Perceived discrimination and use of preventive health services Authors
Received: 02 September 2005 Revised: 17 November 2005 Accepted: 04 January 2006 DOI:
Cite this article as: Trivedi, A.N. & Ayanian, J.Z. J Gen Intern Med (2006) 21: 553. doi:10.1111/j.1525-1497.2006.00413.x Abstract Little is known about the relation between perceptions of health care discrimination and use of health services. BACKGROUND: To determine the prevalence of perceived discrimination in health care, its association with use of preventive services, and the contribution of perceived discrimination to disparities in these services by race/ethnicity, gender, and insurance status. OBJECTIVES: Cross-sectional study of 54,968 respondents to the 2001 California Health Interview Survey. DESIGN, SETTING, AND PARTICIPANTS: Subjects were asked about experience with discrimination in receiving health care and use of 6 preventive health services, all within the previous 12 months. MEASUREMENTS: We used multivariate logistic regression with propensity-score methods to examine the adjusted relationship between perceived discrimination and receipt of preventive care. METHODS: Discrimination was reported by 4.7% of respondents, and among these respondents the most commonly reported reasons were related to type of insurance (27.6%), race or ethnicity (13.7%), and income (6.7%). In adjusted analyses, persons who reported discrimination were less likely to receive 4 preventive services (cholesterol testing for cardiovascular disease, hemoglobin A1c testing and eye exams for diabetes, and flu shots), but not 2 other services (aspirin for cardiovascular disease, prostate specific antigen testing). Adjusting for perceived discrimination did not significantly change the relative likelihood of receipt of preventive care by race/ethnieity, gender, and insurance status. RESULTS: Persons who report discrimination may be less likely to receive some preventive health services. However, perceived discrimination is unlikely to account for a large portion of observed disparities in receipt of preventive care. CONCLUSIONS: Key words discrimination disparities preventive care quality of care
The authors have no conflicts of interest to disclose.
Preliminary results from this study were presented at the 2004 Society of General Internal Medicine Annual Meeting in Chicago, IL, and the 2004 Academy Health Annual Research Meeting in San Diego, CA.
Dr. Trivedi was supported by an institutional National Research Service Award (#5 T32 HP11001-15) from the Health Resources and Services Administration.
Ayanian JZ, Weissman JS, Schneider EC, Ginsburg JA, Zaslavsky AM
. Unmet health needs of uninsured adults in the United States. JAMA. 2000;284:2061–9.
Institute of Medicine. Coverage Matters: Insurance and Health Care. Washington, DC: National Academy Press; 2001.
Ayanian JZ, Epstein AM
. Differences in the use of procedures between women and men hospitalized for coronary artery disease. N Engl J Med. 1991;325:221–5.
Ayanian JZ, Weissman JS, Chasan-Taber S, Epstein AM
. Quality of care by race and gender for congestive heart failure and pneumonia. Med Care. 1999;37:1260–9.
Mayberry RM, Mili F, Ofili E
. Racial and ethnic differences in access to medical care. Med Care Res Rev. 2000;57:108–45.
Smedley BD, Stith AY, Nelson AR, eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: National Academy Press; 2002.
Jary J, Jary D. Collins Dictionary of Sociology. 2nd edn. Glasgow, UK: HarperCollins; 1995.
. Levels of racism: a theoretic framework and a gardener’s tale. Am J Public Health. 2000;90:1212–5.
Krieger N. Discrimination and health. In: Berkman L, Kawachi I, eds. Social Epidemiology. Oxford: Oxford University Press; 2000;36–75.
James SA, La Croix AZ, Kleinbaum DG, Strogatz DS
. John Henryism and blood pressure differences among black men: the role of occupational stressors. J Behav Med. 1984;7:259–75.
. Racial and gender discrimination: risk factors for high blood pressure? Soc Sci Med. 1990;30:1273–81.
Krieger N, Sidney S
. Racial discrimination and blood pressure: the CARDIA study of young black and white adults. Am J Public Health. 1996;86:1370–8.
Din-Dzietham R, Nembhard WN, Collins R, Davis SK
. Perceived stress following race-based discrimination at work is associated with hypertension in African-Americans. The metro Atlanta heart disease study, 1999–2001. Soc Sci Med. 2004;58:449–61.
