Title: The cross-national impact of discrimination on health: considering social and genetic vulnerabilities
Funder: The Academy of Medical Sciences

Abstract: Aim: This study will use longitudinal data from three cohort studies (n=~78,000) to assess the impact of discrimination based on a range of characteristics on mental and physical health. Objective 1: To conduct a cross-national comparison of the link between discrimination and health a.To investigate how discrimination from different sources (e.g. sexism + ageism) affects health over time, assessing whether associations vary by country. b.To assess the impact of repeated discrimination (based on frequency of exposure) on health over time, and to explore whether these associations vary cross-nationally. Objective 2: To assess how discrimination interacts with social and genetic vulnerabilities to influence health a.To investigate how discrimination interacts with social vulnerability (e.g. low socioeconomic status) to influence health, assessing cross-national variations. b.To assess how discrimination interacts with genetic vulnerability (polygenic risk scores) to influence health, across countries. Data sources: 1) US Health and Retirement Study (HRS) 2) English Longitudinal Study of Ageing (ELSA) and 3) Survey of Health, Ageing and Retirement in Europe (SHARE). HRS and ELSA have harmonised discrimination and health data, and polygenic risk scores for depression, wellbeing and cardiometabolic disease. SHARE has discrimination and health data from 27 European countries. Value of the investigation: The study is powered to investigate discrimination from multiple sources and assess whether findings vary cross-nationally. The study will test whether discrimination exacerbates social gradients in health. It will capitalise on innovative biological measures, to assess whether there is a super-additive effect of genetic risk and discrimination on health.

Lay abstract: Background: Discrimination is a common experience, as highlighted by the #MeToo and #BlackLivesMatter movements. Growing evidence suggests that people who experience discrimination suffer poorer mental health and may even be at risk of poorer physical health. Why new research is needed: Most of the evidence to date comes from small studies of racism in the US. Studies on other types of discrimination in different countries are needed. It is also unclear whether some people who experience discrimination have a greater health risk due to their socio-economic position or genetic make-up. Objectives: 1. To estimate the effect of varied types of discrimination (e.g. on the basis of age, sex, sexual orientation, weight) on health, and checking whether the findings vary by country. 2. To investigate if social vulnerability (e.g. low socio-economic status) or genetic vulnerability adds to the health burden of discrimination. Methods: The study will use data on discrimination from three studies that have tracked the health of over 78,000 people for many years. The studies have surveyed adults from the US, UK and 27 European countries. Poverty and other social vulnerabilities have been assessed in all the studies. Genetic data is also available for the US and UK studies. Value of the results: This study will provide crucial evidence on how discrimination affects health in at-risk groups. Ultimately, these findings will help policymakers and practitioners develop interventions to help improve the health of groups that experience discrimination.

Research activity codes: 2.1 BIOLOGICAL AND ENDOGENOUS FACTORS;2.3 PSYCHOLOGICAL, SOCIAL AND ECONOMIC FACTORS
Health categories: GENERIC HEALTH RELEVANCE