Discrimination, discrimination distress, and chronic health conditions: an intersectional examination using I-MAIHDA

Abstract

The goal of this study was to understand the relation between discrimination and discrimination-related distress and risk for chronic health conditions among college students with marginalized racial, ethnic, gender identity and sexual orientation identities. Furthermore, I aimed to understand how prevalence of chronic health conditions among college students varies by these identities and whether, controlling for discrimination and discrimination distress, intersectional effects contribute to the variance in outcomes beyond the additive effect of each identity. Using the Intersectional Multi-level Analysis of Individual Heterogeneity and Discriminatory Accuracy (I-MAIHDA), I nested individuals (N = 291,805) within 54 identity strata. I conducted six stages of analysis, each consisting of multi-level regressions to assess for nine health outcomes: count of chronic conditions and endorsement of chronic pain/migraines, asthma, diabetes, endocrine disorders, sleep disorders, autoimmune disorders, cardiovascular and heart conditions, and digestive disorders. The first stage was a null model for all health outcomes, the second stage added discrimination experiences as a fixed effect, and the third stage controlled for discrimination experiences and fixed effects for race/ethnicity, gender identity, and sexual orientation. For stages four, five, and six, the sample was filtered to include only individuals who endorsed discrimination during the past 12-months (n = 60,140). The fourth stage was a null model for the reduced sample, the fifth stage added level of discrimination-related distress as a fixed effect, and the sixth stage controlled for discrimination-related distress but added fixed effects for race/ethnicity, gender identity, and sexual orientation. Results indicated that discrimination experiences and discrimination-related distress were associated with significantly increased odds for all chronic health conditions and increased the incidence rate for number of chronic health conditions. After controlling for discrimination experiences, gender minorities reported the highest odds of any gender for chronic pain/migraines, asthma, diabetes, sleep disorders, autoimmune disorders, and digestive disorders. There was no association between gender minority identity and cardiovascular disorders after controlling for discrimination. Cisgender women reported higher rates than cisgender men for all chronic conditions except cardiovascular disorders, with the highest odds of any gender for endocrine disorders. Sexual orientation minorities reported higher odds than heterosexuals for chronic pain/migraines, asthma, diabetes, autoimmune disorders, sleep disorders cardiovascular disorders, and digestive disorders after controlling for discrimination experiences. American Indian/Native Alaskans reported the highest odds of any racial/ethnic group for chronic pain/migraines, endocrine disorders, autoimmune disorders, and cardiovascular disorders and higher rates than White/Europeans for diabetes, sleep disorders, and asthma after controlling for discrimination experiences. Black/African Americans, Latino/a/e and Hispanics, and Pacific Islanders showed higher odds than White/Europeans for diabetes after controlling for discrimination and discrimination-related distress. Multiracial individuals had the second highest odds of any racial group for asthma after controlling for discrimination-related distress. People of additional races and ethnicities had the highest average number of chronic conditions and the highest rates of digestive and sleep disorders. The variance partition coefficients (VPC) for each model and proportion of change in variance (PCV) between models showed that most (>99%) of the variance between strata could be explained by the effects of discrimination or discrimination distress, and racial/ethnic, gender identity, and sexual orientation. Results suggest differences in outcomes can be attributed to the additive effects of intersecting identities as well as discrimination and discrimination distress related to holding intersecting marginalized identities.