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Department of Population and Quantitative Health Sciences

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Behavior and Behavior Mechanisms | Cardiology | Cardiovascular Diseases | Cardiovascular System | Clinical Epidemiology | Epidemiology | Gender and Sexuality | Health Services Administration | Health Services Research | Investigative Techniques | Mental and Social Health | Pathology | Race and Ethnicity


Testing hypotheses from the emerging Identity Pathology (IP) framework, we assessed race-gender differences in the effects of reporting experiences of racial and gender discrimination simultaneously compared with racial or gender discrimination alone, or no discrimination, on future cardiovascular health (CVH). Data were from a sample of 3758 black or white adults in CARDIA, a community-based cohort recruited in Birmingham, AL; Chicago, IL; Minneapolis, MN, and Oakland, CA in 1985-6 (year 0). Racial and gender discrimination were assessed using the Experiences of Discrimination scale. CVH was evaluated using a 12-point composite outcome modified from the Life's Simple 7, with higher scores indicating better health. Multivariable linear regressions were used to evaluate the associations between different perceptions of discrimination and CVH scores two decades later by race and gender simultaneously. Reporting racial and gender discrimination in > /=2 settings were 48% of black women, 42% of black men, 10% of white women, and 5% of white men. Year 30 CVH scores (mean, SD) were 7.9(1.4), 8.1(1.6), 8.8(1.6), and 8.7(1.3), respectively. Compared with those of their race-gender groups reporting no discrimination, white women reporting only gender-based discrimination saw an adjusted score difference of +0.3 (95% CI: 0.0,0.6), whereas white men reporting only racial discrimination had on average a 0.4 (95% CI: 0.1,0.8) higher score, and scores among white men reporting both racial and gender discrimination were on average 0.6 (95% CI: 1.1,-0.1) lower than those of their group reporting no discrimination. Consistent with predictions of the IP model, the associations of reported racial and gender discrimination with future CVH were different for different racially-defined gender groups. More research is needed to understand why reported racial and gender discrimination might better predict deterioration in CVH for whites than blacks, and what additional factors associated with gender and race contribute variability to CVH among these groups.


Cardiovascular health, Discrimination, Gendered race, Health inequities, Identity pathology, Intersectionality, USA

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© 2019 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (

DOI of Published Version



SSM Popul Health. 2019 Jul 4;8:100446. doi: 10.1016/j.ssmph.2019.100446. eCollection 2019 Aug. Link to article on publisher's site

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SSM - population health

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Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.