Differential associations between everyday versus institution-specific racial discrimination, self-reported health, and allostatic load among black women: implications for clinical assessment and epidemiologic studies

Abstract

Purpose-Black women have the highest estimated allostatic load (AL). AL and self-perceived health are strong health predictors and have been linked to racial discrimination. Research suggests that everyday and institution-specific racial discrimination may predict different AL and self-reported health (SRH) outcomes. Furthermore, discrepancies between AL and self-perceived health could widen disparities. We estimated associations between everyday versus institutionspecific racial discrimination with AL and SRH. Methods-Data are from a San Francisco Bay Area community sample of 208 black women aged 30-50 years. Participation involved a questionnaire, self-interview, blood draw, and anthropometric measurements. Adjusted generalized linear regression models estimated associations of racial discrimination with AL and SRH. Results-After adjusting for age, socioeconomic position, and medication use, institutionspecific discrimination was negatively associated with AL (i.e., better health), whereas everyday experiences showed no association. Those reporting very-high (vs. moderate) institution-specific discrimination had lower AL (β = −1.31 [95% CI: −2.41, −0.20]; AL range: 0-15). No racial discrimination-SRH association was found. Conclusions-For black women, (1) institution-specific racial discrimination may be differentially embodied compared with everyday experiences and (2) institutional racism may contribute to physiologic stress-regulation regardless of self-perceived health status. Potential

Association Between Federal Value-Based Incentive Programs and Health Care–Associated Infection Rates in Safety-Net and Non–Safety-Net Hospitals

“…9 The reason for the disparities is likely multifactorial and associated with a complex mix of health care environmental factors and patient-related clinical and social factors, [31][32][33] including the adverse effects of structural racism, discrimination, and toxic stress among patients disproportionately served by safety-net institutions such as those with low income and/or those who identify as members of racial/ ethnic minority groups. [34][35][36][37] Whatever their cause, these disparities in health care-associated infection rates contribute to the disproportionate representation of safety-net hospitals among penalized institutions 11,13 and may have unintended consequences for the financial stability of the safety net and the quality of health care for the patients served. Although Medicaid expansion under the Affordable Care Act reduced uncompensated care costs for many safety-net hospitals, 38,39 these hospitals continue to have low operating margins and often rely on nonclinical sources of revenue 40 or state and federal funds, particularly DSH payments, 41 to offset financial losses associated with remaining uncompensated care and Medicaid reimbursement that is below actual costs.…”

Racial discrimination, the superwoman schema, and allostatic load: exploring an integrative stress‐coping model among African American women

“…Last, our findings suggest that different forms of coping may have differential health effects based on the severity or chronicity of the stressor. Further, given the context‐dependent nature of stress and coping, those relationships may vary by social context (e.g., institutional versus public setting) . This may help explain the mixed findings in the literature on racism, coping, and health; and the inability to identify coping strategies that are adaptive in relation to racism stress.…”

“We get double slammed!”: Healthcare experiences of perceived discrimination among low-income African-American women

“… 23 – 25 The additional layers of socioeconomic disadvantage, historical trauma, and ongoing experiences of micro-aggressions make AA women one of the most vulnerable groups with regards to health. 26 , 27 Several studies have demonstrated evidence of implicit racial/ethnic bias against AA women by healthcare providers. 25 , 28 , 29 …”