Can Structural Racism Raise Your Blood Pressure?

Editor’s note: This comment is in response to “Manifestations of Structural Racism and Inequities in Cardiovascular Health Across US Neighborhoods” by Lawrence, et al. published in JAMA Health Forum.

The article by Lawrence, et al. echoes a recurring narrative in academic medicine: America’s history, dating back to colonial times, has created disparities that shape current racial health inequities, & in this case, cardiovascular (CV) health. The authors report that neighborhoods ranked highest on the Structural Racism Effect Index (SREI) have greater prevalence of hypertension, obesity, diabetes, smoking, & lack of physical activity.

Indeed, Lawrence, et al. single out structural racism as the explanation for these observed health disparities. By doing so they disregard other factors like geography, access, comorbidities, choice, & genetics. And while they acknowledge their study is limited by ecological fallacy, recall bias, & potentially missing covariates, they nevertheless conclude that CV risk factors and CV disease are associated with racism.

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