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

Objective

To analyze the relationship between perceived discrimination over the life course, social status, and limited health literacy (HL).

Methods

5040 adults who participated in the 2023 Survey of Racism and Public Health. We applied stratified multilevel models adjusted for sociodemographic characteristics.

Results

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.

Conclusion

This analysis has implications for public health practice, indicating that multi-level interventions are needed to address limited HL.

Innovation

Our findings provide novel insights for identifying key SDOH indicators to assess in clinical settings to provide health literate care.