Racism as a Determinant of Health: A Systematic Review and Meta-Analysis
Racism as a Determinant of Health: A Systematic Review and Meta-Analysis
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DOI：
10.1371/journal.pone.0138511
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发表时间：
2015-09-23
期刊：
影响因子：
3.7
通讯作者：
Gee, Gilbert
中科院分区：
文献类型：
--
作者：
Paradies, Yin;Ben, Jehonathan;Gee, Gilbert
尽管近年来有越来越多的流行病学证据证明种族主义对健康的影响，但尚未将累积的证据基础综合起来，进行一项综合性的元分析，具体侧重于将种族主义作为健康的一个决定因素。这项荟萃分析回顾了文献，重点是报告的种族主义与身心健康结果之间的关系。数据来自1983年至2013年间发表的333篇文章中报告的293项研究，主要在美国进行，使用随机效应模型和平均加权效应量进行分析。种族主义与较差的心理健康相关（消极心理健康：r = -.23，95%CI [-.24，-.21]，k = 227;积极心理健康：r = -.13，95%CI [-.16，-.10]，k = 113），包括抑郁，焦虑，心理压力和其他各种结果。种族主义还与较差的一般健康状况（r = -.13（95% CI [-.18，-.09]，k = 30）和较差的身体健康状况（r = -.09，95% CI [-.12，-.06]，k = 50）相关。研究和暴露特征方面的一些结果发现了适度效应。与纵向数据相比，种族主义对心理健康的影响大小在横截面中更强，在非代表性样本中比代表性样本更强。年龄、性别、出生地和教育水平并没有缓和种族主义对健康的影响。种族显著缓和了种族主义对消极心理健康和身体健康的影响：与非洲裔美国人参与者相比，亚裔美国人和拉丁裔美国人参与者的种族主义和消极心理健康之间的关联明显更强，与非洲裔美国人参与者相比，拉丁裔美国人参与者的种族主义和身体健康之间的关联明显更强。
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.