Racial discrimination is associated with greater arterial stiffness and carotid intima-media thickness: the ELSA-Brasil study.

PURPOSE: The association between racial discrimination and subclinical cardiovascular markers remains under-examined. We aimed to investigate the association of race/skin color and racial discrimination with pulse wave velocity (PWV) and carotid intima-media thickness (c-IMT) in the Brazilian context. METHODS: We used data from 13,284 participants from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline with information of PWV and 9850 for c-IMT. Self-reported race/skin color and perceived racial discrimination were the exposures. PWV and c-IMT were used continuously and categorizing according to cutoff that indicates increased cardiovascular risk. Linear and logistic regression models were used. RESULTS: Experience of racial discrimination was reported by 7% of total participants, but this prevalence was much higher among Blacks than Browns (PWV sample: 31,9% vs. 6,1%; c-IMT sample: 33,7% vs. 6,8%). After adjustments for age, sex, and research center, Blacks and Browns presented higher means of PWV and c-IMT and had greater chances of PWV>10 m/s and c-IMT≥75th percentile than Whites. The magnitude of all these associations were higher among Blacks and Browns with racial discrimination. In final models adjusted for education this pattern of association remained the same, although an attenuation in the magnitude of the association has been observed. CONCLUSIONS: Blacks and Browns presented worse profiles of subclinical cardiovascular markers compared to Whites and those exposed to racial discrimination seem to have an additional cardiovascular risk.

Racial inequality, racial discrimination and obesity incidence in adults from the ELSA-Brasil cohort.

BACKGROUND: This study investigated whether self-reported race/skin colour and perceived racial discrimination predict higher obesity incidence after approximately 4-year follow-up of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). We also investigated whether these associations are modified by educational level. METHODS: Following exclusion of individuals defined as obese (body mass index ≥30 kg/m2) at baseline, associations between race/skin colour and obesity incidence between the first (2008-2010) and second (2012-2014) visits were investigated in 10 130 participants. Next, associations between perceived racial discrimination and obesity incidence among black (n=1532) and brown (n=2958) individuals were investigated separately. Racial discrimination (yes/no) was assessed using the Lifetime Major Event Scale. Logistic regression models adjusted for age, sex and research site were used. All analyses were stratified for educational level. RESULTS: Obesity risk was higher in Blacks with high education compared with white individuals to the same education level (OR: 2.22; 95% CI 1.62 to 3.04) following adjustments. After adjustments, obesity incidence was higher among black individuals reporting racial discrimination compared with peers who did not report this experience, but only among the low education group (OR: 1.64; 95% CI 1.08 to 2.51). No statistical association with perceived discrimination was observed among brown individuals. CONCLUSION: Results are congruent with findings from other studies reporting associations between racial inequality and obesity incidence and also suggest racial discrimination may be one of the mechanisms leading to such inequalities. Also, it supports the paradox theory by which education modify the association in distinct directions.

Raça/cor da pele, discriminação racial e obesidade entre adultos do ELSA-Brasil / Race/skin color, racial discrimination and obesity among adults in the ELSA-Brasil

