Effects of Racial Prejudice on the Health of Communities: A Multilevel Survival Analysis.

OBJECTIVES We examined whether and how racial prejudice at both the individual and community levels contributes to mortality risk among majority as well as minority group members. METHODS We used data on racial attitudes from the General Social Survey (1993-2002) prospectively linked to mortality data from the National Death Index through 2008. RESULTS Whites and Blacks living in communities with higher levels of racial prejudice were at an elevated risk of mortality, independent of individual and community sociodemographic characteristics and individually held racist beliefs (odds ratio = 1.24; 95% confidence interval = 1.04, 1.49). Living in a highly prejudiced community had similar harmful effects among both Blacks and Whites. Furthermore, the interaction observed between individual- and community-level racial prejudice indicated that respondents with higher levels of racial prejudice had lower survival rates if they lived in communities with low degrees of racial prejudice. Community-level social capital explained the relationship between community racial prejudice and mortality. CONCLUSIONS Community-level racial prejudice may disrupt social capital, and reduced social capital is associated with increased mortality risk among both Whites and Blacks. Our results contribute to an emerging body of literature documenting the negative consequences of prejudice for population health.