A negative net worth more than doubles the risk of hypertension in black women


February 24, 2022

3 minute read

Disclosures: The authors report no relevant financial information.

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Black women who reported having a negative net worth were 2.5 times more likely to have sustained hypertension than black women reporting a positive net worth, regardless of education level and income, the researchers reported.

This finding suggests that limited assets or a lack of economic reserve may be associated with poor cardiovascular outcomes in this at-risk group.


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“We focused on African-American women because studies report that compared to white men, white women, and African-American men, African-American women are most affected by the pay gap, more likely to be single parents/heads of households, and among college-educated adults most burdened with student loan debt,” Tene T. Lewis, PhD, from the Department of Epidemiology at Emory University’s Rollins School of Public Health, and colleagues wrote in the context of the study. “Therefore, African American women may be particularly vulnerable to the association between limited assets and CVD risk.”

In a cross-sectional study, Lewis and colleagues analyzed data from 384 black women aged 30 to 46 without clinical cardiovascular disease, recruited from December 2016 to March 2019 for the Mechanisms Underlying the Impact of Stress and Disorders cohort. African American women’s health emotions (middle age, 38). The researchers used ambulatory blood pressure monitors to obtain ambulatory blood pressure readings for 2 consecutive days.

Along with education level and income level, net worth was assessed with a single component: “Suppose you and other members of your household had to sell all your major assets (including your house), transform all your investments and other assets in cash, and pay off all your debts. Would you have something extra, break even, or would you have debt?” Participants were stratified by positive net worth (asset exceeds debt), neutral net worth (an equal debt-to-asset ratio), and negative net worth (debt exceeds assets).Researchers assessed average daytime and nighttime BP levels and sustained hypertension.

The findings were reported in JAMA network open.

Debt and high BP

Within the cohort, 47.7% of women reported having a positive net worth, 23.2% reported having a neutral net worth, and 29.2% of women reported having a negative net worth. Women reporting positive or negative net worth had higher incomes, were more likely to be college graduates, were more likely to be married or living with a partner, and were less likely to report job stress. indebtedness.

After excluding 66 women who were not receiving antihypertensive medication, women reporting negative net worth (debt) had higher daytime levels (beta = 6.7; standard error = 1.5; P 0.001) and nocturnal (beta = 6.4; standard error = 1.4; P 0.001) systolic BP compared to women reporting positive net worth.

“We observed an association between net worth and 48-hour ambulatory BP, with African American women who said they would be in debt having daytime systolic BP levels approximately 6.7 mm Hg higher than women who would have something more, even after adjusting for sociodemographic and behavioral covariates, remaining significant after further adjustments for BMI and smoking,” the researchers wrote.

Similar associations were observed with sustained hypertension. Women reporting a negative net worth had a 150% higher risk (OR = 2.5; 95% CI, 1.3-4.7) of sustained hypertension than those reporting a positive net worth. The associations remained significant after additional adjustments for smoking, BMI, psychosocial stress due to debt, and depressive symptoms. Results were similar but attenuated when women receiving antihypertensive drugs were included and treatment was controlled in all analyses.

Impact of COVID-19

“While further studies are needed to identify potential mechanisms that could explain the observed results, these results have particular significance in the context of the COVID-19 pandemic, as job loss in 2020 significantly affected women, especially those from racial and ethnic minorities,” the researchers wrote. “Furthermore, compared to all other racial and sexual groups, African American women experienced the most slower through November 2021. However, more research is needed to document the longitudinal results of the COVID-19 pandemic and resulting economic recession on net worth and CVD risk and outcomes among African American women. , as well as other race and gender groups.

The researchers noted that policies that reduce the enduring racial wealth gap could be potential structural-level interventions that could ultimately reduce CVD risk among black women.


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