A new Boston University led study is putting fresh data behind a hard conversation about how racism and early life trauma may shape Black women’s heart health decades later.
According to JAMA Network Open, researchers followed 48,320 Black women and found that certain forms of psychosocial stress, including reported discrimination in employment, housing, and interactions with police, were associated with an increased risk of heart failure. The peer-reviewed study was published August 18, 2026, and used information from the long-running Black Women’s Health Study.
The research followed women who were free of heart failure when the relevant assessments began. Participants provided information about experiences of racism beginning in 1997, while a 2005 questionnaire asked some women about physical and sexual abuse during childhood and adolescence. Researchers followed participants through 2023, with a median follow-up of 24 years. During that period, 1,343 heart failure events were recorded, according to the study.
One of the clearest findings involved discrimination that touched major parts of everyday life. According to the researchers’ findings in JAMA Network Open, women who reported discrimination involving employment, housing, or police interactions had an elevated heart failure risk. The highest risk appeared among the 11 percent of participants who reported discrimination across all three areas. After researchers accounted for multiple demographic and clinical factors, that group had a 27 percent higher relative risk of heart failure compared with the reference group.
The study also found an association between repeated sexual abuse early in life and heart failure later on. Women who reported sexual assault four or more times during childhood or adolescence showed elevated risk in the researchers’ analyses. Frequent adolescent sexual assault remained significantly associated with heart failure after multivariable adjustment, according to the study.
Body mass index, or BMI, appeared to explain part of that relationship. Researchers estimated that BMI accounted for between 19.6 percent and 35.9 percent of the association between frequent childhood or adolescent sexual assault and later heart failure. The authors said the finding points to one possible pathway connecting long-term psychosocial stress with established cardiovascular risk factors, though more research is needed to understand exactly what is happening biologically.
There was also an important distinction in how racism showed up in the data. Participants with the highest scores for everyday racism initially showed greater heart failure risk in an analysis adjusted for age. However, that association weakened after researchers adjusted for clinical risk factors. By comparison, discrimination involving employment, housing, and police interactions remained a notable part of the study’s findings.
“In this cohort study of psychosocial stress and heart failure among Black women in the US, we found that several domains of psychosocial stress were associated with incident heart failure,” the authors conclude. “Our findings underscore that different aspects of psychosocial stress disproportionately experienced by Black women may portend elevated heart failure risk independent of socio-demographic risk factors, identifying additional risk factors that may underlie the disparity in heart failure risk among Black women. Further studies are needed to understand the biological pathways underlying this risk and how it may vary by heart failure phenotype.”
That larger health disparity is already well documented. According to the American Heart Association’s 2026 cardiovascular statistics for Black Americans, 59.5 percent of non-Hispanic Black women age 20 and older had some form of cardiovascular disease when high blood pressure, coronary heart disease, heart failure, and stroke were included in the definition. The CDC’s guidance on women and heart disease also reports that Black women are nearly 60 percent more likely to have high blood pressure than White women. High blood pressure is a major risk factor for heart disease and stroke.
Researchers and cardiovascular organizations have increasingly examined how social conditions fit into that picture. The American Heart Association has said that traditional medical risk factors explain only part of racial and ethnic disparities in women’s cardiovascular health, while social, environmental, and behavioral factors can also affect risk. The CDC similarly notes that research has connected stress tied to racism, discrimination, adverse childhood experiences, and social inequities with hypertension, heart disease, and poorer cardiovascular outcomes in some populations.
The new study does not mean researchers proved that discrimination or sexual trauma directly causes heart failure. It was an observational cohort study, and the authors acknowledged several limitations, including the possibility of unmeasured factors influencing the results. They also lacked detailed information about heart failure subtypes, cardiac imaging, and certain additional risk factors such as sleep, diet, and chronic kidney disease.
Still, the size and length of the research give scientists another window into health factors that may be especially relevant for Black women. According to the study, the broader Black Women’s Health Study enrolled about 59,000 Black women from across the United States, creating a large data set researchers have been able to follow for decades. The heart failure analysis included women across geographic regions, socioeconomic backgrounds, education levels, and cardiovascular risk profiles.
The study was led by Danielle Davis, MD. According to her Boston University faculty profile, Davis is a clinical instructor in general internal medicine at Boston University’s Chobanian & Avedisian School of Medicine and an internal medicine resident at Boston Medical Center. She is also an NIH R38 grant recipient whose research uses large databases to study the pathophysiology and clinical outcomes of heart failure. Boston University says Davis earned her medical degree from the University of Colorado School of Medicine.
For Black women, the findings add another layer to a health conversation that cannot be reduced to diet, exercise, weight, or family history alone. This research suggests the environments people move through, the discrimination they encounter, and trauma experienced years earlier may also deserve attention as scientists work to understand why heart failure continues to hit Black women differently.