Racial and Gender Discrimination, Early Life Factors, and Chronic Physical Health Conditions in Midlife

Abstract

Purpose Most studies of perceived discrimination have been cross-sectional and focused primarily on mental rather than physical health conditions. We examined the associations of perceived racial and gender discrimination reported in adulthood with early life factors and self-reported physician-diagnosis of chronic physical health conditions. Methods We used data from a racially diverse birth cohort of U.S. women (N=168, average age=41 years) with prospectively collected early life data (e.g., parental socioeconomic factors) and adult reported data on perceived discrimination, physical health conditions, and relevant risk factors. We performed modified robust Poisson regression due to the high prevalence of the outcomes. Results Fifty-percent of participants reported racial and 39% reported gender discrimination. Early life factors did not have strong associations with perceived discrimination. In adjusted regression models, participants reporting at least three experiences of gender or racial discrimination had a 38% increased risk of having at least one physical health conditions (RR=1.38, 95% CI: 1.01-1.87). Using standardized regression coefficients, the magnitude of the association of having physical health conditions was larger for perceived discrimination than for being overweight or obese. Conclusion Our results suggest a substantial chronic disease burden associated with perceived discrimination, which may exceed the impact of established risk factors for poor physical health.

Cardiovascular disease and perceived weight, racial, and gender discrimination in U.S. adults

“…Even after adjusting for socio-demographic variables, reporting multiple forms of perceived discrimination was associated with significantly increased risk for hypertension and minor heart conditions, relative to reporting one form of discrimination. These findings are consistent with those from a previous study which found increased risk for reporting at least one physical condition among women in midlife who reported three or more discrimination experiences [20]. When further statistical adjustments were made for additional co-variates (BMI, smoking, alcohol use, depression, and stressful life events in the past 12 months), however, dose-response associations were no longer significant in our study, although the odds ratios were greater for those reporting multiple forms of discrimination, relative to those reporting one form of discrimination.…”

“…The relationship between perceived discrimination and health may be heterogeneous making research on potential moderators essential [7]. For example, the strengths of associations between perceived discrimination and physical or mental health may differ by gender or race [7, 20, 26, 44]. With regard to subthreshold CVD, cumulative unfair treatment was significantly associated among Caucasian women, but not observed for African-American, Hispanic-American, or Chinese-American women [26].…”

“…However, the potential effects of perceived gender discrimination on physical health, including CVD, have received relatively little attention. Women of midlife age who experienced three or more gender discrimination incidences had significantly increased risk for reporting at least one physical health condition; this association, however, became non-significant after adjusting for BMI, income, race/ethnicity, and perceived racial discrimination [20]. One study reported that gender discrimination may be associated with increased risk for hypertension, particularly among racial minority groups [21].…”

“…Thus, less is known about the relationship between perceived discrimination and other forms of CVD. In addition, while some studies have adjusted for other forms of discrimination when exploring associations between perceived discrimination and health (e.g., adjusting for report of gender discrimination when testing the relationship between racial discrimination and physical conditions [20]), no study has compared the strength of association between CVD and different forms of perceived discrimination. A meta-analysis by Schmitt and colleagues [5] concluded that the association between perceived discrimination and psychological well-being was weaker for racial and gender discrimination relative to stigma based on mental health, weight, medical condition, or disability.…”

The Relation Between Discrimination, Sense of Coherence and Health Varies According to Ethnicity: A Study Among Three Distinct Populations in Israel

“…Studies have found variations in the association between health and discrimination in different population groups [1,2,[18][19][20][21][22][23][24]. These inconsistencies in the association between discrimination and health may be due to the different populations and health measures used in the studies [25].…”