Perceived Racial Discrimination and Health Outcomes in the Behavioral Risk Factor Surveillance System (BRFSS) 2022 US Study

Abstract

Background: Research has highlighted significant health disparities between Black Americans and their White counterparts in the U.S., attributing to racism and racial discrimination a variety of adverse health outcomes. Prior studies have linked perceived discrimination and elevated risks of cardiovascular diseases, psychological distress, and reduced cognitive function, among other conditions, with a particular focus on specific populations such as African Americans and Black women. To address this gap in understanding the effects of racism and racial discrimination on the broader U.S. population, our study aims to explore the relationship between perceived race-related discrimination—both emotional and physical—and seven health outcomes: Diabetes, Heart Attack, Asthma, Arthritis, Depression, Cognitive Decline, and Chronic Obstructive Pulmonary Disease (COPD), across a diverse demographic, irrespective of color or race.

Methods: In our cross-sectional study, we utilized Behavioral Risk Factor Surveillance System (BRFSS) data in 2022, to investigate the association between perceived race-related discrimination and a range of health outcomes among U.S. adults. The study focused on adults aged 18 and above, with cognitive decline assessed in individuals aged 45 and above, across a dataset of 445,132 records. We specifically analyzed four indicators for "Reactions to Race”, which encompassed experiences of racial treatment in general, at work, in healthcare settings, and physical symptoms resulting from race-related treatment. We also used a new predictor “Racism”, generated as a summative measure of the four aforementioned indicators of Reactions to Race. All these indicators were recoded as binary variables and their associations with our seven health outcomes were thoroughly examined. Frequency distribution and weighted percentages for these outcomes and predictors, alongside weighted logistic regression models were reported and employed, thereby providing insights into the broader implications of race-related discrimination on health outcomes within the general U.S. population.

Results: Our weighted adjusted analysis revealed significant associations between perceived racial discrimination (Racism) and increased odds of several health conditions, including Diabetes (OR= 1.686; 95% CI: 1.260-2.257, p < 0.001), Heart Attack (OR = 1.802; 95% CI: 1.261-2.575, p = 0.001), Asthma (OR = 1.396; 95% CI: 1.136-1.715, p = 0.001), Arthritis (OR = 1.365; 95% CI: 1.093-1.706, p = 0.006), Depression (OR = 1.504; 95% CI: 1.165-1.943, p = 0.002), Cognitive Decline (OR = 1.614; 95% CI: 1.014-2.569, p = 0.004), and Chronic Obstructive Pulmonary Disease (COPD) (OR = 1.692; 95% CI: 1.305-2.257). However, when examining the relationship between each of the indicators of Reactions to Race and health outcomes individually, the adjusted associations were not uniformly significant. Notably, significant relationships were identified between racial disparity in the workplace and Depression, Inferior Healthcare Experiences compared to other Races and Cognitive Decline, and Physical Symptoms Related to Race-based Treatment and health conditions such as Diabetes, Heart Attack, Arthritis, Depression, Cognitive Decline, and COPD. These results suggest that the impact of racial discrimination on health is multifaceted, with specific factors linked to particular outcomes. Additionally, our findings indicated that individuals who are financially secure and perceive themselves as well-supported may encounter or perceive less racial discrimination.

Conclusion: This study highlights the associations between perceived racial discrimination and adverse health outcomes, stressing the need for actions to eliminate racism. It calls for health equity promotion, mental health interventions, and equitable healthcare practices to reduce health disparities. Advocating for a collaborative approach among policymakers, healthcare systems, and communities, the findings emphasize a multi-layered strategy for fostering a healthier, more inclusive society for all.