Associations between race, discrimination and risk for chronic disease in a population-based sample from Canada

A major epidemiological finding emerging from studies using U.S. samples is that racial differences in experiences of discrimination are associated with racial differences in health. A newer area of research is exploring the population-level dynamics between race, discrimination, and health status in various societies. The objective of this study is to assess for the first time in a national sample from Canada: (a) racial differences in experiences of discrimination and, (b) the association between discrimination and chronic conditions and their major risk factors. Data were obtained from the 2013 Canadian Community Health Survey (n = 16,836). Race was categorized as Aboriginal, Asian, Black, or White. Discrimination was measured using the Williams Everyday Discrimination Scale. Outcomes included having any chronic condition or major risk factors (obesity, hypertension, smoking, binge drinking, infrequent physical activity, and poor self-rated health). Crude and adjusted (for age, sex, immigrant status, socioeconomics) logistic regressions modeled the association between (a) race and discrimination and, (b) discrimination and each outcome. Results indicated that Blacks were most likely to experience discrimination, followed by Aboriginals. For example, Blacks were almost twice as likely (OR: 1.92, 95% CI: 1.19-3.11), and Aboriginals 75 percent more likely (OR: 1.75, 95% CI: 1.37-2.22) to report being treated with less courtesy or respect than others. Blacks were more than four times as likely (OR: 4.27, 95% CI: 2.23-8.19), and Aboriginals more than twice as likely (OR: 2.26, 95% CI: 1.66-3.08) to report being feared by others. Asians were not statistically different from Whites. With two exceptions (binge drinking and physical activity), discrimination was associated with chronic conditions and their risk factors (OR for any chronic condition: 1.78, 95% CI: 1.52-2.08). Initial results suggest that in Canada, experience of discrimination is a determinant of chronic disease and chronic disease risk factors, and Blacks and Aboriginals are far more exposed to experiences of discrimination.