Associations between perceived discrimination over the life course, subjective social status, and health literacy: A racial/ethnic stratification analysis

• Published in: PEC innovation 2024-12, Vol.5, p.100334, Article 100334
• Main Authors: Bather, Jemar R., Cuevas, Adolfo G., Harris, Adrian, Kaphingst, Kimberly A., Goodman, Melody S.
• Format: Article
• Language: English
• Subjects: Full length article; Low health literacy; Marginalized populations; Race; Racism; Social epidemiology; Social status
• ISSN: 2772-6282; 2772-6282
• DOI: 10.1016/j.pecinn.2024.100334

To analyze the relationship between perceived discrimination over the life course, social status, and limited health literacy (HL). 5040 adults who participated in the 2023 Survey of Racism and Public Health. We applied stratified multilevel models adjusted for sociodemographic characteristics. The average age was 47 years, 48% identified as White, 20% as Latinx, and 17% as Black. In the overall sample, we observed associations of perceived discrimination (b = 0.05, 95% CI: 0.01, 0.09), subjective social status (b = −0.16, 95% CI: −0.23, −0.10), and their interaction (b = 0.02, 95% CI: 0.01, 0.03). More perceived discrimination was associated with lower HL in the White and Multiracial participants. Higher subjective social status was associated with higher HL in the White and Latinx participants. There was a statistically significant interaction between perceived discrimination and subjective social status on HL among the White, Latinx, and Multiracial participants. This analysis has implications for public health practice, indicating that multi-level interventions are needed to address limited HL. Our findings provide novel insights for identifying key SDOH indicators to assess in clinical settings to provide health literate care. •There is limited data on how social determinants of health are related to HL.•Perceived discrimination and subjective social status (SSS) are associated with HL.•The two social determinants of health interacted in their impact on HL.•Understanding the predictors of HL is key to developing clinical screening tools.