Community black business ownership prevalence and self-reported stroke risk factors among black residents.

backgroundNon-Hispanic Black Americans have a greater risk of stroke than other racial and ethnic groups in the United States. However, race is primarily a sociopolitical construct associated with differential access to power related to inequities in social, economic, and political resources. Racial differences in stroke incidence may be explained by this power differential. We sought to examine the relationship between Black business ownership, viewed as an economic resource that facilitates racial power, and stroke risk factors.

methodsThis was a cross-sectional analysis using data from the pooled 2017 and 2019 Selected Metropolitan/Micropolitan Area Risk Trends of the Behavioral Risk Factor Surveillance System; 2017 Annual Business Survey; 2015-2019 American Community Survey; and 2019 Small Business Policy Index. Black business ownership was estimated at the micropolitan or metropolitan statistical area (MMSA) level as a continuous measure defined as: (1) (Black-owned firms/ non-Black-owned firms)/ (Black population/ non-Black population), BBO1; and (2) (Black-owned firms/ White-owned firms)/ (Black population/ White population), BBO2. MMSAs with scores greater than 1 represented places where Black residents were overrepresented as business owners relative to their share of the local population. We examined the relationship between the Black business ownership ratios (BBO1 and BBO2) and self-reported stroke risk factors (hypertension, diabetes, smoking, cholesterol) among non-Hispanic Black residents (N = 31,149). Multivariate logistic regression models controlled for participant age, gender, income, education, region, and state-level business friendliness.

resultsIn multivariate logistic regressions, a one-point increase in BBO1 was associated with lower odds (95% CIs) of self-reported hypertension (0.48 [0.29-0.81]), diabetes (0.51 [0.35-0.75]), and hypercholesterolemia (0.70 [0.51-0.96]), but not associated with smoking (1.14 [0.60, 2.19]). A one-point increase in BBO2 was associated with greater odds of smoking (1.90 [1.26-2.87]), but was not associated with hypertension, diabetes, and hypercholesterolemia.

conclusionsAmong Black individuals, living in a community with a higher prevalence of Black business ownership was linked to lower levels of stroke biological risk factors. However, it may also be associated with higher levels of stress-related behaviors, such as smoking. Policies that create an environment conducive to Black businesses may also create environments that reduce racial disparities in vascular risk factors and consequent disease burden.