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Instrumental Variable Analysis of Racial Discrimination and Blood Pressure in a Sample of Young Adults
Journal article   Open access   Peer reviewed

Instrumental Variable Analysis of Racial Discrimination and Blood Pressure in a Sample of Young Adults

Jourdyn A Lawrence, Ichiro Kawachi, Kellee White, Mary T Bassett and David R Williams
American journal of epidemiology, v 192(12), pp 1971-1980
Dec 2023
url
https://doi.org/10.1093/aje/kwad150View
Published, Version of Record (VoR) Open

Abstract

Abstract Racial inequities in blood pressure levels have been extensively documented. Experiences of racial discrimination could explain some of this disparity, although findings from previous studies have been inconsistent. To address limitations of prior literature, including measurement error, we implemented instrumental variable analysis to assess the relationship between racial discrimination in institutional settings and blood pressure. Using data from 3,876 Black and White adults with an average age of 32 years from examination 4 (1992–1993) of the Coronary Artery Risk Development in Young Adults Study, our primary analysis examined the relationship between self-reported experiences of racial discrimination in institutional settings and blood pressure using reflectance meter measurement of skin color as an instrument. Findings suggested that an increase in experiences of racial discrimination was associated with higher systolic and diastolic blood pressure (β = 2.23 mm Hg (95% confidence interval: 1.85, 2.61) and β = 1.31 (95% confidence interval: 1.00, 1.62), respectively). Our instrumental variable estimates suggest that experiences of racial discrimination within institutional settings contribute to racial inequities in elevated blood pressure and cardiovascular disease outcomes in a relatively young cohort of adults and may yield clinically relevant differences in cardiovascular health over the life course.

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