Table 1.
Summary of the included study
| First author, year | Sample size and ages* | Racism measure(s) | Health outcome(s) measure(s) | Findings in older Black adults (significant at p < 0.05 unless otherwise specified) | Study design |
|---|---|---|---|---|---|
| Aiken-Morgan 2015 | 420, ages 50 + | School segregation (self-report) | Change in cognition over a 3-year period; tests of global cognition, reasoning, memory, working memory, language, perceptual speed | The desegregated group scored better for language (desegregated: 52.438 ± 0.720 vs. segregated: 49.404 ± 0.577; F(1412) = 10.586, p = 0.001) and perceptual speed (desegregated: 52.970 ± 0.651 vs. segregated: 50.461 ± 0.521; F(1412) = 8.856, p = 0.003) | Longitudinal |
| Assari 2016 | 3648 aggregated total, sample sizes for older Black adult strata are unspecified (middle age: 35–65; older aged: 66–89; Black and White) | "Everyday discrimination" and "lifetime discrimination"; author doesn't cite or name Williams but description of measures suggests that the Everyday Discrimination and Major Experiences of Discrimination Scale may have been used | Body mass index | None | Cross-sectional |
| Ayalon 2011 | 956 (everyday discrimination) and 950 (major lifetime discrimination), ages 50 + | Everyday Discrimination (Williams) and Major Experiences of Discrimination | Depression (CES-D) | Increased major lifetime discrimination and everyday discrimination associated with depressive symptoms; (β = 0.16, SE 0.04, p < 0.001) and (β = 0.16, SE 0.05, p < 0.01), respectively | Cross-sectional |
| Barnes 2012 | 407, ages 65 + | Everyday Discrimination (Williams) | Tests of cognition in episodic memory, semantic memory, working memory, perceptual speed, visuospatial ability | Perceived discrimination is negatively associated with global cognition (β = − 0.02; SE = 0.01), and with two of the five domains: episodic memory, β = − 0.03; SE = 0.01 and perceptual speed, β = − 0.04; SE = 0.02 | Cross-sectional |
| Beatty Moody 2019 | 23, ages 54.41–69.40 | 1 item from Major Experiences of Discrimination (Williams); Experiences of Discrimination Scale (Krieger) | White matter lesion volume (WMLV) using structural MRI | As major experiences burden increased, WMLV increased (β = 0.65, p = 0.016); as experiences of discrimination increased, WMLV increased (β = 0.22, p = 0.024) | Cross-sectional |
| Bor 2018 | 34,612, ages 50–64; 28,973, ages 65 + | Number of police killings of unarmed Black Americans occurring 3 months prior to interview in the participant’s state of residence | Self-reported mental health (number of days reported “not good” in the previous month) | In participants aged 50–64, number of police killings of unarmed Black Americans in 3 months prior associated with an increase in poor mental health (β = 0.27, 95% CI: 0.057, 0.48, p = 0.014); not significant in those aged 65 + | Cross-sectional |
| Chae 2012 | 1490, ages 50 + | Major Experiences of Discrimination and Everyday Discrimination (Williams) | Mood disorder (major depression, dysthymia, bipolar disorder) (World Mental Health Organization Composite International Diagnostic Interview (WMH-CIDI)); cardiovascular disease history (self-report of hypertension, atherosclerosis, heart attack, stroke) | None | Cross-sectional |
| Clay 2015 | 251, ages 65 + | Single question about experiences of discrimination based on race or skin color in past 6 months | Short physical performance battery (SPPB) | None | Cross-sectional |
| Cobb 2020 | 964, ages 50 + | Major Experiences of Discrimination (Williams) | C-reactive protein (inflammatory biomarker) | Major discrimination associated with high-risk CRP (PR: 1.36, 95% CI: 1.25–1.47) | Cross-sectional |
| Cole 2017 | 1139, ages 50 + | Residential segregation (census tract) | Stage of hypertension (average of 3 readings) | None | Cross-sectional |
| Coley 2017 | 5652, ages 65 + | Everyday Discrimination (Williams) | Health-related quality of life (HRQOL) (2 NHANES questions) | Higher perceived discrimination associated with worse overall HRQOL (OR = 1.11; 95% CI: 1.08, 1.15), with stronger effects for women in overall and mental HRQOL | Cross-sectional |
| Greer 2014 | 265 metropolitan statistical areas (MSAs) with 935 counties total; minimum of 5000 non-Hispanic Black residents per MSA, ages 65 + | Residential segregation (census tract) | Heart disease and stroke mortality | Segregation positively associated with heart disease mortality rates (RR = 1.13; 95% CI: 1.08, 1.19) in people aged 65 + | Cross-sectional |
