More than half of Black women in America aged 20 and older have cardiovascular diseases, according to the American Heart Association, and every year, 50,000 will die as a result.

Some researchers have tied Black women‘s increased risk of heart disease to genetics, others to higher rates of obesity and diabetes. The new study points to another key factor.

Researchers followed more than 48,000 Black women over 22 years. The women were participants in Boston University’s Black Women’s Health Study, a more than 25-year effort to track the health of 59,000 women in the United States.

“This is the first longitudinal evidence that perceived racism is associated with increased risk of coronary heart disease,” says Shanshan Sheehy, an assistant professor at the Boston University Chobanian & Avedisian School of Medicine.

The research kicked off in 1997, when participants—then with a mean age of 40.5—answered a series of questions about their experiences of racism. The first set of questions aimed to get at instances of perceived discrimination and unfair treatment while job hunting or at work, when trying to rent or buy a home, or during a law enforcement stop or search. Another set looked at experiences of interpersonal racism in everyday life: whether the women felt they’d received poorer restaurant service, been looked down upon, or treated as unintelligent, dishonest, or as a threat.

Read the full article about racism and Black women's health by Andrew Thurston at Futurity.