Discrimination and Chronic Disease: The BeWELL Study
Overview
Racial disparities in chronic disease are not due to biological or behavioral differences between groups; rather, they reflect the measurable consequences of differential exposure to structural inequities and chronic psychosocial stress across the life course. This project, supported through my NIH-funded (F31) dissertation research, uses longitudinal data from the Black Women’s Experiences Living with Lupus (BeWELL) Study to investigate the multilevel social and structural determinants of racial disparities in chronic disease progression and outcomes. While the work centers on systemic lupus erythematosus (SLE) — a chronic autoimmune disease that disproportionately burdens Black women with more severe and rapidly progressing disease — the findings carry implications for a broad range of chronic conditions that operate via inflammatory mechanisms and exhibit stark racial disparities in prevalence, progression, and outcomes.
Current Work
A defining feature of this project is its multilevel approach to measuring discrimination and structural racism. At the interpersonal level, the BeWELL Study’s longitudinal design — with repeated survey assessments over multiple clinic visits — enables examination of within-person change in discrimination experiences and their prospective associations with biological and clinical outcomes. At the structural level, the project integrates area-level administrative data, including U.S. Census-derived measures of residential segregation, neighborhood poverty, and community composition, to capture how macro-level structural inequities shape the social environments in which participants live.
Across multiple first-authored papers, this project has generated novel evidence on the social drivers of lupus progression and comorbid conditions. Key findings include one of the first longitudinal studies documenting that incident racial discrimination predicts subsequent increases in C-reactive protein; evidence that vicarious racism stress is independently associated with greater lupus disease activity; and studies linking residential segregation to neighborhood stressors and mental health comorbidities, as well as distinct sociodemographic profiles of organ damage accrual.
Future Directions
This body of work challenged the field’s predominantly biomedical framing of lupus disparities by demonstrating that social and structural inequities are primary drivers of accelerated disease progression among Black women. Because SLE shares inflammatory pathways and demographic burden patterns with many other chronic conditions, these findings have broad relevance for understanding racial disparities in cardiovascular disease, metabolic disease, and other conditions characterized by chronic immune dysregulation.
Future work will extend this framework toward understanding how cumulative life course exposure to discrimination and structural inequality shapes risk for cognitive aging and neurodegeneration, integrating this project’s foundational insights on chronic stress, inflammation, and biological aging with an emerging focus on AD/ADRD disparities in later life.
Selected Publications
Martz CD, Wang Y, Chung KW, Jiakponnah NN, Danila MI, Webb-Detiege T, Allen AM, Chae DH. (2023). Incident racial discrimination predicts elevated C-reactive protein in the BeWELL Study. Brain, Behavior, & Immunity, 112:77–84.
Martz CD, Allen AM, Fuller-Rowell TE, Spears EC, Chung K, Hunter EA, Lim SS, Drenkard C, Chae DH. (2019). Vicarious racism stress, racial discrimination, and disease activity: The BeWELL Study. Journal of Racial and Ethnic Health Disparities, 6(5):1044–1051.
Martz CD, Hunter EA, Kramer M, Wang Y, Chung K, Brown M, Drenkard C, Lim SS, Chae DH. (2021). Pathways linking census tract typologies with subjective neighborhood disorder and depressive symptoms in the BeWELL Study. Health & Place, 70:102587.
Martz CD, Webb-Detiege T, Danila MI, Chae DC. (2024). Sociodemographic profiles and organ damage accrual in the BeWELL Study. Lupus, 33(1):17–25.
Additional manuscripts under review.
Connor D. Martz, PhD 