| Han 2020 | 124, ages 65 + | Everyday Discrimination (Williams) | Tests of cognition in memory, semantic memory, visuospatial ability, perceptual speed, working memory; 3 T MRI brain scan to assess functional connectivity |
Discrimination associated with stronger functional connectivity between the left insula and bilateral intracalcarine cortex, weaker functional connectivity between the left insula and right dorsolateral prefrontal cortex (cluster size = 471 voxels, t-value = − 4.91, FDR cluster p = 0.016), and weaker functional connectivity between the right insula and left supplementary motor cortex (cluster size = 778 voxels, t-value = − 5.26, FDR cluster p = 0.002) |
Cross-sectional |
| Kim 2017 | 429, ages 55 + | Everyday Discrimination (Williams) | Past-year psychiatric disorder (World Health Organization Composite International Diagnostic Interview-CIDI) | Greater perceived discrimination associated with increased odds of having any past-year psychiatric disorder with results varying by region (stronger in the West (odds ratio [OR] = 1.44, 95% CI: 1.12, 1.85) than in the South (OR = 1.06, 95% CI: 1.01, 1.11)) | Cross-sectional |
| Kovalchik 2015 | 437, ages 50 + | Racial composition (census tract) and residential segregation (county) | Global cognitive functioning (Telephone Interview for Cognitive Status-TICS) | None | Longitudinal |
| Krieger 2014 | National mortality data, deaths before age 65 years | State did or did not have legal racial discrimination overturned by 1964 Civil Rights Act | Premature mortality (< 65 years old) | A temporal pattern emerged for Black people across the twentieth century (higher Jim Crow–related mortality for oldest group, followed by no difference, then smaller reemerging difference) | Cross-sectional |
| Krieger 2017 | 43,384, ages 52 + | Birth in a Jim Crow State | Estrogen-receptor (ER)-negative breast tumors | Odds of ER − versus ER + cancer for those born in Jim Crow state: 1.10 (95% CI: 1.01, 1.18) for those born in or before 1945 and 1.10 (95% CI: 1.02, 1.20) for those born in 1946–1965 | Cross-sectional |
| Lamar 2020 | 497, ages 65 + | Region of birth and residence and school segregation status (self-reported) |
Tests of global cognition episodic memory, semantic memory, working memory, perceptual speed, and visuospatial ability |
Southern birth predicted lower global cognitive functioning (estimate = − 0.22, SE = 0.04, p < 0.0001), lower levels of performance in episodic memory, semantic memory, working memory, perceptual speed, and visuospatial ability; southern birth did not predict change in cognition over time. Southern residence at age 12 associated with lower level of global cognitive functioning (estimate = − 0.20, SE = 0.04, p < 0.0001), and all of the cognitive domains except episodic memory, but not change over time; school segregation status not associated with either baseline levels or rates of change in any of the cognitive outcomes (p-values ≥ 0.08) | Longitudinal |
| Lee 2017 | 595, ages 50 + | Major Experiences of Discrimination (Williams) | Leukocyte telomere length | Increased experiences of discrimination were associated with shorter telomere length (age-adjusted: β = − 0.033, SE = 0.14, p = 0.018; sociodemographic factors-adjusted: β = − 0.034, SE = 0.14, p = 0.017; health-related factors-adjusted: β = − 0.034, SE = 0.14, p = 0.016; depressive symptoms-adjusted: β = − 0.034, SE = 0.14, p = 0.017; stress-related factors-adjusted: β = − 0.030, SE = 0.15, p = 0.046) | Cross-sectional |
| Linnenbringer 2020 | 2273, ages 65 + | Neighborhood racial composition (census block group) | Breast cancer subtype (ER/PR/HER2 expression) | Black women who were diagnosed with breast cancer at age 65 or older had a 5.8% lower odds of TNBC vs. HR + /HER2 − breast cancer (OR = 0.94; 95% CI: 0.90, 0.99) per 10% unit increase in block group percentage Black (greater concentration of Black neighbors) | Cross-sectional |
