High-income countries like Canada have the highest self-reported levels of life satisfaction in the world, although little is known regarding the experiences of racialized people and immigrants to these countries. This study investigates the factors that influence subjective well-being among a large national cohort study of 8,063 adults from the Canadian Alliance of Healthy Hearts and Minds cohort study recruited between 2014 and 2018, including a subset of 2,142 immigrants. Measures of demographic, socioeconomic, health, healthcare access, and self-reported ethnicity, from which racialized status was derived, were investigated in relation to self-reported life satisfaction as measured by the validated Cantril ladder score. Among 8,063 adults average age of 58 years, approximately half were women, 18.6% were racialized, and 26.6% were immigrants. Racialized immigrants had significantly lower life satisfaction compared to non-racialized immigrants and Canadian-born persons, whether racialized or not. Multivariable analysis showed that factors associated with higher life satisfaction included older age, male sex, having trusted neighbours, and having a language-concordant family doctor. Factors associated with lower life satisfaction included being racialized, having a higher social disadvantage, poorer cardiovascular health, and being unable to afford prescription medications. Amongst immigrants, those racialized were more likely to report experiencing discrimination based on skin colour and reported lower life satisfaction. Although high income countries like Canada have amongst the highest life satisfaction scores in the world, racialized people, especially immigrants, have lower life satisfaction compared to non-racialized people.

The authors have declared no competing interest.

CAHHM was funded by the Canadian Partnership Against Cancer (CPAC), Heart and Stroke Foundation of Canada (HSF-Canada), and the Canadian Institutes of Health Research (CIHR). Financial contributions were also received from the Population Health Research Institute and CIHR Foundation Grant no. FDN-143255 to S.S.A.; FDN-143313 to J.V.T.; and FDN 154317 to E.E.S. In-kind contributions from A.R.M. and S.E.B. from Sunnybrook Hospital, Toronto for MRI reading costs, and Bayer AG for provision of IV contrast. The Canadian Partnership for Tomorrow's Health is supported by the Canadian Partnership Against Cancer, BC Cancer, Genome Quebec, Centre de recherche CHU Sainte-Justine, Ontario Institute for Cancer Research, Alberta Health, Alberta Cancer Foundation, Alberta Health Services, and Dalhousie University. The PURE Study was funded by multiple sources. The Montreal Heart Institute Biobank is funded by Mr Andre Desmarais and Mrs France Chretien-Desmarais and the Montreal Heart Institute Foundation. S.S.A. was supported by the Heart and Stroke Foundation Chair in Population Health. S.A.L is supported by the Pfizer/Heart & Stroke Foundation Chair in Cardiovascular Prevention Research at St. Paul's Hospital. P.A. was supported by a Ministry of Research and Innovation of Ontario Investigator Award. S.E.B. was supported by the Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, and the Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto. E.L. was supported by the Laval University Chair of Research & Innovation in Cardiovascular Imaging and the Fonds de recherche du Quebec-Sante. J.-C.T. holds the Tier 1 Canada Research Chair in translational and personalized medicine and the Universite de Montreal Pfizer endowed research chair in atherosclerosis. CG is supported by grants from the Swiss National Science Foundation (SNSF, # PP00P3_163892 and # PP00P3_190074), the Olga Mayenfisch Foundation, Switzerland, the OPO Foundation, Switzerland, the Novartis Foundation, Switzerland, the Swissheart Foundation, the Helmut Horten Foundation, Switzerland, the University Hospital Zurich (USZ) Foundation, the Iten-Kohaut Foundation, Switzerland, and the EMDO Foundation, Switzerland. Some of the data used in this research were made available by the Canadian Partnership for Tomorrow's Health along with BC Generations Project, Alberta's Tomorrow Project, Ontario Health Study, CARTaGENE, and the Atlantic PATH. Data were harmonized by Maelstrom Research and access policies and procedures were developed by the Centre of Genomics and Policy in collaboration with the Cohorts.

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Ethics Committee of Hamilton Integrated Research Ethics Board gave ethical approval for this work (HiREB #13-255).

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

The data underlying this article will be shared on reasonable request to the corresponding author.