Intersectional Discrimination and Change in Blood Pressure Control among Older Adults: The Health and Retirement Study

Background: The association of intersectional discrimination (e.g., ageism in conjunction with classism) and blood pressure control in diverse older populations remains unestablished.

Methods: Participants were 14582 non-institutionalized individuals (59% women) in the Health and Retirement Study aged at least 51 years at baseline (76% Non-Hispanic White, 15% Non-Hispanic Black, 9% Hispanic/Latinx). Discrimination measures included the mean frequency of discrimination in everyday life, intersectional discrimination (defined as ascribing everyday discrimination to more than one reason), and the sum of discrimination over the lifespan. We assessed whether discrimination was independently associated with change in measured hypertension status (N=14582) and concurrent medication use among reported hypertensives (N=9086) over a four-year period (2008-2014).

Results: There was no association between the frequency of everyday discrimination and change in measured hypertension in men or women. Lifetime discrimination was associated with a higher odds of hypertension four years later among men (OR: 1.21, 95% CI: 1.08, 1.36) but not women (OR: 1.00, 95% CI: 0.87, 1.15). Also among men, ascribing everyday discrimination to at least two reasons was associated with a 1.50 (95% CI: 1.07, 2.19)-fold odds of hypertension than reporting no everyday discrimination; intersectional discrimination was not associated with developing hypertension among women (OR: 0.96, 95% CI: 0.73, 1.26). All three discriminatory measures were associated with lower likelihood of reported antihypertensive medication use, without apparent gender differences.

Conclusions: Experiences of lifetime as well as intersectional everyday discrimination may elevate hypertensive risk among older men, and decrease the likelihood of antihypertensive medication use among older adults overall.