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Structural racism and myocardial infarction in the United States

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  • Lukachko, Alicia
  • Hatzenbuehler, Mark L.
  • Keyes, Katherine M.

Abstract

There is a growing research literature suggesting that racism is an important risk factor undermining the health of Blacks in the United States. Racism can take many forms, ranging from interpersonal interactions to institutional/structural conditions and practices. Existing research, however, tends to focus on individual forms of racial discrimination using self-report measures. Far less attention has been paid to whether structural racism may disadvantage the health of Blacks in the United States. The current study addresses gaps in the existing research by using novel measures of structural racism and by explicitly testing the hypothesis that structural racism is a risk factor for myocardial infarction among Blacks in the United States. State-level indicators of structural racism included four domains: (1) political participation; (2) employment and job status; (3) educational attainment; and (4) judicial treatment. State-level racial disparities across these domains were proposed to represent the systematic exclusion of Blacks from resources and mobility in society. Data on past-year myocardial infarction were obtained from the National Epidemiologic Survey on Alcohol and Related Conditions (non-Hispanic Black: N = 8245; non-Hispanic White: N = 24,507), a nationally representative survey of the U.S. civilian, non-institutionalized population aged 18 and older. Models were adjusted for individual-level confounders (age, sex, education, household income, medical insurance) as well as for state-level disparities in poverty. Results indicated that Blacks living in states with high levels of structural racism were generally more likely to report past-year myocardial infarction than Blacks living in low-structural racism states. Conversely, Whites living in high structural racism states experienced null or lower odds of myocardial infarction compared to Whites living in low-structural racism states. These results raise the provocative possibility that structural racism may not only harm the targets of stigma but also benefit those who wield the power to enact stigma and discrimination.

Suggested Citation

  • Lukachko, Alicia & Hatzenbuehler, Mark L. & Keyes, Katherine M., 2014. "Structural racism and myocardial infarction in the United States," Social Science & Medicine, Elsevier, vol. 103(C), pages 42-50.
    • Handle: RePEc:eee:socmed:v:103:y:2014:i:c:p:42-50
    DOI: 10.1016/j.socscimed.2013.07.021
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    5. Eli K. Michaels & Alexis N. Reeves & Marilyn D. Thomas & Melisa M. Price & Rebecca E. Hasson & David H. Chae & Amani M. Allen, 2019. "Everyday Racial Discrimination and Hypertension among Midlife African American Women: Disentangling the Role of Active Coping Dispositions versus Active Coping Behaviors," IJERPH, MDPI, vol. 16(23), pages 1-18, November.
    6. Kellogg, Alexander J. & Hancock, David W. & Cho, Grace Y. & Reid, Allecia E., 2023. "Reprint of: Community-level age bias and older adult mortality," Social Science & Medicine, Elsevier, vol. 320(C).
    7. Caryn N. Bell & Jordan Kerr & Jessica L. Young, 2019. "Associations between Obesity, Obesogenic Environments, and Structural Racism Vary by County-Level Racial Composition," IJERPH, MDPI, vol. 16(5), pages 1-17, March.
    8. Homan, Patricia, 2017. "Political gender inequality and infant mortality in the United States, 1990–2012," Social Science & Medicine, Elsevier, vol. 182(C), pages 127-135.
    9. Riley, Taylor & Schleimer, Julia P. & Jahn, Jaquelyn L., 2024. "Organized abandonment under racial capitalism: Measuring accountable actors of structural racism for public health research and action," Social Science & Medicine, Elsevier, vol. 343(C).
    10. Gilbert, Paul A. & Zemore, Sarah E., 2016. "Discrimination and drinking: A systematic review of the evidence," Social Science & Medicine, Elsevier, vol. 161(C), pages 178-194.
    11. Neblett, Enrique W., 2023. "Racism measurement and influences, variations on scientific racism, and a vision," Social Science & Medicine, Elsevier, vol. 316(C).
    12. Trani, Jean-Francois & Ballard, Ellis & Peña, Juan B., 2016. "Stigma of persons with disabilities in Afghanistan: Examining the pathways from stereotyping to mental distress," Social Science & Medicine, Elsevier, vol. 153(C), pages 258-265.
    13. Trani, Jean-Francois & Moodley, Jacqueline & Anand, Paul & Graham, Lauren & Thu Maw, May Thu, 2020. "Stigma of persons with disabilities in South Africa: Uncovering pathways from discrimination to depression and low self-esteem," Social Science & Medicine, Elsevier, vol. 265(C).
    14. Regina Baker, 2021. "The Historical Racial Regime and Racial Inequality in Poverty in the American South," LIS Working papers 820, LIS Cross-National Data Center in Luxembourg.
    15. Feagin, Joe & Bennefield, Zinobia, 2014. "Systemic racism and U.S. health care," Social Science & Medicine, Elsevier, vol. 103(C), pages 7-14.

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