Identifying the social mechanisms for multiracial-monoracial health disparities

The United States is witnessing rapid growth in multiracial populations, yet the social mechanisms producing health disparities between multiracial and monoracial groups remain poorly understood. Using the nationally representative Behavioral Risk Factor Surveillance System (2001–2012, N = 4,363,547), we examine mental and physical health outcomes through self-reported measures of poor mental and physical health days, systematically investigating four pathways potentially explaining multiracial-monoracial health disparities: 1) socioeconomic status, 2) early life adversity, 3) race-related experiences, and 4) health behaviors. Results based on negative binomial regressions and Karlson-Holm-Breen mediation tests reveal that Black multiracial, American Indian or Alaska Native multiracial, and Other multiracial individuals report worse mental and physical health despite higher socioeconomic status compared to their monoracial counterparts. Among Asian multiracial individuals, worse health outcomes compared to monoracial peers are partially attributed to socioeconomic factors and health behaviors. Across all multiracial groups, health disadvantages are largely explained by differences in early life social conditions, particularly exposure to family instability and adverse childhood experiences. Unexpectedly, race-related experiences show suppression rather than mediation effects, suggesting that accounting for discrimination actually increases observed health gaps. Our findings demonstrate how non-socioeconomic pathways, particularly early life adversity, play crucial roles in producing health disparities in an increasingly diverse society.