# Examining the Impact, Pathways, and Cost of County-Level Structural Racism on Hypertension Disparities in Black and White US Adults

> **NIH NIH R01** · JOHNS HOPKINS UNIVERSITY · 2024 · $576,188

## Abstract

PROJECT SUMMARY
Black Americans have the highest hypertension (or high blood pressure, HBP) rates in the world, with stark
racial disparities between Black and White adults that have persisted for decades and at the highest cost to
society of all cardiovascular conditions. The underlying cause of HBP disparities is unknown, and previous
studies have mostly focused on individual-level behaviors, stressors, and physiologic risk factors leaving a
missed opportunity to uncover and address the root causes of these disparities. Structural racism may be a
root cause of HBP disparities and, as such, HBP disparities will persist if structural racism is not addressed.
Thus, to eliminate HBP disparities, we must first investigate if structural racism is a fundamental cause and use
longitudinal studies to explore the pathways through which structural racism influences HBP risk factors and
disparities. Using a novel 5-domain measure of structural racism, our previous cross-sectional studies have
demonstrated that greater structural racism is associated with higher BMI, one behavioral risk factor for HBP;
however, this work has left gaps in understanding how structural racism is related to other risk factors for HBP,
as well as questions about the timing and geographic scales at which structural racism operates. We seek to
fill these gaps in responding to RFA-MD-21-004’s request for “observational research to understand the role of
structural racism…in causing and sustaining health disparities” for HBP. Our goal is to conduct a multi-level
national study to investigate associations between our novel multi-dimensional measure of county-level
structural racism (CSR) and: physiologic, behavioral, and structural risk factors for HBP (Aim 1), HBP
incidence, prevalence, and severity (Aim 2), and how much counties could save in HBP healthcare costs if
CSR was eliminated (Aim 3). We leverage pre-existing resources that are uniquely available to us: (a) our
published County Structural Racism Scale, (b) US News & World Report hospital rankings of healthcare
quality, and (c) longitudinal behavioral and biomarker HBP data from 30,239 Black and White adults across the
US in the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. We expand beyond
previous studies by using a multi-domain measure of structural racism, applying it to longitudinal health data
that allows us to assess exposure to structural racism at multiple times in the lifecourse, and quantifying how
much structural racism costs counties in HBP healthcare spending when it goes unaddressed. We will
translate our findings into policy briefs targeted toward county-level executives in the US. Our team of experts
in CVD disparities, social and clinical epidemiology, and health economics, with representation from
REGARDS, two Hopkins disparities centers, Hopkins’ CVD Epidemiology, and former county leaders, are well-
equipped to execute this New Investigator application. Our results will offer...

## Key facts

- **NIH application ID:** 10870153
- **Project number:** 5R01HL164116-03
- **Recipient organization:** JOHNS HOPKINS UNIVERSITY
- **Principal Investigator:** Lorraine Tiera Dean
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $576,188
- **Award type:** 5
- **Project period:** 2022-07-20 → 2026-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10870153

## Citation

> US National Institutes of Health, RePORTER application 10870153, Examining the Impact, Pathways, and Cost of County-Level Structural Racism on Hypertension Disparities in Black and White US Adults (5R01HL164116-03). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10870153. Licensed CC0.

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