Intersectionality, discrimination, and quality of life in the adult population in Florianópolis, Southern Brazil

The study investigated how the interaction between axes of marginalization based on race/color, gender, schooling, and interpersonal discrimination affect different dimensions of quality of life in adult individuals. This is a cross-sectional study with data from the second wave of the EpiFloripa Adult Study in Florianópolis, southern Brazil, in 2012. We estimated linear regression models for each domain and for overall quality of life, measured with WHOQOL-Bref. The KHB method was used to estimate the mediating role of perceived discrimination in the associations between the axes of marginalization and quality of life. The analysis showed that schooling and gender operate additivelly, but not intersectionally, on overall quality of life and on the physical domain, with a disadvantage for women and individuals with 11 years of schooling or less. Schooling and race/color were predictors of the environmental domain, with lower mean values for blacks and individuals with 11 years of schooling or less. In the psychological domain, the intersection between gender and schooling resulted in a mean value 2.9 points higher for women with 12 or more years of schooling. Gender and race/color were predictors of quality of life in the social domain, reducing the mean value for black women by 11.3 points. Mediation analyses showed that 29.6% of the effect of the intersection between schooling and gender on the psychological domain and 4.3% of the effect of the intersection between race/color and gender on the social domain were mediated by interpersonal discrimination. These results confirmed the study hypotheses, pointing to the importance and contribution of an intersectional analysis for studying inequities in quality of life.本研究旨在探讨基于种族/肤色、性别、受教育程度的边缘化维度与人际歧视的交互作用，对成年人群体生活质量各维度的影响。本研究为横断面研究，数据来源于巴西南部弗洛里亚诺波利斯市2012年开展的EpiFloripa成人研究（EpiFloripa Adult Study）第二波调研，采用世界卫生组织生活质量量表简版（WHOQOL-Bref）对总体生活质量及各维度生活质量进行评估，并针对每个维度分别构建线性回归模型，同时采用KHB法（KHB method）评估感知歧视在边缘化维度与生活质量间的关联中所起的中介作用。分析结果显示，受教育程度与性别对总体生活质量及生理领域存在相加效应，而非交叉交互效应，女性及受教育年限≤11年的群体生活质量水平更低；受教育程度与种族/肤色为环境领域生活质量的预测因素，黑人及受教育年限≤11年的群体该领域平均得分更低；在心理领域，性别与受教育程度的交叉交互作用显示，受教育年限≥12年的女性该领域平均得分较其他群体高出2.9分；性别与种族/肤色为社会领域生活质量的预测因素，黑人女性的该领域平均得分降低11.3分。中介分析表明，受教育程度与性别间的交叉交互作用对心理领域的影响中，有29.6%可通过人际歧视的中介效应予以解释；种族/肤色与性别间的交叉交互作用对社会领域的影响中，有4.3%可通过人际歧视的中介效应予以解释。本研究结果验证了预设研究假设，证实了交叉性分析在研究生活质量公平性问题中的重要价值与贡献。