Journal of Behavioral Medicine

, Volume 37, Issue 3, pp 402–413 | Cite as

Relationships between discrimination in health care and health care outcomes among four race/ethnic groups

Article

Abstract

Discrimination has been found to be detrimental to health, but less is known about the influence of discrimination in health care. To address this, the current study (1) compared levels of racial/ethnic discrimination in health care among four race/ethnic groups; (2) determined associations between this type of discrimination and health care outcomes; and (3) assessed potential mediators and moderators as suggested by previous studies. Multivariate logistic regression models were used within a population-based sample of 1,699 White, African American, Mexican, and Puerto Rican respondents. Overall, 23 % of the sample reported discrimination in health care, with levels varying substantially by race/ethnicity. In adjusted models, this type of discrimination was associated with an increased likelihood of having unmet health care needs (OR = 2.48, CI = 1.57–3.90) and lower odds of perceiving excellent quality of care (OR = 0.43, CI = 0.28–0.66), but not with the use of a physician when not sick or use of alternative medicine. The mediating role of mental health factors was inconsistently observed and the relationships were not moderated by race/ethnicity. These findings expand the literature and provide preliminary evidence that can eventually inform the development of interventions and the training of health care providers.

Keywords

Discrimination Racism Coping Race Ethnicity Health care utilization Quality of care CAM 

