Associations of regional racial attitudes with chronic illness in the United States

A growing body of literature has identified a robust relationship between the experience of racial discrimination and negative self-reported physical and mental health outcomes. The current study seeks to identify which factors -at the community level- predict racial disparities in actual disease manifestation. This study focuses on the extent to which regional demographics and racial attitudes, both implicit and explicit, are associated with prevalence rates of several diseases for Black and White patients in the United States. Implicit and explicit racial attitudes obtained from Project Implicit (Xu et al., 2017) were aggregated at the county level to predict variation in the prevalence rates of several chronic illnesses among Medicare recipients. When controlling for economic indicators, Black and White patients who live in areas with high implicit and explicit racial bias tend to exhibit a higher incidence of chronic health problems, including cancer, stroke, asthma, diabetes, and heart failure. These relationships tended to be stronger for Black patients. Additionally, patients in racially diverse and racially segregated regions also tended to exhibit a higher incidence of chronic health problems. Findings from the study highlight the reliable relationship between both racial biases and regional demographics and the incidence rates of several chronic diseases, particularly in Black patients. •Region-level implicit and explicit racial biases are linked with negative health outcomes.•Link between bias and negative health is strongest for Black Medicare patients.•Implicit biases are associated with health outcomes over and above explicit biases.