Experiences of and reactions to race-based differential treatment with multiple chronic conditions by race: Evidence from the South Carolina behavioral risk factor surveillance systems surveys prior to the COVID-19 pandemic.

Background: Multiple chronic conditions (MCCs) are of increasing public health concern. There remain significant gaps in understanding the relationship between racial discrimination as a determinant of MCC burden. This study examines the association between race-based differential treatment and MCC prevalence by race. Methods: We analyzed data from Black and White adults who completed the South Carolina Behavioral Risk Factor Surveillance System (2016-2017) survey Reactions to Race optional module (n=18,047). MCCs were summed and categorized (0; 1; 2-3; 4+ conditions). Racial discrimination was operationalized across multiple domains: experiences of race-based differential treatment in work settings and in healthcare settings, and emotional and physical reactions to race-based differential treatment. Multinomial logistic regression models were stratified by race and adjusted for confounders. Results: Overall, 63.7% of Black and 60.4% of White adults had ≥2 MCC. Experiences of race-based differential treatment in work and health care settings and emotional reactions to race-based differential treatment were associated with a higher risk of MCCs among Black and White adults. Conclusions: Our findings suggest that experiences and reactions to race-based differential treatment were associated with greater MCC burden among Black and White adults. This adds to a growing literature highlighting the importance of examining racial discrimination as a key factor contributing to the MCC burden within populations. Future research should interrogate potential social mechanisms identifying high MCC risk within racial groups.