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Original research
Impact of increasing workforce racial diversity on black-white disparities in cardiovascular disease mortality
  1. Hilary L Colbeth1,
  2. Corinne A Riddell1,2,
  3. Marilyn Thomas3,
  4. Mahasin Mujahid1,
  5. Ellen A Eisen4
  1. 1School of Public Health, Division of Epidemiology, University of California Berkeley, Berkeley, California, USA
  2. 2School of Public Health, Division of Biostatistics, University of California Berkeley, Berkeley, California, USA
  3. 3Departments of General Internal Medicine and Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California, USA
  4. 4School of Public Health, Division of Environmental Health Sciences, University of California Berkeley, Berkeley, California, USA
  1. Correspondence to Dr Hilary L Colbeth; hcolbeth{at}berkeley.edu

Abstract

Background Structural racism’s influence on workforce policies and practices presents possible upstream targets for assessing and reducing racial health disparities. This study is the first to examine workforce racial diversity in association with racial disparities in cardiovascular disease (CVD) outcomes.

Methods This retrospective cohort study of 39 693 hourly autoworkers from three Michigan automobile plants, includes 75 years of follow-up (1941–2015). Workforce racial diversity (per cent black autoworkers) was a plant and year level variable. Annual exposure was cumulated over each individual’s working life and divided by time since hire. This time-varying measure was categorised into low, moderate and high. We estimated age-standardised rates of CVD and Cox proportional HRs by race.

Results CVD mortality per 100 000 person-years decreased among autoworkers over the study period; however, black workers’ rates remained higher than white workers. Among black workers, we observed a strong protective association between greater workforce racial diversity and CVD mortality. For example, at the Detroit plant, the HR for moderate exposure to racial diversity was 0.94 (0.83, 1.08) and dropped to 0.78 (0.67, 0.90) at the highest level. Among white workers, results were mixed by plant, with protective effects in plants where less than 20% of workers were black and null results where black workers became the majority.

Conclusion Our findings provide evidence that workplace racial diversity may reduce CVD mortality risk among black workers. Workplace practices encouraging diverse hiring and retention have potential to improve all workers’ health; particularly the socially racialised groups in that workforce.

  • EPIDEMIOLOGY
  • OCCUPATIONAL HEALTH
  • CARDIOVASCULAR DISEASES
  • COHORT STUDIES
  • Health inequalities

Data availability statement

Data are available upon reasonable request. Data are available upon reasonable request, with limitations to preserve the autonomy and the rights of the individual participants.

https://doi.org/10.1136/jech-2024-222094

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    Data availability statement

    Data are available upon reasonable request. Data are available upon reasonable request, with limitations to preserve the autonomy and the rights of the individual participants.

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    Footnotes

    • X @datavisitor

    • Contributors HLC serves as a guarantor for this study. HLC contributed to this manuscript’s conceptualisation, data curation, methodology, formal analysis, visualisation, the writing of the original draft, and draft review and editing. CAR contributed to the conceptualisation, methodology, and draft review and editing. MT contributed to the conceptualisation and draft review and editing. MM contributed to the draft review and editing. EAE contributed to the conceptualisation, data curation, funding acquisition, methodology, supervision, and draft review and editing. All authors had approval of the final version of this manuscript and consider this honest work.

    • Funding This work was supported by the National Institute for Occupational Safety and Health (NIOSH)/Centers for Disease Control and Prevention (CDC) [grant number R01OH011092]. HLC is additionally supported by the Training Grant, T42OH008429, funded by the National Institute for Occupational Safety and Health (NIOSH)/Centers for Disease Control and Prevention (CDC).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.