Compared to White Americans, African-Americans are less likely to use primary care (PC) as their usual source of care. This is generally attributed to race differences in socioeconomic status and in access to primary care services. Little is known about the relationship between race differences in medical mistrust and the usual source of care disparity. Using data from the Exploring Health Disparities in Integrated Communities (EHDIC) study, we examined the role of medical mistrust in choosing usual source of care in 1408 black and white adults who were exposed to the same healthcare facilities and low-income racially integrated community. Multinomial logistic regression models were estimated to examine the relationship between race, medical mistrust, and usual source of care. After adjusting for demographic and health-related factors, African-Americans were more likely than whites to use the emergency department (ED) (relative risk ratio [RRR] = 1.43 (95 % confidence interval (CI) [1.06–1.94])) and hospital outpatient department (RRR1.50 (95 %CI [1.10–2.05])) versus primary care as a usual source of care. When medical mistrust was added to the model, the gap between African-Americans’ and whites’ risk of using the ED versus primary care as a usual source of care closed (RRR = 1.29; 95 % CI [0.91–1.83]). However, race differences in the use of the hospital outpatient department remained even after accounting for medical mistrust (RRR = 1.67; 95 % CI [1.16–2.40]). Accounting for medical mistrust eliminated the ED-as-usual-source of care disparity. This study highlights the importance of medical mistrust as an intervention point for decreasing ED use as a usual source of care by low-income, urban African-Americans.
Primary care Emergency department Usual source of care Medical mistrust Healthcare utilization Social context
This is a preview of subscription content, log in to check access.
This work was supported by the National Center on Minority Health and Health Disparities of the National Institutes of Health (P60MD000214-01) and Pfizer, Inc.
Gaskin DJ, Arbelaez JJ, Brown JR, et al. Examining racial and ethnic disparities in site of usual source of care. J Natl Med Assoc. 2007; 99: 22–30.PubMedPubMedCentralGoogle Scholar
Kaplan SH, Greenfield S, Ware JE. Assessing the effects of physician-patient interactions on the outcomes of chronic disease. Med Care. 1989; 27: S110–S127.CrossRefPubMedGoogle Scholar
Starfield B. Primary care: an increasingly important contributor to effectiveness, equity, and efficiency of health services. SESPAS report 2012. Gac Sanit. 2012; 26(1): 20–6.CrossRefPubMedGoogle Scholar
Hargraves JL, Hadley J. The contribution of insurance coverage and community resources to reducing racial/ethnic disparities in access to care. Health Serv Res. 2008; 38: 809–829.CrossRefGoogle Scholar
Weinick RM, Zuvekas SH, Cohen JW. Racial and ethnic differences in access to and use of health care services, 1977-1996. Medical Care Res Rev. 2000; 57: 35–54.CrossRefGoogle Scholar
King WD. Examining African Americans’ mistrust of the health care system: expanding the research question. Commentary on “race and trust in the health care system”. Public Health Rep. 2003; 118(4): 366–7.CrossRefPubMedPubMedCentralGoogle Scholar
Scheppers E, van Dongen E, Dekker J, Geertzen J. Potential barriers to the use of health services among ethnic minorities: a review. Fam Pract. 2006; 23: 325–348.CrossRefPubMedGoogle Scholar
LaVeist TA, Isaac L, Williams K. Mistrust of health care organizations is associated with underutilization of health services. Health Serv Res. 2009; 44: 2093–2105.CrossRefPubMedPubMedCentralGoogle Scholar
Doescher MP, Saver BG, Franks P, Fiscella K. Racial and ethnic disparities in perceptions of physician style and trust. Arch Fam Med. 2000; 9(10): 1156–63.CrossRefPubMedGoogle Scholar
LaVeist TA, Nickerson KJ, Bowie JV. Attitudes about racism, medical mistrust and satisfaction with care among African american and white cardiac patients. Med Care Res Rev. 2000; 57: 146–61.CrossRefPubMedGoogle Scholar
Hammond WP, Matthews D, Mohottige D, et al. Masculinity, medical mistrust, and preventive health services delays among community-dwelling African-american Men. J Gen Inten Med. 2010; 25: 1300–1308.CrossRefGoogle Scholar
White K, Haas JS, Williams DR. Elucidating the role of place in health disparities: the example of racial/ethnic residential segregation. Health Serv Res. 2012; 47(3Pt2): 1278–99.CrossRefPubMedPubMedCentralGoogle Scholar
Massey D, White M, Voon-Chin P. The dimensions of segregation revisited. Sociol Method Res. 1996; 25: 172–206.CrossRefGoogle Scholar
Cummins S, Curtis S, Diez-Roux AV, et al. Understanding and representing ‘place’ in health research: a relational approach. Soc Sci Med. 2007; 65: 1825–1838.CrossRefPubMedGoogle Scholar
Kershaw KN, Diez Roux AV, Burgard SA, et al. Metropolitan-level racial residential segregation and Black-White disparities in hypertension. Am J Epidemiol. 2011; 174(5): 537–45.CrossRefPubMedPubMedCentralGoogle Scholar
White K, Borrell LN. Racial/ethnic residential segregation: framing the context of health risk and health disparities. Health Place. 2011; 17: 438–448.CrossRefPubMedGoogle Scholar
Massey D, Fong E. Segregation and neighborhood quality: blacks, Hispanics, and Asians in the San Francisco metropolitan area. Soc Forces. 1990; 69:15–32.CrossRefGoogle Scholar
Massey DS, Gross AH, Eggers ML. Segregation, the concentration of poverty, and the life chances of individuals. So Sci Res. 1991; 20:397–420.Google Scholar
Kirby JB, Kaneda T. Neighborhood socioeconomic disadvantage and access to health care. J Health Soc Behav. 2005; 46(1): 15–31.CrossRefPubMedGoogle Scholar
Smith DB. The politics of racial disparities: desegregating the hospitals in Jackson. Mississippi Milbank Q. 2005; 83(2): 247–269.CrossRefPubMedGoogle Scholar
Ko M, Ponce NA. Community residential segregation and the local supply of federally qualified health centers. Health Serv Res. 2013; 48(1): 253–270.CrossRefPubMedGoogle Scholar
Uslaner EM. Trust, diversity, and segregation in the United States and the united kingdom. Int J Comp Sociol. 2011; 10: 221–247.CrossRefGoogle Scholar
Laveist TA, Thorpe RJ, Bowen-Reid T, et al. Exploring health disparites in integrated communities: overview of the EHDIC study. J Urban Health. 2008; 85: 11–21.CrossRefPubMedGoogle Scholar
Bernstein AB, Hing E, Moss AJ, Allen KF, Siller AB, Tiggle RB. National center for health statistics: health care in America: trends in utilization. Hyattsville, Maryland: 2003. Available: http://www.cdc.gov/nchs/data/misc/healthcare.pdf. Accessed May 4, 2015.
Brandon DT, Isaac LA, LaVeist TA. The legacy of Tuskegee and trust in medical care: is Tuskegee responsible for race differences in mistrust of medical care? J Natl Med Assoc. 2005; 97(7):951–6.PubMedPubMedCentralGoogle Scholar
Shi L, Lebrun LA, Hung L, Zhu J, Tsai J. US primary care delivery after the health center growth initiative. J Ambulatory Care Manag. 2012; 35(1): 60–74.CrossRefGoogle Scholar
Rothkopf J, Brookler K, Wadhwa S, Sajovetz M. Medicaid patients seen at federally qualified health centers use hospital services less than those seen by private providers. Health Aff (Millwood). 2011; 30(7): 1335–42.CrossRefGoogle Scholar