Recent Research on How Experiencing Racial Discrimination Impacts Health

Racial discrimination is an underlying driver of health disparities that affects experiences across many aspects of everyday life as well as in health care settings. Repeated and ongoing exposure to racial discrimination can negatively affect individuals’ health and well-being, increasing risks of poor outcomes across multiple domains. Understanding how exposure to racial discrimination affects health can inform efforts to reduce health disparities. Racial and ethnic health and health care disparities result in higher rates of illness and death across a wide range of health conditions and are costly to the health care system, resulting in excess medical care costs and lost productivity, as well as additional economic losses due to premature deaths each year. Amid current federal efforts to reduce resources and initiatives focused on addressing disparities, identifying and understanding the continued evidence base about the role of racial discrimination in contributing to negative health outcomes remains important.

This brief provides an overview of the relationship between racial discrimination and health and highlights research published since 2015 examining mechanisms underlying health outcomes linked to self-reported experiences of racial discrimination, including biological changes, chronic stress, mental health, substance use, pregnancy-related outcomes, and sleep. Other research has also identified how structural racism negatively impacts health but is beyond the scope of this brief.

A large body of research conducted over several decades prior to 2015 has linked experiences of racial discrimination to negative health outcomes. While not exhaustive, this brief builds on past analyses by capturing more recent literature, including large-scale longitudinal studies and those based on methodological advances that study genetic, protein, and brain imaging biomarkers to better understand biological changes linking experiences of racial discrimination to health outcomes. Criteria for inclusion included studies conducted among U.S. populations that used validated measures of racial discrimination experiences and examined associations with biomarkers or health outcomes by race. Key takeaways include the following:

• Recent research builds upon earlier evidence that racial discrimination is associated with worse health across multiple domains, which may contribute to health disparities. Research linked self-reported experiences of racial discrimination to a greater risk of chronic disease, mental health disorders, substance use, adverse pregnancy outcomes, and sleep problems among people of color compared to White people. For example, Black and Hispanic people who reported experiencing racial discrimination had elevated risk for cardiovascular disease compared to those who did not report discrimination. Exposure to racial discrimination also is associated with higher rates of preterm births and low birth weight among infants born to Black women compared to White women.
• Emerging studies suggest racial discrimination may impact health outcomes through biological mechanisms linked to stress, inflammation, and changes in the brain. Recent findings associated experiences of racial discrimination with elevated stress and inflammation, shortened telomere length, and changes in brain structure and activity that can increase the risk of chronic disease, poor mental health outcomes, and shortened lifespans.
• Some research gaps and limitations remain. Most studies relied on self-reported experiences of discrimination, which researchers identified as challenging to measure. Moreover, most research focused primarily on Black populations and therefore gaps remain in understanding impacts for other groups who experience ongoing discrimination. Some studies controlled for a more robust set of potential confounding factors, such as age, gender, income, and education, than others, largely due to limitations in sample size. Additionally, studies had mixed findings on the protective social and coping factors that mitigate the negative effects of racial discrimination.

Future research into how experiences of racial discrimination impact health may be limited due to actions by Trump administration, including executive orders eliminating federal diversity, equity, inclusion, and accessibility (DEIA) programs and related initiatives. A major impact of these efforts has been a reduction in federal support for health disparities research, which may limit the information available to track disparities and better understand the underlying factors affecting health outcomes.

Racism and discrimination at all levels contribute to differences in experiences across many aspects of everyday life which can negatively impact people’s health and well-being. It contributes to underlying inequities in social and economic factors that reflect historical and contemporary policies and drive racial and ethnic disparities in health, including access to housing, food, and economic and educational opportunities. However, racial health disparities persist even when controlling for differences in socioeconomic status. Many people of color continue to report experiences with daily discrimination. KFF survey data from 2023 found that at least half of American Indian or Alaska Native (AIAN) (58%), Black (54%), Hispanic adults (50%), and about 4 in 10 Asian adults (42%) say they experienced at least one type of interpersonal discrimination in daily life in the past year. These experiences included receiving poorer service than others at restaurants or stores; people acting as if they are afraid of them or as if they aren’t smart; being threatened or harassed; or being criticized for speaking a language other than English. 

