Racial Disparities in Avoidant Coping and Hypertension Among Midlife Adults

In the United States (U.S.), roughly one in three adults has hypertension, and the burden of hypertension is particularly high among African American populations (African American: 40.3%; White: 27.8%). Existing literature has demonstrated that experiencing stress is positively associated with hypertension. Coping strategies, or how individuals respond to stress, have been hypothesized to explain disparate associations between stress and hypertension.

Whether directly stated or implied, public health has historically tended to focus on behavioral and individual- level explanations for understanding patterns in racial/ethnic or class health inequities. Past research has demonstrated that attributing health disparities to poorer health behaviors (e.g., not following recommended guidelines) and individual-level factors without accounting for the broader social context in which they arise is insufficient and inaccurate in seeking to understand and address disparities.

This research examined the association between avoidant coping (often perceived to be maladaptive, individual-level behavior) and hypertension while assessing potential differences by race. Additionally, we assessed this relationship both with regard to coping responses to discrimination and stress more generally.

We found that avoidant coping in response to the general stress and discrimination was associated with increased hypertension among White respondents and no associations among African American respondents. This research suggests that racial disparities in hypertension may not be attributable to individual-level coping behaviors.

As this paper examined coping in relation to hypertension, we are not suggesting that general stress and discrimination do not impact the cardiovascular health of African Americans. The impacts of stress and discrimination on cardiovascular health are well supported by the literature, which we suggest be a continued area of research.

We recommend further research build on examinations of stress and social context as determinants of hypertension. Our findings call for a nuanced analytic approach that situates findings within broader social contexts that shape both stressors and coping responses when studying relationships between coping and health. To mitigate the impacts of stress on hypertension, we recommend health interventions not only address individual-level behavior change but also address policies that reinforce health disparities at the structural level.

Read the full paper: Batayeh, B., Shelton, R., Factor-Litvak, P. et al. Racial Disparities in Avoidant Coping and Hypertension Among Midlife Adults. J. Racial and Ethnic Health Disparities (2022). https://doi.org/10.1007/s40615-022-01232-7