背景:这项横断面研究检查了种族-迁移关系之间的关联,对交叉歧视的累积暴露(在COVID-19大流行之前和期间的2年),和长期条件。
方法:从2020年8月4日至24日加拿大统计局的众包在线调查中获得了一个全国性的自选样本(n=32,605)。使用二元和多元逻辑回归模型来检查种族迁移关系在多种情况和基于身份的歧视及其与长期条件的关系的积累经验中的差异,在控制社会人口统计学协变量后。
结果:在大流行期间,来自种族化的歧视-例如种族/肤色(24.4%vs20.1%)和种族/文化(18.5%vs16.5%)-和网络空间(34.1%vs29.8%)相对于大流行前时期被夸大;与加拿大出生的(CB)白人相比,经历多重歧视的可能性随着歧视领域的增加而增加(例如,基于身份,所有p<0.001)在CB种族化少数民族中(ORs2.08至11.78),外国出生的(FB)种族少数群体(ORs1.99至12.72),和土著居民(ORs1.62至8.17),除FB白色外(p>0.01);在累积暴露于多重歧视和报告长期状况的几率之间发现了剂量-反应关系(p<0.001),包括查看(ORs1.63至2.99),听证(ORs1.83至4.45),物理(ORs1.66至3.87),认知(ORs1.81至3.79),和心理健康相关的损害(ORs1.82至3.41)。
结论:尽管有全民卫生系统,加拿大人是CB/FB种族化和土著居民,在COVID-19大流行期间,与多种长期疾病相关的不同方面的歧视累积暴露率较高。需要公平驱动的解决方案,通过根除种族和移民社区面临的交叉歧视来解决健康不平等的上游决定因素。
BACKGROUND: This cross-sectional study examines associations between the race-migration nexus, cumulative exposure to intersectional discrimination (2 years before and during the COVID-19 pandemic), and long-term conditions.
METHODS: A nationwide self-selected sample (n = 32,605) was obtained from a Statistics Canada\'s Crowdsourcing online survey from August 4 to 24, 2020. Binary and multinomial logistic regression models were used to examine disparities by the race-migration nexus in accumulative experiences of multiple situations- and identity-based discrimination and their relations with long-term conditions, after controlling for sociodemographic covariates.
RESULTS: During the pandemic, discrimination stemming from racialization - such as race/skin color (24.4% vs 20.1%) and ethnicity/culture (18.5% vs 16.5%) - and cyberspace (34.1% vs 29.8%) exaggerated relative to pre-pandemic period; compared to Canadian-born (CB) whites, the likelihood of experiencing multiple discrimination increased alongside the domains of discrimination being additively intersected (e.g., identity-based, all p\'s < 0.001) among CB racialized minorities (ORs 2.08 to 11.78), foreign-born (FB) racialized minorities (ORs 1.99 to 12.72), and Indigenous populations (ORs 1.62 to 8.17), except for FB whites (p > 0.01); dose-response relationships were found between cumulative exposure to multiple discrimination and odds of reporting long-term conditions (p\'s < 0.001), including seeing (ORs 1.63 to 2.99), hearing (ORs 1.83 to 4.45), physical (ORs 1.66 to 3.87), cognitive (ORs 1.81 to 3.79), and mental health-related impairments (ORs 1.82 to 3.41).
CONCLUSIONS: Despite a universal health system, Canadians who are CB/FB racialized and Indigenous populations, have a higher prevalence of cumulative exposure to different aspects of discrimination that are associated with multiple long-term conditions during the COVID-19 pandemic. Equity-driven solutions are needed to tackle upstream determinants of health inequalities through uprooting intersectional discrimination faced by racialized and immigrant communities.