A large body of research conducted over several decades has consistently documented strong associations between self-reported experiences of racial discrimination and negative health outcomes. These outcomes include poor mental health, such as depression, anxiety, and psychological distress. In addition, numerous studies have linked racial discrimination to physical health outcomes, such as hypertension, cardiovascular disease, obesity, asthma, and breast cancer, underscoring its broad impact on both physical and psychological well-being. Two conceptual frameworks help explain the mechanisms through which these associations may arise. The weathering hypothesis describes how chronic exposure to social and economic adversity, including racism and socioeconomic disadvantages, can accelerate health deterioration and contribute to racial health disparities. Allostatic load theory similarly focuses on cumulative physiologic “wear and tear” from repeated or chronic stress activation, which is associated with poorer health outcomes. Allostatic load is typically measured using various indicators, including blood pressure, cardiometabolic indicators, and other biomarkers. Research has found elevated allostatic load among adults who experienced various types of discrimination, including childhood racial discrimination.

Building on existing research, studies since 2015 have sought to replicate previous studies to confirm and extend findings by applying existing theories to more subgroups and outcomes and using new tools. The research often relies on associating health outcomes and biological indicators with self-reported experiences of racial discrimination, most commonly captured using validated survey instruments which measure individuals’ exposure to racial discrimination, such as the Experiences of Discrimination Scale. As this is an evolving body of research, several research limitations exist. Nearly all research studies utilize self-reported experiences of racial discrimination, which may underestimate actual exposure due to social desirability bias, recall errors, or confounds with other intersectional social factors. Some survey instruments that assess perception of racial discrimination may not perform equivalently across different racial and socioeconomic groups, which could affect cross-group comparisons. Most studies focus on Black people, while studies including populations such as AIAN and Native Hawaiian and Pacific Islander (NHPI) people are limited, reducing the generalizability of findings to these and other groups, such as Hispanic and Asian people, who experience ongoing racism. While most studies also analyzed interactions and effects due to variables other than exposure to racial discrimination, such as age, gender, income, and education, some used a less robust set of potential confounding factors due to limitations in sample size.

Impacts on Chronic Disease, Biological Changes, and Stress

Multiple studies find that racial discrimination is associated with a higher risk of chronic diseases and other conditions that may increase mortality risk. Research suggests that racial discrimination is associated with higher risk for cardiovascular and metabolic diseases, including high blood pressure, obesity, diabetes, chronic kidney disease, and other health conditions. A study found that people who reported experiencing racial discrimination had a 5% elevated risk for cardiovascular disease compared to those who did not report discrimination, with the strongest association between racial discrimination and cardiovascular disease risk seen among Asian and Latino people and among women compared to men. Additionally, exposure to experiences of racial discrimination during childhood among Black adults was associated with poorer cardiovascular health outcomes in adulthood compared to those who did not report discrimination. Other studies have highlighted a connection between racial discrimination and higher rates of obesity among women, as well as other health outcomes, including lupus and organ damage among Black women. One study found that experiencing discrimination was associated with an increase in mortality risk due to cardiovascular disease among Black people regardless of health behaviors, clinical risk factors, or social factors such as gender or racial and ethnic residential segregation. Another study found that experiencing racial discrimination was associated with higher risk of mortality due to any cause among Black adults ages 50 and older, even when controlling for health, behavioral, and economic factors.

