Health Disparities
Experiences of in-group and out-group skin tone discrimination and their associations with incident cardiovascular disease among African American adults in the Jackson Heart Study Sydney Barlow* Sydney Barlow Jessica R. Fernandez Juliana S. Sherchan Ellis P. Monk Jaime Slaughter-Acey Mario Sims
Background: African American adults face an elevated risk of cardiovascular disease (CVD) compared to other racial/ethnic groups in the United States. Although discrimination has been linked to this disparity, the relationship between skin tone discrimination and CVD incidence remains scarce. Therefore, this study investigated the associations of in-group skin tone discrimination (from African American individuals) and out-group skin tone discrimination (from White individuals) with incident CVD and whether these associations differed by sex and optimism.
Methods: We analyzed data from 3,519 African American adults (aged 21-95 years) in the Jackson Heart Study (JHS). Cox Proportional Hazards regression, including interaction terms, estimated HR and 95% CI to examine whether skin tone discrimination (in-group, out-group) was associated with incident CVD (stroke, coronary heart disease (CHD), congestive heart failure (HF)), adjusting for sociodemographic variables, health behaviors, and CVD risk factors.
Results: Over the 16-year follow-up period, 12.6% of JHS participants developed CVD, 3.9% developed stroke, 4.9% developed CHD, and 7.3% developed HF. In-group skin tone discrimination through better treatment (i.e., Black individuals treated participants better than other Black individuals due to their skin tone) was associated with a higher incidence of CVD. Out-group skin tone discrimination, whether better or worse treatment, was associated with a higher incidence of CHD (see figure 1). These associations did not vary by sex. Optimism moderated the association between out-group skin tone discrimination and HF, such that those who reported worse treatment and had the highest-level of optimism had the greatest risk of HF.
Conclusions: Findings suggest that in-group skin tone discrimination is associated with CVD for African American adults over time, presenting it as a possible risk factor for CVD for African American individuals.
Figure 1. Hazard Ratios for Associations between Skin Tone Discrimination and Cardiovascular Health Outcomes
Cardiovascular Disease includes Stroke, Coronary Heart Disease, and Heart Failure.
