title: Racism as a Determinant of Health: A Systematic Review and Meta-Analysis.
abstract: 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. Protocol PROSPERO registration number: CRD42013005464.
authors.affiliation: Alfred Deakin Institute for Citizenship and Globalization, Faculty of Arts and Education, Deakin University, Melbourne, Victoria, Australia.
authors.forename: Yin
authors.initials: Y
authors.lastname: Paradies
authors.affiliation: Alfred Deakin Institute for Citizenship and Globalization, Faculty of Arts and Education, Deakin University, Melbourne, Victoria, Australia.
authors.forename: Jehonathan
authors.initials: J
authors.lastname: Ben
authors.affiliation: School of Social Sciences and Psychology, University of Western Sydney, Sydney, New South Wales, Australia.
authors.forename: Nida
authors.initials: N
authors.lastname: Denson
authors.affiliation: Alfred Deakin Institute for Citizenship and Globalization, Faculty of Arts and Education, Deakin University, Melbourne, Victoria, Australia.
authors.forename: Amanuel
authors.initials: A
authors.lastname: Elias
authors.affiliation: Australian Centre for Applied Social Research Methods, Australian National University, Canberra, Australian Capital Territory, Australia.
authors.forename: Naomi
authors.initials: N
authors.lastname: Priest
authors.affiliation: Division of Counseling Psychology, University at Albany, State University of New York, New York, New York, United States of America.
authors.forename: Alex
authors.initials: A
authors.lastname: Pieterse
authors.affiliation: Oppenheimer Center for Neurobiology of Stress, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, United States of America.
authors.forename: Arpana
authors.initials: A
authors.lastname: Gupta
authors.affiliation: Centre for Health Policy Programs and Economics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Margaret
authors.initials: M
authors.lastname: Kelaher
authors.affiliation: Department of Community Health Sciences, University of California, Los Angeles, Fielding School of Public Health, Los Angeles, California, United States of America.
authors.forename: Gilbert
authors.initials: G
authors.lastname: Gee
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006262:Health; D006801:Humans; D008297:Male; D008603:Mental Health; D017063:Outcome Assessment, Health Care; D063505:Racism