Experiencing racial discrimination is associated with biological changes that increase inflammation and stress, which may increase the risk of developing chronic conditions and shorten lifespan. Inflammation is a natural response to injury and illness, but chronic inflammation that occurs in the absence of injury or illness can lead to various health issues, including cardiovascular disease, diabetes, and immune function. A longitudinal study found that elevated inflammation and higher levels of cumulative lifespan stress, which included experiences of discrimination, partly accounted for the shorter lifespans seen among Black participants compared to those who were White. Recent studies showed that individuals who experienced discrimination, including racial discrimination, exhibited higher levels of inflammation biomarkers compared to those who did not report discrimination. For example, one study found that Black people experienced more stress than White people across various measures, including due to racial discrimination, and that stress exposure was strongly associated with higher levels of a protein associated with inflammation. Research also found a similar pattern among pregnant Black women who reported experiencing racial discrimination compared to those who had not. Further, research at the genetic level, including the mechanisms that control inflammation levels, found that Black study participants had higher inflammatory signaling than White participants, and that racial discrimination explained over half of the race-related differences in expression of genes that promote inflammation. Another study of Black and White adults found that, among participants reporting high perceived discrimination, Black adults had a higher expression of a different set of genes linked to immune function and inflammation compared with White participants, suggesting a unique gene expression linked to experiences of racial discrimination.

Racial discrimination is also associated with shortened telomere length, which contributes to accelerated biological aging. Telomeres, which protect the ends of chromosomes, naturally shorten over time and serve as an indicator of aging. Chronic stress can accelerate telomere shortening and is associated with earlier onset of age-related disease, such as heart disease and cancer. Research found that, among Black people, those who reported racial discrimination had faster telomere shortening over a ten-year period than those who did not, though a separate study observed this effect only among Black adults ages 50 and older due to everyday discrimination rather than racial discrimination specifically. Another study found that experiences of racial discrimination were associated with shorter telomere length among Black women, Black people with high socioeconomic status, Black adults under age 40, and White men under age 40, illustrating complex interactions between experiences of discrimination and other sociodemographic factors. One hypothesis for the association observed among younger White men is that younger White males feeling “targeted” due to perceptions of race-related disadvantages as a result of increases in diversity efforts. Such perceptions may be especially pronounced among younger adults navigating educational and career advancement, although additional research is needed to better understand these relationships.

Research also has identified mitigating social and coping factors that may limit the impact of racial discrimination on stress and allostatic load, but some findings on protective buffers are mixed. Research among Black youth ages 16–18 found that higher parental and peer emotional support was associated with lower allostatic loads. A study found that, among Black women who reported experiences of racial discrimination, those with higher education levels and lower poverty status had lower allostatic load regardless of how much racial discrimination they reported experiencing compared to those with lower education levels. However, a study comparing allostatic load between Black and White adults found that experiencing higher levels of racial discrimination was associated with higher allostatic load regardless of education level, income, or wealth. Another study found that “John Henryism” among Black people, a high-effort, active coping style in response to racism and sociodemographic challenges, was associated with fewer depressive episodes but higher allostatic load, suggesting that some social coping strategies may come at the expense of health. Similarly, research conducted on the “superwoman schema” among Black women, where resilience, self-reliance, and other social processes are central to coping with discrimination, found mixed results where some coping strategies limit stress while others exacerbate it.

Pregnancy and Birth Outcomes

Recent research expands on a large body of research that shows racial discrimination is associated with adverse pregnancy outcomes. Research has documented that racism and chronic stress contribute to poor maternal and infant health outcomes, including higher rates of pregnancy-related depression and preterm birth among Black women and higher rates of mortality among Black infants. Racial discrimination during pregnancy may contribute to disparities in maternal and infant health outcomes as research has found that women of color experienced greater stress from experiencing racial discrimination than White women. Pregnancy-specific stress and lifetime exposure to racial discrimination disproportionately affect Black women and other women of color, and racial discrimination is associated with increased risk of psychological distress and reduced social support during pregnancy. Exposure to racial discrimination is associated with higher rates of preterm births, small for gestational age, and low weight births among infants born to Black women compared to White women. Additionally, experiencing racial discrimination during pregnancy is associated with elevated stress-related inflammatory markers and poor sleep among Black women, which may negatively affect maternal and perinatal health outcomes. Research among Black women also links maternal experiences of racial discrimination to poor sleep health among their children.

