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Journal of General Internal Medicine

, Volume 33, Issue 3, pp 291–297 | Cite as

Trends for Reported Discrimination in Health Care in a National Sample of Older Adults with Chronic Conditions

  • Thu T. Nguyen
  • Anusha M. Vable
  • M. Maria Glymour
  • Amani Nuru-Jeter
Original Research

Abstract

Background

Discrimination in health care settings is associated with poor health outcomes and may be especially harmful to individuals with chronic conditions, who need ongoing clinical care. Although efforts to reduce discrimination are growing, little is known about national trends in discrimination in health care settings.

Methods

For Black, White, and Hispanic respondents with chronic disease in the 2008–2014 Health and Retirement Study (N = 13,897 individuals and 21,078 reports), we evaluated trends in patient-reported discrimination, defined based on frequency of receiving poorer service or treatment than other people from doctors or hospitals (“never” vs. all other). Respondents also reported the perceived reason for the discrimination. In addition, we evaluated whether wealth predicted lower prevalence of discrimination for Blacks or Whites. We used generalized estimating equation models to account for dependency of repeated measures on individuals and wave-specific weights to represent the US non-institutionalized population aged 54+ .

Results

The estimated prevalence of experiencing discrimination in health care among Blacks with a major chronic condition was 27% (95% CI: 23, 30) in 2008 and declined to 20% (95% CI: 17, 22) in 2014. Reports of receiving poorer service or treatment were stable for Whites (17%, 95% CI: 16, 19 in 2014). The Black–White difference in reporting any health care discrimination declined from 8.2% (95% CI: 4.5, 12.0) in 2008 to 2.5% (95% CI: −1.1, 6.0) in 2014. There was no clear trend for Hispanics. Blacks reported race and Whites reported age as the most common reason for discrimination.

Conclusions

Findings suggest national declines in patient-reported discrimination in health care among Blacks with chronic conditions from 2008 to 2014, although reports of discrimination remain common for all racial/ethnic groups. Our results highlight the critical importance of monitoring trends in reports of discrimination in health care to advance equity in health care.

KEY WORDS

health care discrimination disparities epidemiology 

Notes

Funding/Support

Dr. Nguyen’s work was supported by the American Heart Association Western States Affiliate Postdoctoral Fellowship, award number 16POST29660005. The funder had no role in the design and conduct of the study, the data analysis and interpretation, review and approval of the manuscript, or decision to submit the manuscript for publication.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Supplementary material

11606_2017_4209_MOESM1_ESM.docx (38 kb)
ESM 1 (DOCX 38 kb)

