Self-reported health, perceived racial discrimination, and skin color in African Americans in the CARDIA study

Abstract

This study investigates the association between self-reported physical and mental health and both perceived racial discrimination and skin color in African American men and women. We used data from the longitudinal coronary artery risk development in young adults study (CARDIA) in African American men and women (n=1722) in the USA. We assessed self-reported mental and physical health status and depressive symptoms at the Year 15 (2000-2001) follow-up examination using the Medical Outcomes Study Short Form (SF-12) and the Center for Epidemiologic Studies Depression scale. Skin color was measured at the Year 7 examination (1992-1993). To assess racial discrimination, we used a summary score (range 0-21) for 7 questions on experiencing racial discrimination: at school, getting a job, getting housing, at work, at home, getting medical care, on the street or in a public setting. Self-reported racial discrimination was more common in men than in women (78.1% versus 73.0%, p<0.05) and in those with higher educational attainment, independent of gender. Discrimination was statistically significantly associated with worse physical and mental health in both men and women, before and after adjustment for age, education, income, and skin color. For example, mental health (0-100 scale) decreased an average of 0.29 units per unit increase in racial discrimination score in men; this became 0.32 units after adjustment. There was no association between self-reported physical and mental health and skin color. Further studies of the health consequences of discrimination will require investigation of both the upstream determinants of discrimination and the downstream mechanisms by which perceived discrimination affects health outcomes.