Introduction: Variation in exposure to discrimination has been proposed as a contributor to disparities in cardiovascular disease (CVD) among black and white women and men in the U.S. Yet, evidence is conflicting, perhaps due to insufficiently studied race-sex and geographical differences in the pathogenicity of discrimination. We hypothesized that the prevalence of perceived racial discrimination in a variety of settings differs by race, sex, and geographic location.
Methods: We used data from CARDIA, a population-based cohort of black and white adults recruited in Birmingham, AL; Chicago, IL; Minneapolis, MN, and Oakland, CA in 1985-6 (year 0). Racial discrimination perceived in several scenarios was assessed using the Lifetime Discrimination Scale at years 7, 15, and 20 (2005-6). We assessed the prevalence at each of these exams and in each scenario, stratified by race-sex group.
Results: Prevalence of reported discrimination did not differ markedly over time; we report on year 7 only (n=4,025, figure), with qualitatively similar findings at the other years. Reported discrimination in ≥2 scenarios ranged from 52% in Birmingham to 70% in Minneapolis among black women; among black men, from 65% in Birmingham and 75% in Minneapolis and Oakland. This prevalence was <20% among white women and men in every city. Within all groups, discrimination on the street or in a public setting was most prevalent (p<0.001) and least prevalent in receiving medical care (p<0.001). The proportion of black men reporting discrimination by the police or courts was substantially greater than the other three race-sex groups in each of the four cities (all p<0.001).
Conclusions: We found variation in the prevalence of reported racial discrimination across race, sex, and geography. Differences in the experience of discrimination may lead to differences in the health-damaging effects of exposure and partially explain inconsistencies in the evidence of discrimination as a cause of disparities in cardiovascular disease between black and white women and men.