Journal of General Internal Medicine

, Volume 22, Issue 3, pp 389–395 | Cite as

Perceived Discrimination and Adherence to Medical Care in a Racially Integrated Community

  • Sarah Stark Casagrande
  • Tiffany L. GaryEmail author
  • Thomas A. LaVeist
  • Darrell J. Gaskin
  • Lisa A. Cooper
Populations at Risk


Past research indicates that access to health care and utilization of services varies by sociodemographic characteristics, but little is known about racial differences in health care utilization within racially integrated communities.


To determine whether perceived discrimination was associated with delays in seeking medical care and adherence to medical care recommendations among African Americans and whites living in a socioeconomically homogenous and racially integrated community.


A cross-sectional analysis from the Exploring Health Disparities in Integrated Communities Study.


Study participants include 1,408 African-American (59.3%) and white (40.7%) adults (≥18 years) in Baltimore, Md.


An interviewer-administered questionnaire was used to assess the associations of perceived discrimination with help-seeking behavior for and adherence to medical care.


For both African Americans and whites, a report of 1–2 and >2 discrimination experiences in one’s lifetime were associated with more medical care delays and nonadherence compared to those with no experiences after adjustment for need, enabling, and predisposing factors (odds ratio [OR] = 1.8, 2.6; OR = 2.2, 3.3, respectively; all P < .05). Results were similar for perceived discrimination occurring in the past year.


Experiences with discrimination were associated with delays in seeking medical care and poor adherence to medical care recommendations INDEPENDENT OF NEED, ENABLING, AND PREDISPOSING FACTORS, INCLUDING MEDICAL MISTRUST; however, a prospective study is needed. Further research in this area should include exploration of other potential mechanisms for the association between perceived discrimination and health service utilization.

Key words

discrimination health care utilization health disparities adherence 



This research was supported by grant no. P60MD000214-01 from the National Center on Minority Health and Health Disparities (NCMHD) of the National Institutes of Health (NIH), and a grant from Pfizer, Inc. to Dr. LaVeist. Dr. Cooper is supported by a grant from the National Heart, Lung, and Blood Institute (K24HL083113).

Potential Financial Conflicts of Interest

None disclosed.


