Abstract
BackgroundResearch on discrimination and health focused on older adults has been scarce, comparatively with younger and middle-aged adults. Considering where people live matters, accurate measures of perceived discrimination might consider how the place of residence interferes on discriminatory experiences. This study aimed to assess the association between perceived discrimination and urban/rural place of residence among a representative sample of older adults in Brazil.MethodsData came from the baseline of the Brazilian Longitudinal Study of Aging (ELSI-Brazil), conducted in 2015/2016, with individuals aged 50 years and older. Perceived Discrimination was measured by means of the following question: “In the past 12 months have you felt a victim of any type of discrimination” with five possible answers: (1)“when you sought medical services or health care?”, (2)“in social gatherings?”, (3)“in the work place?”, (4)“within the family?”, (5)“due to where you live?”. Participants who answered yes for any of the five domains were coded as having reported an experience of discrimination. The main exposure variable was the urban-rural classification of the households, carried out according to the methods employed by the Brazilian Institute of Geography and Statistics during the 2010 Population Census. Other covariates included: age, sex, skin color, household wealth and education. Multiple Poisson regression was used to estimate prevalence ratios and their respective 95% confidence interval for the association between discrimination and independent variables.ResultsPrevalence of any perceived discrimination among Brazilian older adults was 16.8%. Regardless the place of residence (either urban or rural), participants reported health care settings as the most common domain where discriminatory experiences occurred and the work place as the least common. According to the adjusted model, perceived discrimination was significantly higher among urban dwellers when compared to their rural counterparts, independent of sociodemographic characteristics, health status and neighborhood social environment. The outcome was significant associated with skin color, education and health status.ConclusionsUrban environment plays a core role in perceived discrimination and health care settings constitute the most common domain where discriminatory experiences occurred. Our findings may contribute to fulfill the knowledge gap on discrimination among older adults living in developing countries.
Highlights
Research on discrimination and health focused on older adults has been scarce, comparatively with younger and middle-aged adults
Low social trust was predominant among older adults who lived in urban areas (19.1% versus 15.0% in rural areas)
Adjustment for socioeconomic status, health status and neighborhood social environment in the current study slightly reduced the relation of place of residence to perceived discrimination, suggesting that a part of this relation may be mediated by these factors
Summary
Research on discrimination and health focused on older adults has been scarce, comparatively with younger and middle-aged adults. Considering where people live matters, accurate measures of perceived discrimination might consider how the place of residence interferes on discriminatory experiences. A large and growing body of research suggests that self-reported experiences of discrimination are a form of psychological stress that has an adverse impact on both mental and physical health outcomes, across multiple population groups in a wider range of cultural and national contexts [4,5,6]. Researchers have found associations between reports of discrimination and distress, clinically diagnosed mental disorders (e.g., generalized anxiety, posttraumatic stress disorder, depression), all-cause mortality and a variety of objective clinical disease outcomes such as preclinical endpoints - nighttime blood pressure and visceral fat - and silent indicators of premature aging - higher allostatic load and increased oxidative stress [5, 6]. Perceived discrimination’ studies may contribute to identify what drives population patterns of health and health inequities and to generate knowledge useful for guiding policies and actions to tackle inequities
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