Perceived Racism Among Black Women a Stroke Risk Factor?


Experiencing interpersonal racism in situations involving employment, housing, and the police raises the risk of stroke among Black women, a large cohort study suggests.


  • Researchers examined the association of perceived interpersonal racism (implicit or explicit racial prejudice) with incident stroke among 48,375 US Black women participating in the prospective the Black Women’s Health Study.

  • In 1997, participants had a mean age of 41 years, had no history of stroke, and provided information on reported experiences of racism in everyday life.

  • Participants were followed until onset of stroke, death, loss to follow-up, or to the end of 2019.

  • Findings were adjusted for major confounders, including education, neighborhood socioeconomic environment, and cardiometabolic factors.


  • During the 22-year follow-up period, 1664 stroke cases were identified, including 550 definite cases confirmed by neurologist review and/or National Death Index linkage.

  • For all incident cases, women who reported interpersonal racism related to employment, housing, and the police had a 38% increased risk of stroke (adjusted hazard ratio [aHR], 1.38; P < .001) compared with women who did not report these experiences.

  • Similar results were observed for the smaller group of definite stroke cases, although the findings were not significant (aHR, 1.37; P = .05).

  • For comparisons of women in the highest vs lowest quartile of everyday interpersonal racism, multivariable aHRs were 1.14 (P = .03) for all incident stroke.


“Black people in the US experience stroke and stroke-related mortality at younger ages and more frequently than other racial groups. It is possible that the high burden of racism experienced by Black US individuals may contribute to racial disparities in stroke incidence,” the authors write.


The study, with first author Shanshan Sheehy, ScD, Slone Epidemiology Center, Boston, University, was published online November 10 in JAMA Network Open.


The primary stroke endpoint included self-reported stroke. Medical records were not available for all stroke events. Perceived racism captures an individual’s perceptions of an experience of racism and is inevitably subject to measurement error. The study was observational with the potential for unmeasured and residual confounding. The cohort of Black women had high educational levels compared with the general population of Black women.


The study was funded by the National Institutes of Health. The authors have disclosed no relevant financial relationships.

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