References

  1. Al-Mandhari, S., Hassan, A., & Haran, D. (2004). Association between perceived health status and satisfaction with quality of care: evidence from users of primary health care in Oman. Family Practice, 21, 519–527.PubMedCrossRefGoogle Scholar
  2. Andresen, E. M., Malmgren, J. A., Carter, W. B., & Donald, L. P. (1994). Screening for depression in well older adults: Evaluation of a short Form of the CES-D. American Journal of Preventive Medicine, 10, 77–84.PubMedGoogle Scholar
  3. Ayalon, L., & Gum, M. (2011). The relationships between major lifetime discrimination, everyday discrimination, and mental health in three racial and ethnic groups of older adults. Aging & Mental Health, 15, 587–594.CrossRefGoogle Scholar
  4. Barnes, L. L., Mendes de Leon, C. F., Lewis, T. T., Bienias, J. L., Wilson, R. S., & Denis, E. (2008). Perceived discrimination and mortality in a population-based study of older adults. American Journal of Public Health, 98, 1241–1247.PubMedCentralPubMedCrossRefGoogle Scholar
  5. Benjamins, M. R. (2012). Race/ethnic discrimination and preventive service utilization in a sample of Whites, Blacks, Mexicans, and Puerto Ricans. Medical Care, 50, 870–876.PubMedCrossRefGoogle Scholar
  6. Benjamins, M. R. (2013). Comparing measures of racial/ethnic discrimination, coping, and associations with health-related outcomes in a diverse sample. Journal of Urban Health. doi:10.1007/s11524-013-9787.
  7. Benkert, R., Peters, R. M., Clark, R., & Keves-Foster, K. (2006). Effects of perceived racism, cultural mistrust and trust in providers on satisfaction with care. Journal of the National Medical Association, 98, 1532–1540.PubMedCentralPubMedGoogle Scholar
  8. Blanchard, J., & Lurie, N. (2004). R-E-S-P-E-C-T: Patient reports of disrespect in the health care setting and its impact on care. Journal of Family Practice, 53, 721–729.PubMedGoogle Scholar
  9. Bogart, L. M., Bird, S. T., Walt, L. C., Delahanty, D. L., & Figler, J. (2004). Association of stereotypes about physicians to health care satisfaction, help-seeking behavior, and adherence to treatment. Social Science and Medicine, 58, 1049–1058.PubMedCrossRefGoogle Scholar
  10. Bogart, L. M., Catz, S. L., Kelly, J. A., & Benotsch, E. G. (2001). Factors influencing physicians’ judgments of adherence and treatment decisions for patients with HIV disease. Medical Decision Making, 21, 28–36.PubMedCrossRefGoogle Scholar
  11. Brondolo, E., Brady ver Halen, N., Pencille, M., Beatty, D., & Contrada, R. J. (2009). Coping with racism: A selective review of the literature and a theoretical and methodological critique. Journal of Behavioral Medicine, 32, 64–88.PubMedCentralPubMedCrossRefGoogle Scholar
  12. Brondolo, E., Hausmann, L. R., Jhalani, J., Pencille, M., Atencio-Bacayon, J., Kumar, A., et al. (2011). Dimensions of perceived racism and self-reported health: Examination of racial/ethnic differences and potential mediators. Annals of Behavioral Medicine, 42(1), 14–28.PubMedCrossRefGoogle Scholar
  13. Burgess, D. J., Ding, Y., Hargreaves, M., van Ryn, M., & Phelan, S. (2008). The association between perceived discrimination and underutilization of needed medical and mental health care in a multi-ethnic community sample. Journal of Health Care for the Poor and Underserved, 19, 894–911.PubMedCrossRefGoogle Scholar
  14. Casagrande, S. S., Gray, T. L., LaVeist, T. A., Gaskin, D. J., & Lisa, C. (2007). Perceived discrimination and adherence to medical care in a racially integrated community. Journal of General Internal Medicine, 22, 389–395.PubMedCentralPubMedCrossRefGoogle Scholar
  15. Clark, R., Anderson, N. B., Clark, V. R., & Williams, D. R. (1999). Racism as a stressor for African Americans. A biopsychosocial model. American Psychologist, 54, 805–816.PubMedCrossRefGoogle Scholar
  16. Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24, 385–396.PubMedCrossRefGoogle Scholar
  17. Facione, N. C. & Facione, P. A. (2007). Perceived prejudice in healthcare and women's health protective behavior. Nursing Research, 56(3), 175–184.PubMedCrossRefGoogle Scholar
  18. Finch, B. K., Hummer, R. A., Kolody, B., & William, A. V. (2001). The role of discrimination and acculturative stress in the physical health of Mexican-origin adults. Hispanic Journal of Behavioral Sciences, 23(4), 399–429.CrossRefGoogle Scholar
