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Meta-Analysis
. 2015 Sep 23;10(9):e0138511.
doi: 10.1371/journal.pone.0138511. eCollection 2015.

Racism as a Determinant of Health: A Systematic Review and Meta-Analysis

Yin Paradies  1 , Jehonathan Ben  1 , Nida Denson  2 , Amanuel Elias  1 , Naomi Priest  3 , Alex Pieterse  4 , Arpana Gupta  5 , Margaret Kelaher  6 , Gilbert Gee  7
Affiliations
Meta-Analysis

Racism as a Determinant of Health: A Systematic Review and Meta-Analysis

Yin Paradies et al. PLoS One. .

Abstract

Despite a growing body of epidemiological evidence in recent years documenting the health impacts of racism, the cumulative evidence base has yet to be synthesized in a comprehensive meta-analysis focused specifically on racism as a determinant of health. This meta-analysis reviewed the literature focusing on the relationship between reported racism and mental and physical health outcomes. Data from 293 studies reported in 333 articles published between 1983 and 2013, and conducted predominately in the U.S., were analysed using random effects models and mean weighted effect sizes. Racism was associated with poorer mental health (negative mental health: r = -.23, 95% CI [-.24,-.21], k = 227; positive mental health: r = -.13, 95% CI [-.16,-.10], k = 113), including depression, anxiety, psychological stress and various other outcomes. Racism was also associated with poorer general health (r = -.13 (95% CI [-.18,-.09], k = 30), and poorer physical health (r = -.09, 95% CI [-.12,-.06], k = 50). Moderation effects were found for some outcomes with regard to study and exposure characteristics. Effect sizes of racism on mental health were stronger in cross-sectional compared with longitudinal data and in non-representative samples compared with representative samples. Age, sex, birthplace and education level did not moderate the effects of racism on health. Ethnicity significantly moderated the effect of racism on negative mental health and physical health: the association between racism and negative mental health was significantly stronger for Asian American and Latino(a) American participants compared with African American participants, and the association between racism and physical health was significantly stronger for Latino(a) American participants compared with African American participants. Protocol PROSPERO registration number: CRD42013005464.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. PRISMA screening process flowchart.
Fig 2
Fig 2. Forest plot of the effect sizes for individual studies included in the meta-analysis: Negative Mental Health (k = 227).
Fig 3
Fig 3. Forest plot of the effect sizes for individual studies included in the meta-analysis: Positive Mental Health (k = 113).
Fig 4
Fig 4. Forest plot of the effect sizes for individual studies included in the meta-analysis: Physical Health (k = 50).
Fig 5
Fig 5. Forest plot of the effect sizes for individual studies included in the meta-analysis: General Health (k = 30).
See this image and copyright information in PMC

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