Socioeconomic Status Discrimination and Cardiovascular Disease Risk in African-American and White Adults Open Access

Abstract

Discrimination is a commonly reported form of psychosocial stress that has been associated with incident cardiovascular disease (CVD) and relevant CVD risk factors, such as obesity, smoking, blood pressure, inflammation, and sleep quality. The majority of research on discrimination and health has focused on racial discrimination or overall mistreatment. Consequently, less is known about discrimination on the basis of socioeconomic status, or socioeconomic status (SES) discrimination– despite persistent and pronounced differences in health outcomes by SES background. Using data from African-American and White adults from the Coronary Artery Risk Development in Young Adults Study, this dissertation sought to build upon previously published work from our team to understand how SES discrimination impacts physiological processes (inflammation & atherosclerosis) linked to CVD risk over time among varying demographic groups in the United States. 

Aim 1 examined trends in self-reports of ever experiencing SES discrimination (measured using Krieger’s Experiences of Discrimination Scale) over 18 years across different race-education groups. Self-reports of SES discrimination were higher among African-Americans than Whites and among lower-educated Whites compared to higher-educated Whites at each study visit. Reports of “ever” experiencing SES discrimination declined over time for all groups, with approximately one-third of the cohort “recanting” reports of SES discrimination at later visits. Aims 2 & 3 examined associations between cumulative self-reports of SES discrimination over time and two separate processes related to CVD risk (inflammation & atherosclerosis), and no associations were observed. However, cumulative self-reports of SES discrimination over time were associated with higher levels of depressive symptoms, one of the covariates in our Aim 2 & Aim 3 analyses, examined separately in exploratory analyses. Associations did not vary by race, education, or childhood SES.

Findings from this research add to a limited literature examining whether SES discrimination may impact physiological processes linked to CVD over time. Further, they highlight the need to examine whether self-reports of discrimination can be reliably measured over time using current scales; and the need to further examine how experiences/reports of SES discrimination may vary across different demographic groups in the United States.

Table of Contents

1.  Public Health Importance 1

1.1. Discrimination is a highly prevalent social status stressor 1

1.2. SES discrimination may be an important form of discrimination 2

1.3. Markers associated with cardiovascular disease (CVD) risk  5

1.4. Associations between self-reports of discrimination and CVD risk 5

1.5. Disproportionate burden of discrimination and CVD risk in certain populations 6

1.6. Prior studies on SES discrimination and health 7

1.7. SES discrimination and health among higher educated African-Americans 9

1.8. Effects of SES discrimination may differ by intersecting social identities 11

1.9. SES discrimination among lower educated Whites 12

1.10. Connection between racial and SES discrimination 13

1.11. Novel contributions of the proposed research 14

2.  Aims 15

3.  Study Population and Definitions of Variables 16

3.1. Study population 16

3.2. SES discrimination 18

3.3. Analytic sample 27

3.4. Outcomes 29

3.5. Exposure and outcome associations examined in the CARDIA study 31

3.6. Demographics 34

3.7. Covariates 35

4.  Aim 1: An examination of reports of socioeconomic status discrimination over time 36

5.  Aim 2: Socioeconomic status discrimination and inflammation in African-American and White adults 56

6.  Aim 3: Socioeconomic status discrimination and subclinical cardiovascular disease in African-American and White adults 73

7.  Exploratory Aim 1: Socioeconomic status discrimination and depressive symptoms in African-American and White adults 90

8.  Overall Limitations 107

9.  Areas for Future Research 111

10. Overall Conclusions 119

11. Appendix 120

12.  References 133

About this Dissertation

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School	Laney Graduate School
Department	Epidemiology
Degree	Ph.D.
Submission	Dissertation
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Keyword	Cardiovascular Disease Depression Race Classism Class Discrimination Socioeconomic Status Inflammation
Committee Chair / Thesis Advisor	Tené Lewis, Emory University
Committee Members	Michael Kramer, Emory University Viola Vaccarino, Emory University Natalie Crawford, Emory University

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