Association between race/color and incidence of hypertension in the ELSA-Brasil population: investigating the mediation of racial discrimination and socioeconomic position

Ethn Health. 2022 Jul;27(5):1047-1057. doi: 10.1080/13557858.2020.1861586. Epub 2020 Dec 23.


Objective: To investigate the mediation effect of socioeconomic position and racial discrimination in the association between race/color and incidence of hypertension in 4-years follow up.

Methods: We included 8,370 participants of the Longitudinal Study of Adult Health (ELSA-Brasil). A latent variable was constructed to represent socioeconomic position (SEP). The perception of discrimination was measured through an adaptation of the Lifetime Major Events Scale; and hypertension was defined using standard criteria. We investigated Body Mass Index (BMI) due to its role in proximal risk for hypertension. To investigate the mediating role of SEP and racial discrimination, we used structural equation modeling.

Results: SEP had a direct and negative effect on HT incidence (HT incidence increased in worse SEP categories), while the effect of BMI on HT was direct and positive. We did not find significant direct effects of race/color and racial discrimination on HT. As for indirect effects, we observed associations between race/color and HT only through SEP mediation.

Conclusion: According to our results, race/color is indirectly related to HT incidence, mediated by SEP. Racial discrimination was not a mediator in the relationship between race/color and HT in the follow-up period.

Keywords: Hypertension; racial discrimination; structural equation modeling.

MeSH terms

  • Adult
  • Humans
  • Hypertension* / epidemiology
  • Incidence
  • Longitudinal Studies
  • Racism*
  • Risk Factors
  • Socioeconomic Factors