| Liu 2015 | 1956 aggregated total, sample sizes for older Black strata are unspecified (ages 25–74 during years 1971–75 and 1976–80 of NHANES) | School term length during Jim Crow (disparities in education quality) | Blood pressure and hypertension (readings taken) | Among Black women, a 10% longer school term length was associated with a 2.1 mmHg lower systolic blood pressure (95% CI: − 4.1, − 0.1), 1.0 mmHg lower diastolic blood pressure (95% CI: − 2.2, − 0.1), and 5.0 percentage points lower hypertension prevalence (95% CI: − 8.4, − 1.7) in adjusted models. Associations for Black men were not statistically significant | Cross-sectional |
| Liu 2017 | 550, ages 50+ | Major Experiences of Discrimination and Everyday Discrimination (Williams) | Leukocyte telomere length | Everyday discrimination, but not major discrimination, is associated with shorter leukocyte telomere length among Black older adults (β = –0.23; 95% CI: –0.44, 0.01) but not among white counterparts (β = 0.05; 95% CI: –0.01, 0.10) | Cross-sectional |
| Lu 2019 | 339, ages 60 + | Major Experiences of Discrimination and Everyday Discrimination (Williams) | Relative telomere length | None | Cross-sectional |
| Marshall-Fabien 2016** | 1108, ages 55 + | Everyday Discrimination (Williams) | Depression (CES-D) | Discrimination is associated with depression for overall sample (β = 1.42, p < 0.001) and among African American stratum (β = 1.41, p < 0.001); association among stratum with English-speaking Black participants from the Caribbean was not significant | Cross-sectional |
| Marshall 2012** | 1108, ages 55 + | Everyday Discrimination (Williams) | Depression (CES-D) | Discrimination associated with depression (β = 1.52, 0.29 SE, p < 0.001 in total sample) | Cross-sectional |
| McClendon 2019 | 289, ages 60.7–73.3 | Major Experiences of Discrimination (Williams) | Health-related quality of life (RAND SF36) | Structural equation modeling showed race had an indirect effect through discrimination and various personality traits on physical health (neuroticism: − 0.03, 95% CI: − 0.04, -0.02; conscientiousness: − 0.13, 95% CI: − 0.20, − 0.06), and mental health (neuroticism: − 0.05; 95% CI: − 0.07, − 0.03; agreeableness: − 0.01, 95% CI: − 0.02, − 0.00) | Cross-sectional |
| Mezuk 2011 | 445, ages 50 + | Workplace Discrimination (Williams) | Hypertension (based on readings or self-reporting taking anti-hypertensives) | None | Cross-sectional |
| Mouzon 2017 | 773, ages 55–93 | Everyday Discrimination (Williams) | Lifetime mood disorders; lifetime anxiety disorders; depressive symptoms (CES-D); and serious psychological distress (Kessler 6) | Higher levels of overall everyday discrimination was associated with higher odds of mood disorder (1.05, 95% CI: 1.02, 1.08, p = 0.003), anxiety disorder (1.05, 95% CI: 1.02, 1.08, p = 0.003), any disorder (1.06, 95% CI: 1.04, 1.09, p < 0.0001), number of lifetime DSM-IV disorders (1.03, 95% CI: 1.02, 1.04, p < 0.0001), elevated levels of depressive symptoms (1.02, 95% CI: 1.01, 1.03, p < 0.0001), and serious psychological distress (1.03, 95% CI: 1.02, 1.05, p < 0.0001) | Cross-sectional |
| Nadimpalli 2015 | 487, ages 60–98 | Everyday Discrimination (Williams) | Depression (CES-D) | Perceived discrimination was positively associated with depressive symptoms (OR: 1.20, 95% CI: 1.10, 1.31; p < .001) | Cross-sectional |
| Nguyen 2018 | 278, ages 55 + | Everyday Discrimination (Williams) | Serious Psychological Distress (Kessler 6) | Discrimination associated with serious psychological distress (0.03 (0.01), p < 0.05) | Cross-sectional |
| Nguyen 2019 | 3742 observations (some participants included at more than one observation), ages 50 + | One item from the Everyday Discrimination Scale (Williams) specific to healthcare | Biomarkers of cardiometabolic risk: high sensitivity C-reactive protein (CRP), hemoglobin A1c (HbA1c), high-density lipoprotein (HDL), total cholesterol, cystatin C and blood pressure | Those who reported discrimination in the health care setting had increased likelihood of elevated CRP (OR 1.55, CI 1.34, 1.79; p < 0.001), elevated HbA1c (OR 2.03, CI 1.70, 2.41; p < 0.001) and elevated blood pressure (OR 1.64, CI 1.45, 1.86; p < 0.001), decreased likelihood of low HDL (OR 0.86, CI 0.74, 1.00; p < 0.05), decreased likelihood of high total cholesterol (OR 0.82, CI 0.67, 1.00; p < 0.05) | Cross-sectional |
| Nkimbeng 2020 | 165, ages 55 + | Everyday Discrimination (Williams) | Physical function (PROMIS PF 10a) | High discrimination associated with 2.5 points lower physical functioning compared to low discrimination (β = − 2.51, 95% CI: − 4.84, − 0.17) | Cross-sectional |
