Abstract 3616: Cultural racism as a driver of health disparities
Authors: Oyomoare L. Osazuwa-Peters, Tyson Brown, Nancy Krieger, Tomi Akinyemiju
Journal: Cancer Research (2025)

Abstract Background: Cultural racism (CR), which refers to ideologies, values, belief systems, and tangible manifestations that enable racial oppression, is a distinct component of systemic racism with hypothesized links to health disparities. However, relative to other more widely recognized components of systemic racism— interpersonal and structural racism— CR is poorly studied with sparse epidemiological evidence on its direct relationship with health outcomes and contributions to disparities. Methods: To bridge this gap, we developed the cultural racism factor (CRF), a latent measure derived using confirmatory factor analysis to model interrelationships among seven indicators that are hypothesized to reflect CR: i) anti-immigrant sentiments, ii) racial resentment, iii) online racial animus, iv) number of public symbols of the confederacy/100, 000, v) aggregate implicit racial bias for White residents, vi) lack of White support for Medicaid expansion, and vii) lack of community-oriented policing. These indicators were quantified at the state level, given that data was consistently available at this level, and states are influential political actors that shape population health and allocate resources. Associations between the CRF and a variety of health outcomes (four mortality outcomes, life expectancy at birth, and two mental health outcomes) were evaluated using demographics-adjusted regression models. Results: In analysis of US mortality data between 2018 and 2021 obtained from CDC Wonder, each unit increase in the CRF was associated with ∼136 (95% confidence interval (CI): 90-182) all-cause deaths per 100, 000, ∼40 (21-59) cardiovascular-specific deaths per 100, 000, ∼6 per 100, 000 (3-9) diabetes-specific deaths per 100, 000, and ∼11 per 100, 000 (5-17) cancer-specific deaths per 100, 000. Also, the CRF was associated with a one-year decline in life expectancy at birth (∼ -1 (-2 - -1); National Center for Health Statistic data). Overall, these associations were consistent for both Black and White adults. Also, CRF’s association with all-cause mortality appeared to be independent of structural racism. Further, CRF showed significant associations with mental health outcomes including a higher risk for depression history ranging from 3% overall to 25% among Native Hawaiian/PI and higher risk for poor mental health days ranging from 3% overall to 14% among Hispanics, in CDC’s Behavioral Risk Factor Surveillance System data (2018-2021). Conclusion: In sum, CRF was adversely associated with numerous health outcomes, overall and by racialized groups. These findings highlight cultural racism’s role as a contemporary, consistent, and universally harmful social exposure for US adults that critically needs to be addressed. Further, the CRF makes it possible to advance the science of racism and health and provides an empirical basis for efforts to address US health inequities that result from cultural racism. Citation Format: Oyomoare L. Osazuwa-Peters, Tyson Brown, Nancy Krieger, Tomi Akinyemiju. Cultural racism as a driver of health disparities [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 3616.