressors are associated with asthma risk among older Kuwaitis following the 1990 Iraqi invasion and occupation

J Epidemiol Community Health

Perceived stress and risk of adult-onset asthma and other atopic disorders: a longitudinal cohort study

Allergy

Original Research: Asthma
Experiences of Racism and the Incidence of Adult-Onset Asthma in the Black Women's Health Study