| Pantesco 2018 | 176 aggregated total, sample sizes for older Black strata are unspecified (ages 30–64) | Ten items about experiences of prejudice or discrimination (Laveist); two items from Major Experiences Scale (Williams); 5 items from Experiences of Discrimination Scale (Krieger); Everyday Discrimination Scale (Williams) | Telomere length | None | Cross-sectional |
| Pugh 2021 | 617, ages 57 + | Everyday Discrimination (Williams) | Tests of global cognition, episodic memory, working memory, semantic memory, perceptual orientation, perceptual speed | Discrimination associated with better performance in semantic memory over time and with better working memory | Longitudinal |
| Taylor 2018 | 120, ages 50–80 | General Ethnic Discrimination Scale (GED) adapted from Schedule of Racist Events Scale | Pain intensity (McGill Pain Questionnaire—SFMPQ); depression (CES-D) | Racial discrimination associated with pain intensity (β = 9.45) and depression (β = .71); pain intensity no longer significant after adding depression to the models and a mediation effect was detected | Cross-sectional |
| Vásquez 2019 | 1960, ages 55 + | Study-specific measure of perceived interpersonal and perceived institutional discrimination across 6 domains | Body mass index | None | Cross-sectional |
| Walker 2016 | 120, ages 50–80 | General Ethnic Discrimination Scale adapted from Schedule of Racist Events Scale | Functional limitations (Health Assessment Questionnaire Disability Index—HAQ-DI); disability (Craig Handicap Assessment and Reporting Technique—CHART); depression (CES-D) | Racial discrimination associated with disability (β = − 132.46) and depression (β = 0.65) | Cross-sectional |
| Watkins 2011 | 300, ages 55 + | Everyday Discrimination (Williams) | Depression (CES-D) | None | Cross-sectional |
| Wheaton 2018 | 92, ages 55 + | Major Experiences of Discrimination and Everyday Discrimination (Williams) | Depression (CES-D) | Among older men, only major discrimination predicted elevated symptoms of depression with both forms of discrimination considered (compared to low major discrimination, moderate: 5.20, SE 1.94 and high: 4.54, SE 1.86); both major and everyday discrimination were associated with the depressive symptoms in older men when considered individually (specific results not provided) | Cross-sectional |
| White 2011 | 689, ages 65 + | Residential segregation (Wong’s local index modeling potential for interaction between Blacks and non-Blacks) | Hypertension (self-report of diagnosis) | Foreign-born Blacks aged 65 or older residing in highly segregated areas were 46% (PR: 0.54; 95% CI: 0.40, 0.72) less likely to report hypertension than their counterparts residing in low segregated areas; no significant association found for US-born Blacks | Cross-sectional |
| White 2020 | 2926, ages 50 + | Everyday Discrimination (Williams) | Depression (CES-D) | Respondents in the persistently high racial discrimination trajectory were associated with elevated depressive symptoms (IRR: 1.50; 95% CI: 1.29, 1.73) in comparison to respondents in low to moderate perceived racial discriminatory trajectory | Longitudinal |
| Yoon 2019 | 397, ages 65 + | Major Experiences of Discrimination and Everyday Discrimination (Williams) | Self-reported mental health (mental component summary (MCS) of SF36); self-report of mental health not good after thinking about their mental health) stress, depression, and problems with emotions) in the past 30 days; self-report of diagnosed anxiety/depression | Everyday discrimination associated with worse mental health in men (β = − 0.197) and women (β = − 0.304, p < .001); Major Experiences of Discrimination did not predict mental health outcomes for either gender | Cross-sectional |
| Zahodne 2019 | 1313, ages 65 + | Everyday Discrimination (Williams) | Episodic memory via a telephone assessment | Structural equation modeling showed greater perceived discrimination had a direct effect on faster memory decline (estimate: -0.010, SE: 0.005, p = 0.048) and lower initial memory (estimate: 0.003, SE: 0.002, p = 0.053) via depressive symptoms and external locus of control | Longitudinal |
*If a study included younger participants or participants of a race besides Black, sample size is given for the older Black strata unless otherwise specified
**Same study sample (were looking at different moderators/interactions)