  19. Gee, G. C., Ryan, A., Laflamme, D. J., & Holt, J. (2006). Self-Reported discrimination and mental health status among African descendants, Mexican Americans, and other Latinos in the New Hampshire REACH 2010 initiative: The added dimension of immigration. American Journal of Public Health, 96, 1821–1828.PubMedCentralPubMedCrossRefGoogle Scholar
  20. Green, R., Carney, D. R., Pallin, D. J., Ngo, L. H., Raymond, K. L., Iezzoni, L. I., et al. (2007). Implicit bias among physicians and its prediction of thrombolysis decisions for black and white patients. Journal of General Internal Medicine, 22, 1231–1238.PubMedCentralPubMedCrossRefGoogle Scholar
  21. Hausmann, L. R. M., Hannon, M. J., Kresevic, D. M., Hanusa, B. H., Kwoh, C. K., & Ibrahim, S. A. (2011). Impact of perceived discrimination in healthcare on patient-provider communication. Medical Care, 49, 626–633.PubMedCentralPubMedCrossRefGoogle Scholar
  22. Hausmann, L. R. M., Jeong, K., Bost, J. E., & Ibrahim, S. A. (2008). Perceived discrimination in health care and use of preventive health services. Journal of General Internal Medicine, 23, 1679–1684.PubMedCentralPubMedCrossRefGoogle Scholar
  23. Hausmann, L. R., Kressin, N. R., Hanusa, B. H., & Ibrahim, S. A. (2010). Perceived racial discrimination in health care and its association with patients’ healthcare experiences: Does the measure matter? Ethnicity and Disease, 20, 40–47.PubMedGoogle Scholar
  24. Hoyo, C., Yarnall, K. S., Skinner, C. S., Moorman, P. G., Sellers, D., & Reid, L. (2005). Pain predicts non-adherence to Pap smear screening among middle-aged African American women. Preventive Medicine, 41, 439–445.PubMedCrossRefGoogle Scholar
  25. Inzlicht, M., McKay, L., & Aronson, J. (2006). Stigma as ego depletion: How being the target of prejudice affects self-control. Psychological Science, 17, 262–269.PubMedCrossRefGoogle Scholar
  26. Kish, L. (1965). Survey sampling. New York, NY: Wiley.Google Scholar
  27. Kohout, F. J., Berkman, L. F., Evans, D. A., & Cornoni-Huntley, J. (1993). Two shorter forms of the CES-D depression symptoms index. Journal of Aging and Health, 5, 179.PubMedCrossRefGoogle Scholar
  28. Kressin, N. R., Raymond, K. L., & Manze, M. (2008). Perceptions of race/ethnicity-based discrimination: A review of measures and evaluation of their usefulness for the health care setting. Journal of Health Care for the Poor and Underserved, 19, 697–730.PubMedCentralPubMedCrossRefGoogle Scholar
  29. Krieger, N. (1999). Embodying inequality: A review of concepts, measures, and methods for studying health consequences of discrimination. International Journal of Health Services, 29, 295–352.PubMedCrossRefGoogle Scholar
  30. Krieger, N., Smith, K., Naishadham, D., Hartman, C., & Barbeau, E. M. (2005). Experiences of discrimination: Validity and reliability of a self-report measure for population health research on racism and health. Social Science and Medicine, 61, 1576–1596.PubMedCrossRefGoogle Scholar
  31. LaVeist, T. A., Nickerson, K. J., & Bowie, J. V. (2000). Attitudes about racism, medical mistrust, and satisfaction with care among African American and white cardiac patients. Medical Care Research and Review, 57, 146–161.PubMedCrossRefGoogle Scholar
  32. Lee, C., Ayers, S. L., & Kronenfeld, J. J. (2009). The association between perceived provider discrimination, healthcare utilization and health status in racial and ethnic minorities. Ethnicity and Disease, 19, 330–337.PubMedCentralPubMedGoogle Scholar
  33. MacKinnon, David. P. (2008). Introduction to statistical mediation analysis. New York, NY: Psychology Press, Taylor & Francis Group.Google Scholar
  34. Massey, D. S., & Denton, N. A. (1993). American apartheid: Segregation and the making of the underclass. Cambridge, MA: Harvard University Press.Google Scholar
  35. Paradies, Y. (2006). A systematic review of empirical research on self-reported racism and health. International Journal of Epidemiology, 35, 888–901.PubMedCrossRefGoogle Scholar
  36. Pascoe, E. A., & Richman, L. S. (2009). Perceived discrimination and health: A meta-analytic review. Psychological Bulletin, 135, 531–554.PubMedCentralPubMedCrossRefGoogle Scholar
  37. Peek, M. E., Nunez-Smith, M., Drum, M., & Lewis, T. T. (2011). Adapting the Everyday Discrimination Scale to medical settings: Reliability and validity testing in a sample of African American patients. Ethnicity and Disease, 21(4), 502–509.PubMedCentralPubMedGoogle Scholar
  38. Perez, D. J., Fortuna, L., & Alegria, M. (2008). Prevalence and correlates of everyday discrimination among US Latinos. Journal of Community Psychology, 36, 421–433.PubMedCentralPubMedCrossRefGoogle Scholar
