Perceived Discrimination and Self-Reported Quality of Care Among Latinos in the United States
Given the persistence of health and health-care disparities among Latinos in the United States and evidence that discrimination affects health and health care, an investigation of the relationship between perceived discrimination and quality of health care among Latinos is warranted.
To examine the relationship of perceived discrimination (in general and in regard to doctors and medical personnel) with self-reported quality of health care and doctor-patient communication in a nationally representative Latino population sample.
Participants were 1,067 Latino adults aged ≥18 years living in the US selected via random-digit dialing. Telephone interviews were conducted in 2008 during Wave 2 of the Pew Hispanic Center/Robert Wood Johnson Foundation Hispanic Healthcare Survey.
US-born Latinos were twice as likely to report general discrimination as foreign born: 0.32 SD versus −0.23 SD (P < 0.001) on the Detroit Area Survey (DAS) discrimination scale. Higher DAS discrimination was associated with lower self-reported quality of care in US-born Latinos [OR = 0.5; 95% CI (0.3, 0.9); P = 0.009]. For foreign-born Latinos, report of any doctor or medical staff discrimination was associated with lower quality of care [OR = 0.5; 95% CI (0.3, 0.9); P = 0.03], but the DAS was not. For US-born Latinos, doctor discrimination and higher DAS were jointly associated with worse doctor-patient communication. For foreign-born Latinos, the effect of discrimination on doctor-patient communication was significantly smaller than that observed in US-born Latinos.
Given the association between perceived discrimination and quality of care, strategies to address discrimination in health-care settings may lead to improved patient satisfaction with care and possibly to improved treatment outcomes.
- Trivedi AN, Ayanian JZ. Perceiveddiscrimination and use of preventive health services. J Gen Intern Med. 2006;21(6):553–8. CrossRef
- Stuber J, Galea S, Ahern J, Blaney S, Fuller C. The association between multiple domains of discrimination and self-assessed health: A multilevel analysis of Latinos and Blacks in four low-income New York City neighborhoods. Health Serv Res. 2003;38:1735–60. CrossRef
- Burgess DJ, Ding Y, Hargreaves M, van Ryn M, Phelan S. The association between perceived discrimination and underutilization of needed medical and mental health care in a multi-ethnic community sample. J Health Care Poor Underserved. 2008;19:894–911. CrossRef
- Williams DR, Harold W, Neighbors HW, Jackson JS. Racial/ethnic discrimination and health: findings from community studies. Am J Public Health. 2003;93:200–8. CrossRef
- Pérez DJ, Fortuna L, Alegría M. Prevalence and correlates of everyday discrimination among U.S. Latinos. J Community Psychol. 2008;36:421–33. CrossRef
- Bernstein R. Nation’s Population One-Third Minority. US Census Bureau. 2006. http://www.census.gov/Press-Release/www/releases/archives/population/006808.html. Accessed December 20, 2008.
- Bernstein R. US Hispanic Population Surpasses 45 Million Now 15 Percent of Total. US Census Bureau. 2008. http://www.census.gov/Press-Release/www/releases/archives/population/006808.html. Accessed December 20, 2008.
- Crawley LM, Ahn DK, Winkleby MA. Perceived medical discrimination and cancer screening behaviors of racial and ethnic minority adults. Cancer Epidemiol Biomarkers Prev. 2008;17(8)
- Ryan AM, Gee GC, Griffith D. The effects of perceived discrimination on diabetes management. J Health Care Poor Underserved. 2008;19:149–63. CrossRef
- Van Houtven CH, Voils CI, Oddone EZ, Weinfurt KP, Friedman JY, Schulman KA, Bosworth HB. Perceived Discrimination and Reported Delay of Pharmacy Prescriptions and Medical Tests
- Hausmann LRM, Jeong K, Bost JE, Ibrahim SA. Perceived discrimination in health care and health status in a racially diverse sample. Med Care. 2008;46:905–14. CrossRef
- Lauderdale DS, Wen M, Jacobs EA, Kandula NR. Immigrant perceptions of discrimination in health care: The California Health Interview Survey 2003. Med Care. 2006;44:914–20. CrossRef
- Hicks LS, Ayanian JZ, Orav EJ, Soukup J, et al. Is hospital service associated with racial and ethnic disparities in experiences with hospital care? Am J Med. 2005;118:529–35. CrossRef
- Nadeem E, Lange JM, Edge D, Fongwa M, Belin T, Miranda J. Does stigma keep poor young immigrant and US-born black and Latina women from seeking mental health care? Psychiatr Serv. 2007;58:1547–54. CrossRef
- Moradi B, Risco C. Perceived discrimination experiences and mental health of Latina/o American persons. J Couns Psychol. 2006;53:11–421.
