Discrimination, persecution, and health in older European adults

Abstract Background Discrimination and persecution (henceforth persecution) can affect socioeconomic status (SES) and health. Central and Eastern Europe (CEE) has a history of war and political instability that has contributed to persecution of various groups across generations. We examine its association with memory and health outcomes in older adults across CEE, an area that remains understudied. Methods We analyzed data from 21,989 participants (59% female; mean age 67 years) in 11 CEE countries from wave 7 of the Survey of Health, Ageing, and Retirement in Europe. A self-reported index captured intergenerational persecution with four levels: 0) none, 1) parental only, 2) personal only, 3) both. Outcomes were memory (z-score of immediate and delayed recall), cardiovascular disease (CVD, defined by diagnoses), poor or fair self-reported health (SRH), and chronic disease count. We fitted linear or logistic regression models adjusting for age, sex, region, birth cohort, and childhood SES. Results 37% of participants reported experiences of persecution (23% parental only; 6% personal only; 8% both). CVD, poor SRH, and chronic disease count showed a dose-response relationship, where both personal and parental exposure were associated with the worst outcomes (OR 1.2, 95% CI 1.15-1.5 for CVD; OR 1.43, 95% CI 1.32-1.67 for poor SRH; β = 0.48, 95% CI 0.42-0.57 for chronic disease count). Experiencing only personal or parental persecution was also linked to worse health, but with a smaller effect. In contrast, experiencing both personal and parental persecution was associated with higher memory scores (β = 0.07 SD, 95% CI 0.03-0.07), while parental only was linked to lower memory scores (β=-0.03 SD, 95% CI -0.06 to -0.001). Conclusions Persecution, especially when experienced both personally and by one's parents, is associated with poorer physical health and presents complex associations with memory in older adults in CEE. Key messages • Over one-third of older adults in CEE reported persecution, highlighting its widespread reach across the region. • Parental exposure to persecution is linked to worse physical and cognitive health in older adults across CEE, with a dose-response for physical health outcomes.