Health Disparities
Shifts in relationships between socially-assigned and self-identified race with self-rated health, BRFSS 2022-2023 Tracy* Tracy Lam-Hine Lam-Hine Stanford University School of Medicine
Background: Socially-assigned race (the race one is perceived by others to be) may relate to self-rated health (SRH) differently than self-identified race. Jones et al. 2008 used data from the 8 states using the first Reactions to Race (R2R) module fielded in the 2004 Behavioral Risk Factor Surveillance System, finding strong protective effects of social assignment as White race, particularly among Multiracial adults. We aimed to assess how the influence of socially-assigned and self-identified race on SRH has evolved in more recent data.
Methods: We used data from the 35 states administering the R2R module in 2022-2023. Replicating the prior analysis, we estimated design-weighted prevalence of excellent or very good SRH using predictive marginal standardization from a logistic regression adjusting for age, education, and questionnaire language, and stratified results across combinations of self-identified and socially assigned race. In a sensitivity, we restricted analysis to the same states from the prior study.
Results: Among 391,318 adults with complete data, mean EVGH was 48.5% (95% CI: 48.1-48.9). Marginal SRH was highest among people perceived as Asian and lowest among people perceived as Hispanic, a pattern that held across several self-identified race strata. Among people perceived as Black, SRH increased dramatically for self-identified Multiracial or Hispanic adults, but not for self-identified Black adults. Differences in SRH by socially-assigned race among Multiracial adults were not more pronounced than for other groups. Similar patterns emerged in the sensitivity, suggesting that observed shifts did not solely result from differences in sampling.
Discussion: Our results indicate that the relationship between socially-assigned race and SRH has shifted in the last 20 years, potentially reflecting changes in the process of racialization. Socially-assigned race and health have a time-dependent and contextual relationship which should periodically be revisited.
