Research That Matters (January 17 - 20, 2008)

Purpose: Theoretical discussions of the sources of race and gender differences in health outcomes typically focus on the ways in which privilege, prejudice and discrimination differentially shape the opportunities, resources and life stresses that black and white men and women experience. Despite considerable theorizing, few studies have empirically examined these relationships. This study investigates the prevalence of interpersonal discrimination and its association with health-related quality-of-life (HRQoL) among black and white men and women.

Methods: Data were drawn from the National Health Measurement Study (NHMS), a national sample of 3844 adults. Health was measured using five indexes of HRQoL (EQ-5D, HALex, HUI, SF-6D, QWB-SA). (For description of study and dependent measures see http://www.healthmeasurement.org/index.html.) Racial discrimination was measured along two dimensions--lifetime and everyday discrimination. An everyday discrimination scale was constructed from 5 items, including “how often are you treated with less courtesy or respect than other people?” For each item, responses ranged from “almost every day” to “never, were reverse coded then summed, with sums ranging from 0 to 25.

Lifetime discrimination was constructed from four items, including “at any time in your life, have you ever been unfairly fired from a job or been unfairly denied a promotion?” Yes/no responses were summed for a range of 0-4.

Analysis was restricted to those aged 35-64. To compensate for ceiling effects, CLAD regression was used. Control variables included age, education, household income and household assets.

Results: We found significant differences in reported experiences of lifetime discrimination among blacks and whites, with white men and women more likely to report never having experienced discrimination. Black men tended to report more lifetime experiences of discrimination than either whites or black women. With respect to reports of everyday discrimination, distributions were similar for black men and women, and for white men and women. Both everyday and lifetime discrimination were associated with lower HRQoL. We found that, adjusting for age, education, income and assets, higher levels of reported lifetime discrimination were associated with lower HRQoL for black women and men, and for white women. The association between reported discrimination and HRQoL was found to be weakest for white men. In contrast, black women appear more vulnerable to everyday discrimination.

Implications: The effects of discrimination may help explain why black Americans, despite targeted health programs, continue to have lower health status and higher rates of morbidity, compared to white Americans. These results underscore the need to simultaneously examine race and gender in studies of health.