Steffen PR, McNeilly M, Anderson N, Sherwood A
. Effects of perceived racism and anger inhibition on amblatory blood pressure in African Americans. Psychosom Med. 2003;65:746–50.
Ladrine H, Klonoff EA
. The schedule of racist events: a measure of racial discrimination and study of its negative physical and mental health consequences. J Black Psychol. 1996;22:144–68.
Williams DR, Yu Y, Jackson J, Anderson NB
. Racial differences in physical and mental health: socioeconomic status, stress, and discrimination. J Health Psychol. 1997;2:335–51.
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;38:1735–59.
Mays VM, Cochran SD
. Mental health correlates of perceived discrimination among lesbian, gay, and bisexual adults in the United States. Am J Public Health. 2001;91:1869–76.
Van Houtven CH, Voils CI, Oddone EZ, et al.
Perceived discrimination and reported delay of pharmacy prescriptions and medical tests. J Gen Intern Med. 2005;20:578–83.
O’Malley AS, Sheppard VB, Schwartz M, Mandelblatt J
. The role of trust in use of preventive services among low-income African-American women. Prev Med. 2004;38:777–85.
Schulman KA, Berlin JA, Harless W, et al.
The effect of race and sex on physicians’ recommendations for cardiac catheterization. N Engl J Med. 1999;340:848–57.
California Health Interview Survey. Technical paper no 1. Available at: http://www.chis.ucla.edu/pdf/2001_response_representativeness.pdf. Accessed December 9, 2005.
Behavioral Risk Factor Surveillance System. Technical information and data. 2004 summary data quality report. Available at: http://www.cdc.gov/brfss/technical_infodata/2004QualityReport.htm. Accessed December 9, 2005.
U.S. Preventive Services Task Force. Aspirin for the primary prevention of cardiovascular events: recommendations and rationale. Ann Intern Med. 2002;136:157–60.
Hayden M, Pignone M, Phillips C, Mulrow C. Aspirin for the primary prevention of cardiovascular events: a summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2002;136:157–60.
Smith RA, Cokkinides V, Eyre HJ
. American Cancer Society guidelines for the early detection of cancer. CA Cancer J Clin. 2003;53:27–43.
Centers for Disease Control and Prevention. Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2003;52:1–36.
American Diabetes Association
. Standards of medical care for patients with diabetes mellitus. Diabetes Care. 2003;26:S33–50.
CHIS 2001 Methodology Series. Report 2. Data collection methods. Available at: http://www.chis.ucla.edu/pdf/CHIS2001_method2.pdf. Accessed December 9, 2005.
. Estimating causal effects from large data sets using propensity scores. Ann Intern Med. 1997;127:757–63.
LaVeist TA, Rolley NC, Diala C
. Prevalence and patterns of discrimination among U.S. Health Care Consumers. Intl J Health Serv. 2003;33:331–44.
Blanchard J, Lurie N
. Respect: patient reports of disrespect in the health care setting and its impact on care. J Fam Pract. 2004;53:721–30.
Heisler M, Smith DM, Hayward RA, Krein SL, Kerr EA
. Racial disparities in diabetes care processes, outcomes, and treatment intensity. Med Care. 2003;41:1221–32.
National Center for Health Statistics. Health, United States, 2004 with Chartbook on Trends in the Health of Americans. Washington, DC: U.S. Government Printing Office; 2004.
Nelson K, Norris K, Mangione CM
. Disparities in the diagnosis and pharmacologic treatment of high serum cholesterol by race and ethnicity: data from the third National Health and Nutrition Examination Survey. Arch Intern Med. 2002;162:929–35.
Persell SD, Baker DW
. Aspirin use among adults with diabetes: recent trends and emerging sex disparities. Arch Intern Med. 2004;164:2492–9.
Ward E, Jemal A, Cokkinides V, et al.
Cancer disparities by race and socioeconomic status. CA Cancer J Clin. 2004;54:78–93.
Kaiser Family Foundation. State Health Facts. Available at: www.statehealthfacts.org. Accessed December 6, 2005.
Blank RM, Dabady M, Citro CF, eds. Measuring Racial Discrimination. Washington, DC: National Academy Press; 2004.
Krieger N, Smith K, Naishadham D, Hartman C, Barbeau EM
. Experiences of discrimination: validity and reliability of a self-report measure for population health research on racism and health. Soc Sci Med. 2005;61:1576–96.
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