Metheny Nicholas, Dusing Gabriel John, Ndagurwa Pedzisai, Mkhize Sthembiso Pollen
Nell Hodgson Woodruff School of Nursing, 1520 Clifton Rd. NE, Atlanta, GA, 30322, USA; Division of Nursing and Midwifery, University of Cape Town, Observatory, Cape Town, 7935, South Africa.
Faculty of Health, York University, 4700 Keele Street Toronto, ON, M3J 1P3, Canada; Li Ka Shing Knowledge Institute, St Michael's Hospital, 30 Bond St, Toronto, ON, M5B 1W8, Canada.
Soc Sci Med. 2025 Feb;366:117651. doi: 10.1016/j.socscimed.2024.117651. Epub 2024 Dec 21.
South Africa's history of apartheid has led to persistent inequalities. While progress has been made since 1994, disparities in quality of life (QoL) remain, particularly along racial lines. This study examines how race, gender, and sexual orientation intersect to influence QoL in Gauteng - South Africa's most populous and economically vibrant province.
Using data from the Gauteng City-Region Observatory's QoL 6 (2020/2021) Survey, we analyzed a sample of 10,760 respondents. We employed inverse probability weighting with regression adjustment (IPWRA) to estimate the Average Treatment Effect (ATE) of race, gender, and sexual minority status on QoL, while controlling for socioeconomic factors.
Significant QoL disparities were observed across intersecting identities. White heterosexual men had the highest QoL scores, while Black sexual minority women had the lowest. After adjusting for covariates, all Black groups exhibited significantly lower QoL scores compared to their White counterparts. The largest gap was between White sexual minority women and Black sexual minority men (ATE: -14.47; 95%CI: -17.18,-11.76). Within the Black population, heterosexual men had significantly higher QoL than heterosexual women (ATE: -0.98; 95%CI: -1.54, -0.42).
Despite progress since apartheid, substantial QoL disparities persist in Gauteng, primarily along racial lines, particularly in access to services and socio-economic opportunities. The intersectionality of race, gender, and sexual orientation creates distinct vulnerabilities, particularly for Black sexual minority women. These findings suggest that current policies aimed at improving equity may be insufficient. Addressing these disparities requires a multifaceted approach that considers the complex interplay of race, gender, and sexual orientation in shaping QoL.
南非的种族隔离历史导致了持续的不平等。尽管自1994年以来取得了进展，但生活质量（QoL）方面的差距依然存在，尤其是在种族层面。本研究考察了种族、性别和性取向如何相互作用，以影响豪登省（南非人口最多且经济最活跃的省份）的生活质量。
我们使用了豪登城市区域观测站生活质量6（2020/2021）调查的数据，分析了10760名受访者的样本。我们采用逆概率加权回归调整（IPWRA）来估计种族、性别和性少数群体身份对生活质量的平均治疗效果（ATE），同时控制社会经济因素。
在交叉身份中观察到了显著的生活质量差异。白人异性恋男性的生活质量得分最高，而黑人性少数群体女性的得分最低。在调整协变量后，所有黑人组的生活质量得分均显著低于白人组。最大的差距存在于白人性少数群体女性和黑人性少数群体男性之间（ATE：-14.47；95%CI：-17.18，-11.76）。在黑人人口中，异性恋男性的生活质量显著高于异性恋女性（ATE：-0.98；95%CI：-1.54，-0.42）。
尽管自种族隔离以来取得了进展，但豪登省仍存在巨大的生活质量差距，主要体现在种族层面，尤其是在获得服务和社会经济机会方面。种族、性别和性取向的交叉性造成了独特的脆弱性，尤其是对黑人性少数群体女性而言。这些发现表明，目前旨在改善公平性的政策可能并不充分。解决这些差距需要采取多方面的方法，考虑到种族、性别和性取向在塑造生活质量方面的复杂相互作用。
