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Sao Paulo Med J
Sao Paulo Med J
Sao Paulo Med J
São Paulo Medical Journal
1516-3180
1806-9460
Associação Paulista de Medicina - APM

10.1590/S1516-31802006000500015
Letter to the Editor
Hypothesis: racism is a risk factor for cerebrovascular diseases
Faerstein Eduardo *
Address for correspondence: Rua Sacopã, 191 — Apto. 201 Rio de Janeiro (RJ) — Brasil — CEP 22471-180 Tel. (+55 21) 2587-7959 E-mail: eduardof@uerj.br
Conflict of interest: None

07 9 2006
2006
124 5 306306
06 11 2005
05 6 2006
15 8 2006
https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons license.
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pmcI very much appreciated the editorial "Stroke in Brazil: a neglected disease",1 because it emphasized not only the high mortality rates due to cerebrovascular diseases in Brazil but also the surprising paucity of epidemiological studies that have so far investigated their determinants in our population. The editorial appropriately draws attention to the relevance of the social determinants of these conditions. I would like to suggest that the possible direct and indirect effects of racial discrimination in Brazil should be an issue for empirical investigation as potential determinants of cerebrovascular diseases. In fact, racism constitutes an additional axis of social inequalities that generate disease and deaths in our country, and has been the subject of growing academic interest.2

Recently, Chor and Lima3 reported that, differently from whites, black men and women aged 40-69 years have mortality rates from cerebrovascular diseases that are higher than from ischemic heart disease. In addition, our exploratory analyses among participants in the Pro-Saúde study in Rio de Janeiro suggested that perceived lifetime racial discrimination can increase the risk of hypertension (one major risk factor for cerebrovascular diseases), through the intervention of and/or interaction with socioeconomic adversity. These circumstances may act directly through chronic psychosocial stress and/or through more proximal etiological mechanisms in the causal chain (e.g. related to obesity).4

Research on cerebrovascular diseases in Brazil should take the possible effects of racism into account at the various stages of their natural history. In multiethnic societies such as ours this may shed light both on specific societal features of ethnicity-based discrimination – a historical, ever-changing phenomenon5 – and on its potentially wide-ranging health consequences.

Eduardo Faerstein, MD, PhD. Associate professor, Department of Epidemiology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.

Place where the manuscript was produced: Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil

Sources of funding: None
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REFERENCES

1 Lotufo PA Stroke in Brazil: a neglected disease Sao Paulo Med J 2005 123 1 3 4 15821807
2 Faerstein E Fórum: raça, racismo e saúde no Brasil. [Forum on race, racism, and health in Brazil] Cad Saúde Pública 2005 21 5 1584 1585 16158165
3 Chor D Lima CRA Aspectos epidemiológicos das desigualdades raciais em saúde no Brasil. [Epidemiologic aspects of racial inequalities in health in Brazil] Cad Saúde Pública 2005 21 5 1586 1594 16158166
4 Faerstein E Chor D Werneck G Lopes CS Lynch J Kaplan G Race and perceived racism, education, and hypertension among Brazilian civil servants (abstract) Am J Epidemiol 2004 159 11 S35 S35
5 Fredrichson GM Racism: a short history New Jersey Princeton University Press 2003
