Journal of Racial and Ethnic Health Disparities

, Volume 6, Issue 5, pp 1044–1051 | Cite as

Vicarious Racism Stress and Disease Activity: the Black Women’s Experiences Living with Lupus (BeWELL) Study

  • Connor D. MartzEmail author
  • Amani M. Allen
  • Thomas E. Fuller-Rowell
  • Erica C. Spears
  • S. Sam Lim
  • Cristina Drenkard
  • Kara Chung
  • Evelyn A. Hunter
  • David H. Chae



Indirect or vicarious exposure to racism (e.g., hearing about or observing acts of racism or discrimination) is a salient source of stress for African Americans. Emerging research suggests that these “secondhand” experiences of racism may contribute to racial health inequities through stress-mediated pathways. Systemic lupus erythematosus (SLE) is an inflammatory autoimmune disease that disproportionately impacts African American women and is characterized by racial disparities in severity. Health outcomes in this population may be susceptible to vicarious racism given that SLE is shown to be sensitive to psychosocial stress.


Data are from 431 African American women with SLE living in Atlanta, Georgia in the Black Women’s Experiences Living with Lupus (BeWELL) Study (2015–2017). Vicarious racism stress was measured with four items assessing distress from (1) hearing about racism in the news; (2) experiences of racism among friends or family; (3) witnessing racism in public; and (4) racism depicted in movies and television shows. Multivariable linear regression was used to examine associations with disease activity measured using the Systemic Lupus Activity Questionnaire.


Adjusting for sociodemographic and health-related covariates, vicarious racism stress was associated with greater disease activity (b = 2.15; 95% CI = 1.04–3.27). This association persisted even after adjustment for personal experiences of racial discrimination (b = 1.80; 95% CI = 0.67–2.92).


Vicarious racism may result in heightened disease activity and contribute to racial disparities in SLE. Our findings suggest that acts of racism committed against members of one’s racial group may have distinct health consequences beyond the immediate victim or target.


Vicarious racism Systemic lupus erythematosus African American women Racial discrimination 