Estudos norte-americanos demonstram que a raça/cor da pele e a exposição à discriminação racial são potenciais fatores de risco para o ganho de peso corporal e desenvolvimento da obesidade. Devido a isso, os objetivos desta dissertação foram: 1) investigar a associação da discriminação racial com o aumento do peso corporal e do Índice de Massa Corporal (IMC) entre pretos e pardos (Artigo 1); 2) investigar se a raça/cor da pele e a discriminação racial estão associadas à incidência de obesidade; (Artigo 2); e 3) verificar se a associação entre a raça/cor da pele e a discriminação racial com a incidência de obesidade é modificado pela escolaridade (Artigo 2). Foram utilizados dados de peso e índice de massa corporal (IMC) obtidos na 1ª visita (2008-2010) e na 2ª visita (2012-2014) do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil). A raça/cor da pele autorreferida, a exposição à discriminação racial e as covariáveis foram aferidas na 1ª visita. Para verificar a associação entre a discriminação racial e aumento de peso corporal ao longo do tempo entre indivíduos pretos e pardos (N=5.983), utilizamos modelos de regressão de efeitos mistos estratificados pela raça/cor da pele. Já para verificar se raça/cor da pele e a discriminação racial estão associadas à incidência de obesidade em brancos, pretos e pardos (N=10.130), utilizamos modelos de regressão logística estratificados pela escolaridade. Indivíduos pretos que reportaram discriminação racial tiveram um aumento de peso e de IMC maior e mais acelerado ao longo do tempo quando comparados aos que não reportaram discriminação racial em ambos os sexos. A incidência de obesidade em 4 anos de seguimento foi maior em pretos e pardos do que em brancos (11,3%, 8,5 e 7,4% respectivamente). A raça/cor da pele preta foi associada ao maior risco de obesidade apenas entre os indivíduos de maior escolaridade (OR: 2,22, IC: 1,62 a 3,04). A exposição à discriminação racial foi associada ao maior risco de obesidade apenas em indivíduos pretos de baixa escolaridade (OR: 1,64, IC: 1,08 a 2,51). Não houve associação entre a raça/cor da pele e a discriminação racial com a incidência de obesidade entre pardos. Nossos achados sugerem que a raça/cor da pele e a discriminação racial podem predizer um maior ganho de peso corporal e um maior risco de obesidade, reforçando as evidências já existentes sobre a associação entre a raça/cor da pele e a discriminação racial com desfechos relacionados à obesidade. Além disso, nossos resultados sugerem que a associação entre a raça/cor da pele e a discriminação racial são modificadas pela escolaridade em direções distintas. Tais resultados podem embasar políticas públicas voltadas para a redução das desigualdades raciais em saúde.

North American studies demonstrate that race/skin color and exposure to racial discrimination are potential risk factors for body weight gain and the development of obesity. Because of this, the objectives of this dissertation were: 1) to investigate the association of racial discrimination with increased body weight and body mass index (BMI) in black and brown individuals (Article 1); 2) investigate whether race/skin color and racial discriminationare associated with the incidence of obesity (Article 2); and 3) to verify if the association between race/skin color and racial discrimination with the incidence of obesity is modified by education (Article 2). Weight and body mass index (BMI) data obtained at the first visit (2008-2010) and the second visit (2012-2014) of the Longitudinal Adult Health Study (ELSA-Brazil) were used. Self-reported race/skin color, exposure to racial discrimination, and covariates were measured at the first visit. To verify the association between racial discrimination and body weight gain over time in black and brown individuals (N = 5.983), we used mixed-effect regression models stratified by race/skin color. To verify whether race/skin color and racial discrimination are associated with the incidence of obesity in whites, blacks and browns (N = 10.130), we used logistic regression models stratified by education. Black individuals who reported racial discrimination had a greater and faster weight and BMI increase over time compared to those who did not report racial discrimination in either sex. The obesity incidence in 4 years of follow-up was higher in blacks and browns than in whites (11.3%, 8.5 and 7.4% respectively). Black race/skin color was associated with a higher risk of obesity only among individuals with higher education (OR: 2.22, CI: 1.62 to 3.04). Exposure to racial discrimination was associated with a higher risk of obesity only in black individuals with low education (OR: 1.64, CI: 1.08 to 2.51). There was no association between race/skin color and racial discrimination with the incidence of obesity among browns. Our findings suggest that race/skin color and racial discrimination may predict greater body weight gain and increased risk of obesity, reinforcing existing evidence on the association between race/skin color and racial discrimination with outcomes related to obesity. In addition, our results suggest that the association between race/skin color and racial discrimination is modified by education in different directions. Such results can support public policies aimed at reducing racial inequalities in health.