A latent measure of cultural racism and its association with US mortality and life expectancy

The US social context is characterized by systemic racism, a key driver of racial disparities. While structural and interpersonal racism are well-established components of systemic racism, cultural racism-a system of beliefs (ideology) and societal way of life (culture)-has been less robustly described and currently lacks a validated measure. We conducted confirmatory factor analysis on nine key indicators to define a cultural racism latent measure. In an analysis of US mortality data between 2018 and 2021 obtained from the Centers for Disease Control and Prevention's WONDER system, each unit increase in the cultural racism factor was associated with ~136 (95% confidence interval, 90 to 182) all-cause deaths per 100,000 and a one-year decline in life expectancy (~-1 (-2 to -1)); these associations were consistent for both Black and white adults. The cultural racism factor substantially advances the science of racism and health and provides an empirical basis for efforts to address US health inequities.