- Williams DR, Collins C. US socioeconomic and racial differences in health: Patterns and explanations. Annu Rev Sociol. 1995;21:349–86. CrossRef
- Krieger N, Sidney S. Racial discrimination and blood pressure; the CARDIA study of young Black and White adults. Am J Public Health. 1996;86A(10):1370–78. CrossRef
- Guinier L, Torres G. The Miner’s Canary: Enlisting Race, Resisting Power, Transforming Democracy. Cambridge, Mass: Harvard University Press; 2003.
- Viruell-Fuentes EA. Beyond acculturation: Immigration, discrimination, and health research among Mexicans in the United States. Soc Sci Med. 2007;65:1524–35. CrossRef
- Lillie-Blanton M, Brodie M, Rowland D, et al. Race, ethnicity, and the health care system: public perceptions and experiences. Med Care Res Rev. 2000;57(Supplement 1):218–35.
- PewResearchCenter Project. Hispanics and Health Care in the United States: Access, Information and Knowledge. Washington, DC: A Joint Pew Hispanic Center and Robert Wood Johnson Foundation Research Report; 2008.
- Bureau of the Census for the Bureau of Labor Statistics. Washington, DC: US Census Bureau, 2007.
- Jackson J, Williams D, Torres M. Chapter 8: Perceptions of discrimination, health and mental health: The social stress process. In:Maney A, Ramos J(eds.), Socioeconomic Conditions, Stress and Mental Disorders: Toward a New Synthesis of Research and Public Policy. Ann Arbor, MI: University of Michigan, Institute for Social Research. Available at: http://www.mhsip.org/pdfs/jackson.pdf. Accessed December 10, 2008.
- Williams DR, Yu Y, Jackson JS, Anderson NB. Racial differences in physical and mental health. J Health Psychol. 1997;2:335–51. CrossRef
- Ngo-Metzger Q, Telfair J, Sorkin DH. Cultural Competency and Quality of Care: Obtaining the Patient’s Perspective; Commonwealth Fund Report. 2006.
- Stewart AL, Nápoles-Springer AM, Gregorich SE, Santoyo-Olsson J. Interpersonal processes of care survey: patient-reported measures for diverse groups. Health Serv Res. 2007;42(3 Pt 1):1235–56. CrossRef
- Rao JNK, Scott JA. On chi-squared tests for multiway contingency tables with cell poportions estimated from survey data. Ann Stat. 1984;12:46–60. CrossRef
- Rao JNK, Thomas DR. “Chi-squared tests for contingency tables”. In: Skinner CJ, Holt D, Smith TMF, eds. Analysis of complex surveys. New York: John Wiley & Sons; 1989: 89–114.
- Sribney W. Two-way contingency tables for survey or clustered data. Stata J. 1998;45:33–49.
- Korn E, Graubard B. Simultaneous testing of regression coefficients with complex survey data: Use of Bonferroni t statistics. Am Stat. 1990;44:270–276. CrossRef
- Stata Statistical Software Version 10.1 [computer program]. College Station, TX.; 2008.
- Vega WA, Koury EL, Zimmerman RS, Gil AG, Warheit GJ. Culture conflict and problem behaviors of Latino adolescents in home and school settings. J Commun Psychol. 1995;23:167–79. CrossRef
- Gee GC, Spencer M, Chen J, Yip T, Takeuchi DT. The association between self-reported racial discrimination and 12-month DSM-IV mental disorders among Asian Americans nation wide. Soc Sci Med. 2007;64:1984–96. CrossRef
- Mossakowski K. Coping with perceived discrimination: does ethnic identity protect mental health? J Health Soc Behav. 2003;44:318–31. CrossRef
- Gee GC, Spencer M, Chen J, Takeuchi DT. A nationwide study of discrimination and chronic health conditions among Asian Americans. Am J Public Health. 2007;97:1275–82. CrossRef
- Kessler RC, Michelson KD, Williams DR. The prevalence, distribution and mental health correlates of perceived discrimination in the United States. J Health Soc Behav. 1999;40:208–30. CrossRef
- Piette JD, Bibbins-Domingo K, Schillinger D. Health care discrimination, processes of care, and diabetes patients’ health status. Patient Educ Couns. 2006;60(1):41–8. CrossRef
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