This study was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under award number R01AR065493. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Institutional Review Board approval was obtained for the study.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Lim SS, Drenkard C. Epidemiology of systemic lupus erythematosus: capturing the butterfly. Curr Rheumatol Rep. 2008;10:265–72.CrossRefPubMedGoogle Scholar
  2. 2.
    La Paglia GMC, Leone MC, Lepri G, Vagelli R, Valentini E, Alunno A, et al. One year in review 2017: systemic lupus erythematosus. Clin Exp Rheumatol. 2017;35:551–61.PubMedGoogle Scholar
  3. 3.
    Helmick CG, Felson DT, Lawrence RC, Gabriel S, Hirsch R, Kwoh CK, et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States: part I. Arthritis Rheum. 2008;58:15–25.CrossRefPubMedGoogle Scholar
  4. 4.
    Williams EM, Bruner L, Adkins A, Vrana C, Logan A, Kamen D, et al. I too, am America: a review of research on systemic lupus erythematosus in African-Americans. Lupus Sci Med. 2016;3:e000144.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Pons-Estel GJ, Ugarte-Gil MF, Alarcón GS. Epidemiology of systemic lupus erythematosus. Expert Rev Clin Immunol. 2017;13:799–814.CrossRefPubMedGoogle Scholar
  6. 6.
    Lim SS, Drenkard C. Epidemiology of lupus: an update. Curr Opin Rheumatol. 2015;27:427–32.CrossRefPubMedGoogle Scholar
  7. 7.
    Lim SS, Bayakly AR, Helmick CG, Gordon C, Easley KA, Drenkard C. The incidence and prevalence of systemic lupus erythematosus, 2002-2004: the Georgia lupus registry. Arthritis Rheumatol. 2014;66:357–68.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Demas KL, Costenbader KH. Disparities in lupus care and outcomes. Curr Opin Rheumatol. 2009;21:102–9.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Williams DR, Lawrence JA, Davis BA. Racism and health: evidence and needed research. Annu Rev Public Health. 2019;40:105–25.CrossRefPubMedGoogle Scholar
  10. 10.
    Williams DR, Mohammed SA. Racism and health I: pathways and scientific evidence. Am Behav Sci. 2013;57:1152–73.CrossRefGoogle Scholar
  11. 11.
    Jones CP. Levels of racism: a theoretic framework and a gardener’s tale. Am J Public Health. 2000;90:1212–5.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Geronimus AT, Hicken M, Keene D, Bound J. “Weathering” and age patterns of allostatic load scores among blacks and whites in the United States. Am J Public Health. 2006;96:826–33.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Williams DR, Mohammed SA. Discrimination and racial disparities in health: evidence and needed research. J Behav Med. 2009;32:20–47.CrossRefPubMedGoogle Scholar
  14. 14.
    Lewis T, Cogburn C, Williams D. Self-reported experiences of discrimination and health: scientific advances, ongoing controversies, and emerging issues. Annu Rev Clin Psychol. 2015;11:407–40.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Brody GH, Miller GE, Yu T, Beach SRH, Chen E. Supportive family environments ameliorate the link between racial discrimination and epigenetic aging: a replication across two longitudinal cohorts. Psychol Sci. 2016;27:530–41.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Beatty DL, Matthews KA, Bromberger JT, Brown C. Everyday discrimination prospectively predicts inflammation across 7-years in racially diverse midlife women: study of women’s health across the nation. J Soc Issues. 2014;70:298–314.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Williams DR. Stress and the mental health of populations of color: advancing our understanding of race-related stressors. J Health Soc Behav. 2018;59:466–85.CrossRefPubMedGoogle Scholar
  18. 18.
    Berger M, Sarnyai Z. “More than skin deep”: stress neurobiology and mental health consequences of racial discrimination. Stress. 2015;18:1–10.CrossRefPubMedGoogle Scholar
  19. 19.
    Chae DH, Drenkard CM, Lewis TT, Lim SS. Discrimination and cumulative disease damage among African American women with systemic lupus erythematosus. Am J Public Health. 2015;105:2099–107.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Chae DH, Martz CD, Fuller-Rowell TE, Spears EC, Smith TTG, Hunter EA, et al. Racial discrimination, disease activity, and organ damage: the black women’s experiences living with lupus (BeWELL) study. Am J Epidemiol In press. doi
  21. 21.
    Krieger N. Discrimination and health inequities. Int J Health Serv. 2014;44:643–710.CrossRefPubMedGoogle Scholar
  22. 22.
    Paradies Y, Ben J, Denson N, Elias A, Priest N, Pieterse A, et al. Racism as a determinant of health: a systematic review and meta-analysis. PLoS One. 2015;10:e0138511.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Harrell SP. A multidimensional conceptualization of racism-related stress: implications for the well-being of people of color. Am J Orthop. 2000;70:42–57.CrossRefGoogle Scholar
  24. 24.
    Gee GC, Walsemann KM, Brondolo E. A life course perspective on how racism may be related to health inequities. Am J Public Health. 2012;102:967–74.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Heard-Garris NJ, Cale M, Camaj L, Hamati MC, Dominguez TP. Transmitting trauma: a systematic review of vicarious racism and child health. Soc Sci Med. 2018;199:230–40.CrossRefPubMedGoogle Scholar
  26. 26.
    Elder G, Johnson MK, Crosnoe R. The emergence and development of life course theory. In: Mortimer JT, Shanahan MJ, editors. Handbook of the life course. Boston: Springer; 2003. p. 3–19.CrossRefGoogle Scholar
  27. 27.
    Woods-Giscombé CL, Lobel M, Zimmer C, Cené CW, Corbie-Smith G. Whose stress is making me sick? Network-stress and emotional distress in African-American women. Issues Ment Health Nurs. 2015;36:710–7.CrossRefPubMedGoogle Scholar
  28. 28.
    Bor J, Venkataramani AS, Williams DR, Tsai AC. Police killings and their spillover effects on the mental health of black Americans: a population-based, quasi-experimental study. Lancet. 2018;392:302–10.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Novak NL, Geronimus AT, Martinez-Cardoso AM. Change in birth outcomes among infants born to Latina mothers after a major immigration raid. Int J Epidemiol. 2017;46:839–49.PubMedPubMedCentralGoogle Scholar
  30. 30.
