Perceived discrimination — unfair treatment due to their race, gender, ethnicity, socioeconomic status, or other factors — in day-to-day life was common in young myocardial infarction (MI) survivors and was associated with worse recovery, new research suggests.
In this study, patients completed three questionnaires assessing perceived discrimination, general mental and physical health, and angina-related physical health and quality of life, while they were in hospital and 1 month and 12 months later.
Perceived discrimination was reported by 35% of the patients, and those patients with higher levels of perceived discrimination had higher odds of reporting physical limitations and angina symptoms at 1 month and 1 year as they recovered from the MI, independent of other factors.
Andrew J. Arakaki, MPH, presented these findings from 2670 patients in the Variation in Recovery: Role of Gender on Outcomes (VIRGO) study at the American Heart Association (AHA) 2022 Scientific Sessions.
The results demonstrate “that perceived discrimination has an independent deleterious impact on patient-reported health status during the first year of recovery,” after controlling for “several important sociodemographic, clinical, and psychosocial factors,” he told theheart.org | Medscape Cardiology in an email.
“Much of the existing literature has focused on the impact of discrimination experienced in the healthcare setting on health outcomes,” Arakaki, a doctoral candidate in the department of chronic disease epidemiology at the Yale School of Public Health in New Haven, Connecticut, noted.
“Our study demonstrates that discrimination experienced outside of the healthcare system also has a negative impact on AMI outcomes,” he said.
“Perceived discrimination impacted all of the cardiac-specific outcomes measured using the [Seattle Angina Questionnaire] but was not associated with general physical health status,” he elaborated, “which suggests that perceived discrimination may be especially important among patients with cardiovascular disease.”
“We were surprised to discover how common perceived discrimination was among participants in our study sample, and healthcare professionals should be aware that it appears to play an important role in patients’ recovery,” Arakaki said in a press release from the AHA.
It may be particularly important to consider when treating young patients (ages 18-55) recovering from MI, he added.
“Future research is needed to understand how to support patients with high levels of perceived discrimination during heart attack recovery and whether perceived discrimination is a stronger determinant of outcomes among people from diverse racial, ethnic, or social groups or those who live in under-resourced communities, or if other social determinants of health may also play a role,” Arakaki added.
Viola Vaccarino, MD, PhD, who was not involved with this research but is senior author of a related study among others, said these findings are consistent with a large literature linking psychological stress with poor outcomes in cardiac patients.
“This is yet another piece of evidence that the sphere of psychosocial adversity needs attention in the evaluation and counseling of patients with heart disease,” Vaccarino, professor and chair, Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, told theheart.org | Medscape Cardiology in an email.
“The discrimination scale is a continuous measure capturing both number and frequency of various types of discrimination exposures that are not uncommon in the population,” she said, “so a rate of 35% is not at all surprising when defined as a score > 0.”
Microaggressions and MI Recovery
Perceived discrimination refers to perceived indignities, microaggressions, and other types of mistreatment that members of privileged groups enact towards members of disadvantaged groups, Arakaki said.
Perceived discrimination has been associated with cardiovascular disease biomarkers, risk factors for MI, and risk of MI in middle-aged and older adults.
To investigate discrimination and outcomes in younger adults who survived an MI, the researchers analyzed data from the VIRGO study, which had enrolled twice as many women as men.
The current study included 2670 adults aged 18 to 55 who were hospitalized for MI from August 2008 to May 2012.
Two thirds were women. Most patients (76%) were White, 17% were Black, 6% were American Indian/Alaskan Native, Asian, Pacific Islander, or East Indian, and 7.7% were Hispanic.
The patients replied to three questionnaires — the Everyday Discrimination Scale, the Seattle Angina Questionnaire, and the 12-item Short-Form (SF-12) survey (with a physical health component and a mental health component) in hospital, and then 1 month and 12 months later.
They were asked to indicate the main source of the discrimination they experienced, if any — race, ethnicity, gender, age, income, language, physical appearance, sexual orientation, or other — Arakaki explained.
In the “other” category, patients reported perceived discrimination based on their occupation, education level, medical history or disability, or personal history (divorce, previous incarceration, past abuse, or drug use).
The researchers used the Everyday Discrimination Scale, with an added question number 10, which has been used in other studies.
Patients were asked to answer “never,” “rarely,” “sometimes,” or “often” in reply to 10 questions:
“In your day-to-day life, how often do any of the following things happen to you?
1. You are treated with less courtesy than other people are.
2. You are treated with less respect than other people are.
3. You receive poorer service than other people at restaurants or stores.
4. People act as if they think you are not smart.
5. People act as if they are afraid of you.
6. People act as if they think you are dishonest.
7. People act as if they’re better than you are.
8. You are called names or insulted.
9. You are threatened or harassed.
10. People ignore you or act as if you aren’t there.”
The responses were scored as never (0), rarely (1), sometimes (2), and often (3) for each item, giving a total of 0 to 30, with higher scores indicating greater perceived discrimination.
The data were corrected for sociodemographic variables (sex, race, marital status, educational attainment, employment status, income level, and health insurance status), medical history, and cardiac risk factors (hypertension, diabetes, hypercholesterolemia, smoking history, obesity, history of heart failure, prior MI, prior stroke, prior transient ischemic attack, history of peripheral artery disease, renal dysfunction, chronic obstructive pulmonary disease, history of major psychiatric disorders), and psychosocial factors (history of depression, perceived social support, and low social support at baseline).
The authors and Vaccarino have reported no relevant financial disclosures.
American Heart Association (AHA) 2022 Scientific Sessions. Abstract 547.