Sentiments towards racial/ethnic minorities may impact cardiovascular disease (CVD) through direct and indirect pathways. In this study, we assessed the association between Twitter-derived sentiments towards racial/ethnic minorities at state-level and individual-level CVD-related outcomes from the 2017 Behavioral Risk Factor Surveillance System (BRFSS). Outcomes included hypertension, diabetes, obesity, stroke, myocardial infarction (MI), coronary heart disease (CHD), and any CVD from BRFSS 2017 (N = 433,434 to 433,680 across outcomes). A total of 30 million race-related tweets were collected using Twitter Streaming Application Programming Interface (API) from 2015 to 2018. Prevalence of negative and positive sentiment towards racial/ethnic minorities were constructed at the state level and merged with CVD outcomes. Poisson regression was used, and all the models adjusted for individual-level demographics as well as state-level demographics. Individuals living in states with the highest level of negative sentiment towards racial/ethnic minorities had 11% higher prevalence of hypertension (PR 1.11, 95% CI 1.08, 1.14), 15% higher prevalence of diabetes (PR 1.15, 95% CI 1.08, 1.22), 14% higher prevalence of obesity (PR 1.14, 95% CI 1.10, 1.18), 30% higher prevalence of stroke (PR 1.30, 95% CI 1.16, 1.46), 14% higher prevalence of MI (PR 1.14, 95% CI 1.03, 1.25), 9% higher prevalence of CHD (PR 1.09, 95% CI 1.00, 1.19), and 16% higher prevalence of any CVD outcomes (PR 1.16, 95% CI 1.09, 1.24). Conversely, Twitter-derived positive sentiment towards racial/ethnic minorities was associated with a lower prevalence of CVD outcomes. Programs and policies that promote racially inclusive environments may improve population health.
Keywords: CVD outcomes; Racial sentiment; Racial/ethnic minorities; Twitter.