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State-Level Structural Racism and Incident Coronary Heart Disease.

Monika M Safford1, Tyson Brown2, Joanna Bryan1

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|December 30, 2025
PubMed
Summary
This summary is machine-generated.

Structural racism, specifically residential segregation, is linked to higher rates of fatal coronary heart disease (CHD) in Black Americans. Addressing segregation may help reduce CHD disparities between Black and White individuals.

Keywords:
cohort studiesincidence coronary heart diseaseracial disparitiesstructural racism

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Area of Science:

  • Public Health
  • Sociology
  • Epidemiology

Background:

  • Black Americans experience a disproportionately higher burden of coronary heart disease (CHD) compared to White Americans.
  • These health disparities are significantly influenced by social determinants and structural racism, yet the direct link between structural racism and incident CHD requires further investigation.
  • This study examines the association between validated measures of structural racism and the incidence of CHD, hypothesizing a stronger link for Black individuals.

Purpose of the Study:

  • To investigate the association between three measures of structural racism and incident coronary heart disease (CHD) in a national cohort.
  • To determine if state-level structural racism is associated with incident CHD, particularly for Black individuals compared to White individuals.

Main Methods:

  • Utilized data from the national REGARDS (Reasons for Geographic and Racial Differences in Stroke) cohort (n=30,239).
  • Incident CHD was defined as myocardial infarction or death due to CHD, with expert adjudication.
  • Structural racism was measured using Black:White ratios for poverty and insurance status, and the Dissimilarity Index (DI) for residential segregation, analyzed via race-stratified Cox proportional hazards models.

Main Results:

  • A high Dissimilarity Index (DI), indicating greater residential racial segregation, was significantly associated with incident fatal CHD among Black participants (HR=1.35), but not White participants.
  • Other measures, including Black:White poverty percentage and uninsured percentage, did not show significant associations with incident CHD outcomes for either racial group.
  • Results were consistent across different demographic subgroups, including men and women, and younger and older individuals.

Conclusions:

  • Racial residential segregation, as measured by the Dissimilarity Index, is associated with an increased incidence of fatal coronary heart disease (CHD) specifically in Black individuals.
  • Unlike other structural factors examined, residential segregation emerged as a significant correlate of CHD disparities.
  • Policy interventions aimed at reducing residential racial segregation could potentially mitigate Black-White disparities in CHD incidence.