    Krieger N, Huynh M, Li W, Waterman PD, Wye GV. Severe sociopolitical stressors and preterm births in New York City: 1 September 2015 to 31 august 2017. J Epidemiol Community Health. 2018;72:1147–52.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Richman LS, Jonassaint C. The effects of race-related stress on cortisol reactivity in the laboratory: implications of the Duke lacrosse scandal. Ann Behav Med. 2008;35:105–10.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Nuru-Jeter A, Dominguez TP, Hammond WP, Leu J, Skaff M, Egerter S, et al. “It’s the skin you’re in”: African-American women talk about their experiences of racism. An exploratory study to develop measures of racism for birth outcome studies. Matern Child Health J. 2009;13:29–39.CrossRefPubMedGoogle Scholar
  33. 33.
    Woods-Giscombé CL. Superwoman Schema: African American women’s views on stress, strength, and health. Qual Health Res. 2010;20:668–83.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    McEwen BS. Stress, adaptation, and disease: Allostasis and allostatic load. Ann N Y Acad Sci. 1998;840:33–44.CrossRefPubMedGoogle Scholar
  35. 35.
    Brody GH, Yu T, Miller GE, Chen E. Discrimination, racial identity, and cytokine levels among African-American adolescents. J Adolesc Health. 2015;56:496–501.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Su D-L, Lu Z-M, Shen M-N, Li X, Sun L-Y. Roles of pro- and anti-inflammatory cytokines in the pathogenesis of SLE. J Biomed Biotechnol. 2012;2012:347141.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Eudy AM, Vines AI, Dooley MA, Cooper GS, Parks CG. Elevated C-reactive protein and self-reported disease activity in systemic lupus erythematosus. Lupus. 2014;23:1460–7.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Williams DR, Medlock MM. Health effects of dramatic societal events — ramifications of the recent presidential election. N Engl J Med. 2017;376:2295–9.CrossRefPubMedGoogle Scholar
  39. 39.
    Drenkard C, Bao G, Dennis G, Kan HJ, Jhingran PM, Molta CT, et al. Burden of systemic lupus erythematosus on employment and work productivity: data from a large cohort in the southeastern United States. Arthritis Care Res. 2014;66:878–87.CrossRefGoogle Scholar
  40. 40.
    Aberer E. Epidemiologic, socioeconomic and psychosocial aspects in lupus erythematosus. Lupus. 2010;19:1118–24.CrossRefPubMedGoogle Scholar
  41. 41.
    Pawlak CR, Witte T, Heiken H, Hundt M, Schubert J, Wiese B, et al. Flares in patients with systemic lupus erythematosus are associated with daily psychological stress. Psychother Psychosom. 2003;72:159–65.CrossRefPubMedGoogle Scholar
  42. 42.
    Karlson EW, Daltroy LH, Rivest C, Ramsey-Goldman R, Wright EA, Partridge AJ, et al. Validation of a systemic lupus activity questionnaire (SLAQ) for population studies. Lupus. 2003;12:280–6.CrossRefPubMedGoogle Scholar
  43. 43.
    Atkins R. Instruments measuring perceived racism/racial discrimination: review and critique of factor analytic techniques. Int J Health Serv. 2014;44:711–34.CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Williams DR, Gonzalez HM, Williams S, Mohammed SA, Moomal H, Stein DJ. Perceived discrimination, race and health in South Africa. Soc Sci Med. 2008;67:441–52.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Yazdany J, Trupin L, Gansky SA, Dall’era M, Yelin EH, Criswell LA, et al. The brief index of lupus damage (BILD): a patient-reported measure of damage in SLE. Arthritis Care Res. 2011;63:1170–7.CrossRefGoogle Scholar
  46. 46.
    Hicken MT, Kravitz-Wirtz N, Durkee M, Jackson JS. Racial inequalities in health: framing future research. Soc Sci Med. 2018;Feb;199:11–8.CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Hagiwara N, Alderson CJ, Mezuk B. Differential effects of personal-level vs group-level racial discrimination on health among black Americans. Ethn Dis. 2016;26:453–60.CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Slaughter-Acey JC, Talley LM, Stevenson HC, Misra DP. Personal versus group experiences of racism and risk of delivering a small-for-gestational age infant in African American women: a life course perspective. J Urban Health. 2019;96:181–92.CrossRefPubMedGoogle Scholar
  49. 49.
    Huynh VW, Huynh Q-L, Stein M-P. Not just sticks and stones: indirect ethnic discrimination leads to greater physiological reactivity. Cultur Divers Ethnic Minor Psychol. 2017;23:425–34.CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    Robert Wood Johnson Foundation, National Public Radio, Harvard T.H. Chan School of Public Health. Discrimination in America: Experiences and views of African Americans. 2017. Accessed 21 Nov 2017.
  51. 51.
    United States Department of Justice, Federal Bureau of Investigation. Hate Crime Statistics, 2017. 2018. Accessed 14 Jan 2019.
  52. 52.
    Eligon J. Hate crimes increase for the third consecutive year, F.BI Reports N Y Times 2018. Accessed 14 Jan 2019.
  53. 53.
    Mancini AD, Littleton HL, Grills AE. Can people benefit from acute stress? Social support, psychological improvement, and resilience after the Virginia Tech campus shootings. Clin Psychol Sci. 2015;4:401–17.CrossRefGoogle Scholar
  54. 54.
    Reifels L, Pietrantoni L, Prati G, Kim Y, Kilpatrick DG, Dyb G, et al. Lessons learned about psychosocial responses to disaster and mass trauma: an international perspective. Eur J Psychotraumatol. 2013;4:22897.CrossRefGoogle Scholar

Copyright information

© W. Montague Cobb-NMA Health Institute 2019

Authors and Affiliations

  • Connor D. Martz
    • 1
    Email author
  • Amani M. Allen
    • 2
  • Thomas E. Fuller-Rowell
    • 1
  • Erica C. Spears
    • 3
  • S. Sam Lim
    • 4
    • 5
  • Cristina Drenkard
    • 4
    • 5
  • Kara Chung
    • 1
  • Evelyn A. Hunter
    • 6
  • David H. Chae
    • 1
  1. 1.Department of Human Development and Family StudiesAuburn University, College of Human SciencesAuburnUSA
  2. 2.Divisions of Community Health Sciences and EpidemiologyUniversity of California – Berkeley, School of Public HealthBerkeleyUSA
  3. 3.Department of Health Behavior and Health Systems, University of North Texas Health Sciences Center, School of Public HealthFort WorthUSA
  4. 4.Department of Medicine, Division of RheumatologyEmory University, School of MedicineAtlantaUSA
  5. 5.Department of EpidemiologyEmory University, Rollins School of Public HealthAtlantaUSA
  6. 6.Department of Special Education, Rehabilitation and CounselingAuburn University, College of EducationAuburnUSA

Personalised recommendations