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The onset of cardiometabolic conditions, like diabetes, occurs in younger ages for Black and Hispanic women as compared to White women.

A 2022 cohort study published in JAMA Network Open evaluated racial/ethnic disparities in age-of-onset for four cardiometabolic outcomes. The study also accounted for multiple forms of potential selection bias. The cardiometabolic outcomes examined were hypertension (HTN), isolated systolic hypertension (ISH), insulin resistance (IR), and diabetes.

A Multi-Cultural Cohort Study Was Used With Consideration for Selection Bias

The study used data from the 1995–2016 Study of Women’s Health Across the Nation longitudinal cohort and a cross-sectional screening sample (1995–1997). This data was analyzed from 2019 to 2021. The study participants self-reported to identify their racial or ethnic group (Black, Chinese, Hispanic, Japanese, or White). Cohort eligibility was based on the following participant criteria:

  • Aged 42 to 52 years;
  • Had not received hormone therapy in the 3 months prior;
  • Were not pregnant;
  • Had an intact uterus and at least 1 ovary;
  • Were premenopausal or early perimenopausal.

The Onset of Cardiometabolic Conditions Occurred Earlier in Black and Hispanic Women

A total of 3302 women were included in the study. The median age was 46.2 years. At baseline, 23.9% had HTN, 43.7% had ISH, 13.5% had IR, and 4.6% had diabetes. Hypertension had occurred a median of 5.0 years earlier, and metabolic conditions like diabetes and IR had occurred a median of 11.3 years earlier for Black and Hispanic women vs. White women. ISH occurred at a median of 7.7 years earlier for Black women vs. White women.

Overall, the onset of diabetes, insulin dependence, and hypertension occurred earlier in Black and Hispanic women compared with White women. Addressing study selection was associated with decreased estimation of age at onset, with greater differences among Black and Hispanic vs. White women. These findings suggest that fully addressing selection bias in cohort studies is important for correctly estimating the extent of racial and ethnic health disparities.

Medical Interventions for Hypertension and Metabolic Conditions Should Occur Earlier 

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Based on the study results, hypertension, and metabolic interventions, particularly for Black and Hispanic women, should be targeted to women aged as young as 30 years for hypertension and 40 years for metabolic interventions. Consideration of the timing of the disease and fully addressing inherent selection biases in research are critical to understanding aging and disease risk. This is especially the case for racial and ethnic minoritized populations.


Reeves, A., Elliott, M. R., Lewis, T. T., Karvonen-Gutierrez, C. A., Herman, W. H., & Harlow, S. D. (2022). Study Selection Bias and Racial or Ethnic Disparities in Estimated Age at Onset of Cardiometabolic Disease Among Midlife Women in the US. JAMA Netw Open, 5(11), e2240665. https://doi.org/10.1001/jamanetworkopen.2022.40665


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