Journal of General Internal Medicine

, Volume 22, Issue 3, pp 389–395

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

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

DOI: 10.1007/s11606-006-0057-4

Cite this article as:
Casagrande, S.S., Gary, T.L., LaVeist, T.A. et al. J GEN INTERN MED (2007) 22: 389. doi:10.1007/s11606-006-0057-4

Background

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.

Objective

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.

Design

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

Participants

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

Measurements

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

Results

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.

Conclusions

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 

Copyright information

© Society of General Internal Medicine 2007

Authors and Affiliations

  • Sarah Stark Casagrande
    • 1
  • Tiffany L. Gary
    • 1
    • 2
    • 4
    • 5
  • 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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