Epigenetic Pathways Linking Structural Racism and Health Disparities Among Black Women: A Scoping Review

Background and Purpose: Black women experience persistent and pronounced health disparities across multiple domains. Increasingly, research suggests these disparities are shaped not only by behavioral and socioeconomic factors but also by structural racism and related stressors. Epigenetics offers a promising framework for understanding how chronic exposure to racism and discrimination contributes to long-term health inequities. Emerging studies suggest these stressors may become biologically embedded through epigenetic mechanisms, such as DNA methylation and epigenetic aging, with potential intergenerational effects. Existing reviews have examined social epigenomics, stress, and health disparities broadly; however, none have specifically focused on epigenetic pathways linking structural racism and health disparities among Black women. This systematic review aims to examine and synthesize the literature on this topic. The guiding research question is: What are the epigenetic pathways linking structural racism and health disparities among Black women?

Methods: This systematic review follows PRISMA guidelines. A systematic search was conducted across five databases: PubMed, PsycINFO, CINAHL, Scopus, and Web of Science. Search terms combined keywords and controlled vocabulary related to epigenetics (“epigenetic*,” “DNA methylation”), population (“Black women,” “African American women,” “women of color”), and social exposures (“racism,” “discrimination,” “stress,” “disparities”). Eligible studies included peer-reviewed empirical articles published within the past ten years examining epigenetic processes in relation to structural racism-related exposures and/or health outcomes among Black or African American women. Study quality and risk of bias were assessed using critical appraisal tools appropriate to study design. Studies with mixed-gender or multi-racial samples were included if findings for Black women were reported. Data extraction focused on study design, sample characteristics, measures of structural racism, epigenetic markers (e.g., DNA methylation, epigenetic clocks), and health outcomes. A narrative synthesis was conducted to identify key patterns and gaps.

Results: The search yielded a modest but growing body of literature. After screening, a limited number of studies met inclusion criteria, with most using cross-sectional designs and epigenome-wide approaches. Few studies focused exclusively on Black women; most included broader African American samples. Findings indicate that structural racism-related stressors, including discrimination and chronic stress, are associated with epigenetic alterations in stress- and immune-related pathways and accelerated epigenetic aging. DNA methylation changes were commonly observed in genes involved in stress regulation and inflammation. However, variability in measurement and limited longitudinal data constrain interpretation.

Conclusions and Implications: Evidence suggests that structural racism may contribute to health disparities among Black women through epigenetic pathways related to stress response, immune function, and biological aging. However, the literature remains limited by small samples, cross-sectional designs, and underrepresentation of Black women-specific analyses. These findings underscore the importance of addressing structural determinants of health and incorporating biological embodiment frameworks into social work research, practice, and policy. Future research should prioritize longitudinal designs and Black women-centered samples to better understand these pathways.