  39. Ryan, M., Gee, G. C., & Laflamme, D. F. (2006). The association between self-reported discrimination, physical health and blood pressure: Findings from African Americans, Black immigrants, and Latino immigrants in New Hampshire. Journal of Health Care for the Poor and Underserved, 17, 116–132.PubMedCrossRefGoogle Scholar
  40. Schneiderman, N., Ironson, G., & Siegel, S. D. (2005). Stress and health: Psychological, behavioral, and biological determinants. Annual Review of Clinical Psychology, 1, 607–628.PubMedCentralPubMedCrossRefGoogle Scholar
  41. Schulman, K. A., Berlin, J. A., Harless, W., Kerner, J. F., Sistrunk, S., Gersh, B. J., et al. (1999). The effect of race and sex on physicians’ recommendations for cardiac catheterization. New England Journal of Medicine, 340, 618–626.PubMedCrossRefGoogle Scholar
  42. Schultz, J., Gravlee, C. C., Williams, D. R., Israel, B. A., Mentz, G., & Rowe, Z. (2006). Discrimination, symptoms of depression, and self-rated health among African American Women in Detroit: Results from a longitudinal analysis. American Journal of Public Health, 96, 1265–1270.CrossRefGoogle Scholar
  43. Shah, A. M., Whitman, S., & Silva, A. (2006). Variations in the health conditions of 6 Chicago community areas: A case for local-level data. American Journal of Public Health, 96, 1485–1491.PubMedCentralPubMedCrossRefGoogle Scholar
  44. Shariff-Marco, S., Klassen, C., & Bowie, J. V. (2010). Racial/ethnic differences in self-reported racism and its association with cancer-related health behaviors. American Journal of Public Health, 100, 364–374.PubMedCentralPubMedCrossRefGoogle Scholar
  45. Shavers, V. L., Fagan, P., Jones, D., Klein, W. M., Boyington, J., Moten, C., et al. (2012). The state of research on racial/ethnic discrimination in the receipt of health care. American Journal of Public Health, 102, 953–966.PubMedCentralPubMedCrossRefGoogle Scholar
  46. Smedley, B. D., Stith, Y., & Nelson, R. (Eds.). (2003). Unequal treatment: Confronting racial and ethnic disparities in health care. Washington DC: The National Academies Press.Google Scholar
  47. Sorkin, D., Ngo-Metzger, Q., & De Alba, I. (2010). Racial/ethnic discrimination in health care: Impact on perceived quality of care. Journal of General Internal Medicine, 25, 390–396.PubMedCentralPubMedCrossRefGoogle Scholar
  48. Thoits, P. A. (2010). Stress and health. Journal of Health and Social Behavior, 51, S41–S53.PubMedCrossRefGoogle Scholar
  49. Trivedi, N., & Ayanian, J. Z. (2006). Perceived discrimination and use of preventive health services. Journal of General Internal Medicine, 21, 553–558.PubMedCentralPubMedCrossRefGoogle Scholar
  50. Van Houtven, C. H., Volis, C. I., Oddone, E. Z., Weinfurt, K. P., Friedman, J. Y., Schulman, K. A., et al. (2005). Perceived discrimination and reported delay of pharmacy prescriptions and medical tests. Journal of General Internal Medicine, 20, 578–583.PubMedCentralPubMedCrossRefGoogle Scholar
  51. van Ryn, M. (2002). Research on the provider contribution to race/ethnicity disparities in medical care. Medical Care, 40(1 Suppl), 140–151.Google Scholar
  52. Wallerstein, N. B., & Duran, B. (2006). Using community-based participatory research to address health disparities. Health Promotion and Practice, 7, 312–323.CrossRefGoogle Scholar
  53. Wamala, S., Merlo, J., Bostrom, G., & Hogstedt, C. (2007). Perceived discrimination, socioeconomic disadvantage and refraining from seeking medical treatment in Sweden. Journal of Epidemiology and Community Health, 61, 409–415.PubMedCentralPubMedCrossRefGoogle Scholar
  54. Whitman, S., Shah, M., & Benjamins, M. R. (Eds.). (2010). Urban health: Combating disparities with local data. New York: Oxford University Press.Google Scholar
  55. Whitman, S., Williams, C., & Shah, M. (2004). Sinai Health System’s Improving Community Health Survey: Report I (ten key findings). Chicago, IL: Sinai Health System.Google Scholar
  56. Williams, D. R., Yu, Y., Jackson, J. S., & Anderson, N. B. (1997). Racial differences in physical and mental health: Socioeconomic status, stress, and discrimination. American Journal of Health Psychology, 2, 335–351.CrossRefGoogle Scholar
  57. Williams, D. R., & Mohammed, S. A. (2009). Discrimination and racial disparities in health: Evidence and needed research. Journal of Behavioral Medicine, 32, 20–47.PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Sinai Urban Health InstituteMt. Sinai HospitalChicagoUSA

Personalised recommendations