Mental Health and Substance Use

Recent evidence builds upon prior literature linking racism and discrimination to negative mental health outcomes, including post-traumatic stress disorder (PTSD), depression, and anxiety. Racial discrimination is associated with depression, anxiety, post-traumatic stress symptoms, and suicidal ideation and attempts among Black people. Recent studies indicated that exposure to discrimination exacerbated PTSD symptoms following traumatic injuries, as the added stress of racial bias may compound the psychological impact of the original trauma. Additionally, research among Black adults found that higher experiences of racial discrimination were associated with non-remitting PTSD, or PTSD that does not improve over time. Among Black youth between ages 9–14, higher levels of racial discrimination were associated with a greater risk of developing depressive symptoms over time. A study of school-age youth between 6^th and 12^th grade found that experiences of racial discrimination were associated with serious psychological distress and suicidality, most prominently among Black, Asian, and multiracial students. Research among Black youth between ages 11–19 found associations between online racial discrimination, PTSD symptoms, and suicidal ideation.

Emerging research also suggests that racial discrimination may contribute to changes to brain structure and activity that may increase risk of brain disorders and poor mental health outcomes. Brain structure plays a role in determining cognitive function and emotional regulation, with certain changes in brain volume, white matter integrity, and connectivity between different parts of the brain potentially increasing vulnerability to brain disorders and mental health conditions such as PTSD, depression, and anxiety. Research utilizing brain imaging methods has shown that experiencing racial discrimination is linked to reduced white matter integrity among Black adults 55 and older, which may increase the risk of stroke, dementia, and cognitive decline, and lower overall brain volume, which may be associated with depression. Among Black women, experiencing racial discrimination was associated with further reduced white matter integrity even when accounting for changes associated with trauma and PTSD. Research among Black youth found that coping with racial discrimination was associated with changes in brain activity that increased anxiety, depression, aggression, and rule-breaking symptoms. Research among trauma-exposed Black women also found that experiencing racial discrimination was associated with changes in connectivity between certain brain regions, including heightened activation in brain regions associated with threat vigilance and response, a state of chronic heightened stress. Another study among those who experienced a traumatic brain injury found that exposure to racial discrimination was associated with heightened connections in brain areas responsible for threat arousal, which is a state of heightened alertness that typically activates a stress response due to danger.

Experiencing racial discrimination is associated with an increased risk of substance use and alcohol use disorders. A review of studies found significant links between experiences of racial discrimination and both substance use and negative mental health outcomes. Experiences of racial discrimination were found to be associated with an increased risk for alcohol use disorder among AIAN, Black, Hispanic, and NHPI adults. Research also found that, among Hispanic college students, racial discrimination was a significant risk factor for the development of maladaptive alcohol use. A study of Black adults ages 18–24 found that experiences of racial discrimination were associated with past-year drug use and with frequent drug use, with a stronger association seen among those with a higher socioeconomic status compared to adults with lower socioeconomic status.

Sleep Disruption

Data suggest that racial discrimination is associated with sleep disruption, which may contribute to a range of negative health outcomes. Poor sleep is associated with a range of negative health outcomes, including increased inflammation, heightened risk for diabetes and obesity, and mental health issues such as depression and anxiety. Among youth ages 13–15, experiences of racial discrimination were linked to shorter sleep duration, more frequent disturbances, increased depressive symptoms, and lower levels of self-esteem. Additionally, research among college students found that experiences of racial discrimination contributed to greater increases in sleep problems among Black students compared to White students. Other research among people diagnosed with insomnia disorder found that experiences of racial discrimination were a significant factor in the link between race and insomnia severity for Black, Asian, and multiracial individuals.

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