  1. 1.
    Greene J, Blustein J, Laflamme KA. Use of preventive care services, beneficiary characteristics, and Medicare HMO performance. Health Care Financ Rev 2001;22(4):141–53.PubMedGoogle Scholar
  2. 2.
    Shi L, Macinko J, Starfield B, Politzer R, Wulu J, Xu J. Primary care, social inequalities and all-cause, heart disease and cancer mortality in US counties: a comparison between urban and non-urban areas. Public Health 2005;119(8):699–710.PubMedCrossRefGoogle Scholar
  3. 3.
    Margolis ML, Christie JD, Silvestri GA, Kaiser L, Santiago S, Hansen-Flaschen J. Racial differences pertaining to a belief about lung cancer surgery: results of a multicenter survey. Ann Intern Med 2003;139(7):558–63.PubMedGoogle Scholar
  4. 4.
    Derose KP, Baker DW. Limited English proficiency and Latinos’ use of physician services. Med Care Res Rev 2000;57(1):76–91.PubMedCrossRefGoogle Scholar
  5. 5.
    Boulware LE, Cooper LA, Ratner LE, LaVeist TA, Powe NR. Race and trust in the health care system. Public Health Rep 2003;118(4):358–65.PubMedGoogle Scholar
  6. 6.
    Cooper LA, Gonzales JJ, Gallo JJ, Rost KM, Meredith LS, Rubenstein LV et al. The acceptability of treatment for depression among African-American, Hispanic, and white primary care patients. Med Care 2003;41(4):479–89.PubMedCrossRefGoogle Scholar
  7. 7.
    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(suppl 1):146–61.PubMedCrossRefGoogle Scholar
  8. 8.
    Perez-Stable EJ, Marin G, Posner SF. Ethnic comparison of attitudes and beliefs about cigarette smoking. J Gen Intern Med 1998;13(3):167–74.PubMedCrossRefGoogle Scholar
  9. 9.
    Blanchard J, Lurie N. R-E-S-P-E-C-T: patient reports of disrespect in the health care setting and its impact on care. J Fam Pract 2004;53(9):721–30.PubMedGoogle Scholar
  10. 10.
    Bazargan M, Norris K, Bazargan-Hejazi S, Akhanjee L, Calderon JL, Safvati SD et al. Alternative healthcare use in the under-served population. Ethn Dis 2005;15(4):531–9.PubMedGoogle Scholar
  11. 11.
    Van Houtven CH, Voils CI, Oddone EZ, Weinfurt KP, Friedman JY, Schulman KA et al. Perceived discrimination and reported delay of pharmacy prescriptions and medical tests. J Gen Intern Med 2005;20(7):578–83.PubMedCrossRefGoogle Scholar
  12. 12.
    Krieger N, Sidney S. Racial discrimination and blood pressure: the CARDIA Study of young black and white adults. Am J Public Health 1996;86(10):1370–8.PubMedGoogle Scholar
  13. 13.
    Borrell LN, Kiefe CI, Williams DR, Diez-Roux AV, Gordon-Larsen P. Self-reported health, perceived racial discrimination, and skin color in African Americans in the CARDIA study. Soc Sci Med 2006;63(6):1415–27PubMedCrossRefGoogle Scholar
  14. 14.
    Schulz AJ, Gravlee CC, Williams DR, Israel BA, Mentz G, Rowe Z. Discrimination, symptoms of depression, and self-rated health among African American women in Detroit: results from a longitudinal analysis. Am J Public Health 2006;96(7):1265–70.PubMedCrossRefGoogle Scholar
  15. 15.
    Kessler RC, Mickelson KD, Williams DR. The prevalence, distribution, and mental health correlates of perceived discrimination in the United States. J Health Soc Behav 1999;40(3):208–30.PubMedCrossRefGoogle Scholar
  16. 16.
    Thompson VL. Perceived experiences of racism as stressful life events. Community Ment Health J 1996;32(3):223–33.PubMedCrossRefGoogle Scholar
  17. 17.
    Cooper-Patrick L, Crum RM, Pratt LA, Eaton WW, Ford DE. The psychiatric profile of patients with chronic diseases who do not receive regular medical care. Int J Psychiatry Med 1999;29(2):165–80.PubMedCrossRefGoogle Scholar
  18. 18.
    Giuffirda A TD. Should we pay the patient? Review of financial incentives to enhance patient compliance. Br Med J 1997;315:703–7.Google Scholar
  19. 19.
    Pulliam C, Gatchel RJ, Robinson RC. Challenges to early prevention and intervention: personal experiences with adherence. Clin J Pain 2003;19(2):114–20.PubMedCrossRefGoogle Scholar
  20. 20.
    Dimatteo MR. Social support and patient adherence to medical treatment: a meta-analysis. Health Psychol 2004;23(2):207–18.PubMedCrossRefGoogle Scholar
  21. 21.
    Coker AL, Bond SM, Pirisi LA. Life stressors are an important reason for women discontinuing follow-up care for cervical neoplasia. Cancer Epidemiol Biomarkers Prev 2006;15(2):321–5.PubMedCrossRefGoogle Scholar
  22. 22.
    Andersen R, Aday LA. Access to medical care in the U.S.: realized and potential. Med Care 1978;16(7):533–46.PubMedCrossRefGoogle Scholar
  23. 23.
    LaVeist TA, Jackson JW, Bowen-Reid J, Gaskin DJ, Browne AC. Exploring disparities in integrated communities: the EHDIC study. Under Review 2006.Google Scholar
  24. 24.
    Princeton Survey Research Associates. 2001 Health Care Quality Survey. 2006.
  25. 25.
    Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary care evaluation of mental disorders. Patient health questionnaire. JAMA 1999;282(18):1737–44.PubMedCrossRefGoogle Scholar
  26. 26.
    La Veist TA, Isaac LA, Peterson SH, Jackson JW, Thomas DE. Assessing the validity and reliability of a multidimensional measure of mistrust of healthcare organizations: the Medical Mistrust Index. In Press. 2005.Google Scholar
  27. 27.
    Andersen RM. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav 1995;36(1):1–10.PubMedCrossRefGoogle Scholar
  28. 28.
    La Veist TA, Brandom JT, Jackson JW, Blanc PJ, Gaskin DJ. Do community factors account for race differences in chronic conditions: the Exploring Health Disparities in Integrated Communities Study (EHDIC). Under Review 2006.Google Scholar

Copyright information

© Society of General Internal Medicine 2007

Authors and Affiliations

  • Sarah Stark Casagrande
    • 1
  • Tiffany L. Gary
    • 1
    • 2
    • 4
    • 5
    Email author
  • Thomas A. LaVeist
    • 3
    • 4
  • Darrell J. Gaskin
    • 3
    • 4
  • Lisa A. Cooper
    • 1
    • 2
    • 4
    • 5
  1. 1.Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  2. 2.Division of General Internal MedicineJohns Hopkins School of MedicineBaltimoreUSA
  3. 3.Department of Health Policy and ManagementJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  4. 4.Morgan-Hopkins Center for Health Disparities and SolutionsBaltimoreUSA
  5. 5.Welch Center for Prevention, Epidemiology, and Clinical ResearchBaltimoreUSA

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