The objective of this study was to determine whether exposure to structural racism-related state laws is associated with cardiovascular health among a racially and ethnically diverse sample of US adults. Data were from the Database of Structural Racism-Related State Laws and the Behavioral Risk Factor Surveillance System (BRFSS). The sample included 958 019 BRFSS 2011 and 2013 respondents aged 18 years or older from all 50 US states. The exposure was a summary index of 22 state laws related to the criminal legal system, economics and labor, education, health care, housing, immigration, and political participation. The outcome was the American Heart Association's Life's Simple 7 (LS7), a summary index of 7 cardiovascular health indicators. Linear regression models included fixed effects for year and state to control for time trends and unmeasured, time-invariant, state-level contextual factors. In the full sample, a 1 SD increase in the structural racism state legal index was associated with a 0.06-unit decrease in the LS7 (b = -0.06; 95% CI, -0.09 to 0.02; P = .001), controlling for individual- and state-level covariates. Contrary to expectations, stratified models revealed no statistically significant differences by race and ethnicity in the association between the structural racism state legal index and the LS7.
Keywords: cardiovascular health; legal epidemiology; structural racism.
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