Relationships between discrimination in health care and health care outcomes among four race/ethnic groups
- 1.3k Downloads
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.
KeywordsDiscrimination Racism Coping Race Ethnicity Health care utilization Quality of care CAM
The authors gratefully acknowledge the financial support of the American Cancer Society, IL Division (M. Benjamins, #183618). The Sinai Community Health Survey was completed with generous funding from The Robert Wood Johnson Foundation (#043026) and the Chicago Community Trust (#C2003-00844). We would also like to acknowledge the support of the Michael Reese Health Trust and the Frederick and Florence Roe Health Policy Fund. Finally, statistical advice from Sally Freels, Ph.D., was much appreciated. All mistakes are the authors own.
- 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.
- 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
- 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
- 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
- Kish, L. (1965). Survey sampling. New York, NY: Wiley.Google Scholar
- MacKinnon, David. P. (2008). Introduction to statistical mediation analysis. New York, NY: Psychology Press, Taylor & Francis Group.Google Scholar
- Massey, D. S., & Denton, N. A. (1993). American apartheid: Segregation and the making of the underclass. Cambridge, MA: Harvard University Press.Google Scholar
- 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
- 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
- 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
- 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
- Whitman, S., Shah, M., & Benjamins, M. R. (Eds.). (2010). Urban health: Combating disparities with local data. New York: Oxford University Press.Google Scholar
- 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