Associations between perceived discrimination over the life course, subjective social status, and health literacy: A racial/ethnic stratification analysis

Jemar R Bather; Adolfo G Cuevas; Adrian Harris; Kimberly A Kaphingst; Melody S Goodman

doi:10.1016/j.pecinn.2024.100334

Associations between perceived discrimination over the life course, subjective social status, and health literacy: A racial/ethnic stratification analysis

PEC Innov. 2024 Aug 20:5:100334. doi: 10.1016/j.pecinn.2024.100334. eCollection 2024 Dec 15.

Authors

Jemar R Bather^{1

2}, Adolfo G Cuevas^{1

3}, Adrian Harris¹, Kimberly A Kaphingst^{4

5}, Melody S Goodman^{1

2}

Affiliations

¹ Center for Anti-racism, Social Justice & Public Health, New York University School of Global Public Health, New York, NY 10003, USA.
² Department of Biostatistics, New York University School of Global Public Health, New York, NY 10003, USA.
³ Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, NY 10003, USA.
⁴ Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA.
⁵ Department of Communication, University of Utah, Salt Lake City, UT 84112, USA.

Abstract

Objective: To analyze the relationship between perceived discrimination over the life course, social status, and limited health literacy (HL).

Methods: 5040 adults who participated in the 2023 Survey of Racism and Public Health. We applied stratified multilevel models adjusted for sociodemographic characteristics.

Results: The average age was 47 years, 48% identified as White, 20% as Latinx, and 17% as Black. In the overall sample, we observed associations of perceived discrimination (b = 0.05, 95% CI: 0.01, 0.09), subjective social status (b = -0.16, 95% CI: -0.23, -0.10), and their interaction (b = 0.02, 95% CI: 0.01, 0.03). More perceived discrimination was associated with lower HL in the White and Multiracial participants. Higher subjective social status was associated with higher HL in the White and Latinx participants. There was a statistically significant interaction between perceived discrimination and subjective social status on HL among the White, Latinx, and Multiracial participants.

Conclusion: This analysis has implications for public health practice, indicating that multi-level interventions are needed to address limited HL.

Innovation: Our findings provide novel insights for identifying key SDOH indicators to assess in clinical settings to provide health literate care.

Keywords: Low health literacy; Marginalized populations; Race; Racism; Social epidemiology; Social status.