Key result
Perceived major discrimination linked to ~27% higher incident heart failure risk in Black women.
Why the study?
Black women are disproportionately susceptible to developing heart failure, but factors contributing to this excess risk remain incompletely understood.
Does exposure to psychosocial stressors (interpersonal racism and childhood/adolescent abuse) increase the risk of incident heart failure in Black women?
Cohort (n=48,320)
Yes
Does exposure to psychosocial stressors (interpersonal racism and childhood/adolescent abuse) increase the risk of incident heart failure in Black women?
Hazard Ratio: 1.27 (95% CI 1.06–1.52)
Perceived interpersonal racism and sexual abuse in childhood or adolescence are associated with an increased risk of incident heart failure among Black women, highlighting psychosocial stress as a contributor to cardiovascular disparities.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“The interrelatedness between obesity, heart failure risk, and psychosocial stress in the [Black Women's Health Study] suggests that obesity may represent a key pathway through which stress contributes to heart failure risk, and this finding warrants further study. Taken together, our findings indicate that psychosocial stress exposures may be contributors to the disproportionate heart failure risk observed among U.S. Black women.”
“In this cohort study of psychosocial stress and heart failure among Black women in the US, we found that several domains of psychosocial stress were associated with incident heart failure. Our findings underscore that different aspects of psychosocial stress disproportionately experienced by Black women may portend elevated heart failure risk independent of socio-demographic risk factors, identifying additional risk factors that may underlie the disparity in heart failure risk among Black women. Further studies are needed to understand the biological pathways underlying this risk and how it may vary by heart failure phenotype.”
May inform risk assessment among Black women; leaves open whether mitigating discrimination or abuse reduces incident heart failure.
Importance Black women are disproportionately susceptible to developing heart failure and display more severe morbidity and mortality compared with White women. Factors contributing to excess heart failure risk among Black women remain incompletely understood. Objective To characterize the associations of components of psychosocial stress, including experiences of interpersonal racism and childhood or adolescent abuse, with heart failure development among Black women. Design, Setting, and Participants This was a prospective cohort study with baseline assessment in 1997 for racism and 2005 for abuse variables and median follow-up of 24 years (IQR, 16-24 years), ending in 2023. The cohort included Black Women’s Health Study participants who were free from heart failure at baseline. Participants resided across all geographic regions of the US. Exposures Participants completed questionnaires on perceived interpersonal racism, including questions on everyday interactions and perceived discrimination in employment, housing, or with police. Self-reported type and frequency of childhood or adolescent abuse were also ascertained. Main Outcome and Measures Incident heart failure, ascertained via questionnaire. Cox proportional hazards regression was used to assess prospective associations of psychosocial stress exposures with incident heart failure. Results Among 48 320 Black women (median age at baseline, 40 years [IQR, 32-48 years]; median baseline body mass index [BMI], 27 [IQR, 24-32]), 1343 heart failure events were observed. Perceived discrimination in employment, housing, or interactions with police was associated with increased heart failure risk, with the highest risk observed in the 11% of participants who experienced discrimination in all 3 domains (hazard ratio [HR], 1.27 [95% CI, 1.06-1.52] in multivariate models). The HR for highest (vs lowest) quartile of daily racism score was 1.23 (95% CI, 1.05-1.45) in age-adjusted analyses but was attenuated to 1.04 (95% CI, 0.88-1.22) after adjustment for clinical risk factors. Frequent childhood (HR, 1.54; 95% CI, 1.16-2.06) or adolescent (HR, 1.86; 95% CI, 1.34-2.58) sexual assault (≥4 times) was associated with elevated heart failure risk, with some attenuation after multivariable adjustment, although adolescent abuse remained significant (HR, 1.44; 95% CI, 1.04-2.00). In mediation analysis, BMI was observed to be a partial mediator (proportion mediated, 19.6%-35.9%) of the associations of childhood or adolescent sexual abuse (≥4 times) with incident heart failure. Conclusions and Relevance In this cohort study of US Black women, perceived interpersonal racism and sexual abuse in childhood or adolescence were associated with increased heart failure risk decades later; as these exposures are more prevalent among Black than White women, they may represent risk factors that contribute to heart failure disparities. Future studies are needed to elucidate mechanisms linking psychosocial stress to heart failure, such as changes in BMI.
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Davis et al. (2026) conducted a cohort in Heart failure (n=48,320). Perceived interpersonal racism and childhood or adolescent abuse vs. No discrimination or abuse was evaluated on Incident heart failure (HR 1.27, 95% CI 1.06-1.52). Experiencing perceived discrimination in employment, housing, and interactions with police was associated with an increased risk of incident heart failure (HR 1.27) among US Black women.
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