References

  1. 1.
    Pascoe EA, Smart Richman L. Perceived discrimination and health: a meta-analytic review. Psychol Bull. 2009;135(4):531–54.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Williams DR, Mohammed SA. Racism and Health I: Pathways and Scientific Evidence. Am Behav Sci. 2013;57:1152–73.CrossRefGoogle Scholar
  3. 3.
    Bonilla-Silva E. Rethinking Racism: Toward a Structural Interpretation. Am Sociol Rev. 1997;62(3):465–80.CrossRefGoogle Scholar
  4. 4.
    Harris R, Tobias M, Jeffreys M, Waldegrave K, Karlsen S, Nazroo J. Effects of self-reported racial discrimination and deprivation on Maori health and inequalities in New Zealand: cross-sectional study. Lancet 2006;367(9527):2005–9.CrossRefPubMedGoogle Scholar
  5. 5.
    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.CrossRefPubMedGoogle Scholar
  6. 6.
    Ayalon L, Gum AM. The relationships between major lifetime discrimination, everyday discrimination, and mental health in three racial and ethnic groups of older adults. Aging Ment Health. 2011;15(5):58–94.Google Scholar
  7. 7.
    Sutin AR, Stephan Y, Carretta H, Terracciano A. Perceived discrimination and physical, cognitive, and emotional health in older adulthood. Am J Geriatr Psychiatry. 2015;23(2):171–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Luo Y, Xu J, Granberg E, Wentworth WM. A longitudinal study of social status, perceived discrimination, and physical and emotional health among older adults. Research on Aging. 2012;34(3):275–301.Google Scholar
  9. 9.
    Laveist TA, Nuru-Jeter A. Is doctor-patient race concordance associated with greater satisfaction with care? J Health Soc Behav. 2002;43(3):296-306.CrossRefPubMedGoogle Scholar
  10. 10.
    Saha S, Arbelaez JJ, Cooper LA. Patient-physician relationships and racial disparities in the quality of health care. Am J Public Health. 2003;93(10):1713–19.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Cooper LA, Roter DL, Carson KA, et al. The associations of clinicians’ implicit attitudes about race with medical visit communication and patient ratings of interpersonal care. Am J Public Health. 2012;102(5):979–87.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Smedley B, Stith A, Nelson A, eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: National Academy Press; 2003.Google Scholar
  13. 13.
    Chapman EN, Kaatz A, Carnes M. Physicians and Implicit Bias: How Doctors May Unwittingly Perpetuate Health Care Disparities. J Gen Intern Med. 2013;28(11):1504–10.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Penner LA, Dovidio JF, West TV, et al. Aversive Racism and Medical Interactions with Black Patients: A Field Study. J Exp Soc Psychol. 2010;46(2):436–40.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Green AR, Carney DR, Pallin DJ, et al. Implicit bias among physicians and its prediction of thrombolysis decisions for Black and White patients. J Gen Intern Med. 2007;22(9):1231–8.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Healthy People 2010. http://www.healthypeople.gov/2010/Document/pdf/uih/uih.pdf. Accessed 23 Jan 2017.
  17. 17.
    van Ryn M, Hardeman R, Phelan SM, et al. Medical School Experiences Associated with Change in Implicit Racial Bias Among 3547 Students: A Medical Student CHANGES Study Report. J Gen Intern Med. 2015;30(12):1748–56.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Association of American Medical Colleges. Achieving Health Equity: How Academic Medicine Is Addressing the Social Determinants of Health. 2016; https://www.aamc.org/download/460392/data/sdoharticles.pdf. Accessed 2 Feb 2017.
  19. 19.
    Tervalon M, Murray-Garcia J. Cultural humility versus cultural competence: a critical distinction in defining physician training outcomes in multicultural education. J Health Care Poor Underserved. 1998;9(2):117–25.CrossRefPubMedGoogle Scholar
  20. 20.
    Reich AD, Hansen HB, Link BG. Fundamental Interventions: How Clinicians Can Address the Fundamental Causes of Disease. J Bioeth Inq. 2016;13(2):185–92.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Weldring T, Smith SMS. Patient-Reported Outcomes (PROs) and Patient-Reported Outcome Measures (PROMs). Health Serv Insights. 2013;6:61–8.PubMedPubMedCentralGoogle Scholar
  22. 22.
    Bratter JL, Gorman BK. Is Discrimination an Equal Opportunity Risk? Racial Experiences, Socioeconomic Status, and Health Status among Black and White Adults. J Health Soc Behav. 2011;52(3):365–82.CrossRefPubMedGoogle Scholar
  23. 23.
    Mustillo S, Krieger N, Gunderson EP, Sidney S, McCreath H, Kiefe CI. Self-reported experiences of racial discrimination and Black-White differences in preterm and low-birthweight deliveries: the CARDIA Study. Am J Public Health. 2004;94(12):2125–31.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Pew Research Center. Views on Race and Inequality, Blacks and Whites are Worlds Apart. http://www.pewsocialtrends.org/2016/06/27/5-personal-experiences-with-discrimination/. Accessed 16 Jan 2017.
  25. 25.
    Borrell LN, Jacobs DR, Jr, Williams DR, Pletcher MJ, Houston TK, Kiefe CI. Self-reported racial discrimination and substance use in the Coronary Artery Risk Development in Adults Study. Am J Epidemiol. 2007;166(9):1068–79.CrossRefPubMedGoogle Scholar
  26. 26.
    Sternthal M, Slopen N, Williams DR. Racial Disparities in Health: How Much Does Stress Really Matter? Du Bois Review. 2011;8:95-113.CrossRefGoogle Scholar
  27. 27.
    Baggio S, Iglesias K, Hugli O, et al. Associations between perceived discrimination and health status among frequent Emergency Department users. Eur J Emerg Med. 2015.Google Scholar
  28. 28.
    Weech-Maldonado R, Hall A, Bryant T, Jenkins KA, Elliott MN. The Relationship Between Perceived Discrimination and Patient Experiences With Health Care. Med Care. 2012;50:S62–8.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Skosireva A, O'Campo P, Zerger S, Chambers C, Gapka S, Stergiopoulos V. Different faces of discrimination: perceived discrimination among homeless adults with mental illness in healthcare settings. BMC Health Serv Res. 2014;14(1):376.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Dickerson SS, Gable SL, Irwin MR, Aziz N, Kemeny ME. Social-evaluative threat and proinflammatory cytokine regulation: an experimental laboratory investigation. Psychol Sci. 2009;20(10):1237–44.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Dickerson SS, Gruenewald TL, Kemeny ME. When the social self is threatened: shame, physiology, and health. J Pers. 2004;72(6):1191-1216.CrossRefPubMedGoogle Scholar
  32. 32.
    Kressin NR, Raymond KL, Manze M. Perceptions of Race/Ethnicity-Based Discrimination: A Review of Measures and Evaluation of their Usefulness for the Health Care Setting. J Health Care Poor Underserved. 2008;19(3):697-730.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Utsey SO. Assessing the Stressful Effects of Racism: A Review of Instrumentation. J Black Psychol. 1998;24(3):269–88.CrossRefGoogle Scholar
  34. 34.
    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.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Nuru-Jeter A, Dominguez TP, Hammond WP, et al. It’s the skin you’re in: African-American women talk about their experiences of racism. An exploratory study to develop measures of racism for birth outcome studies. Matern Child Health J. 2009;13(1):29-39.CrossRefPubMedGoogle Scholar
  36. 36.
    Shavers VL, Fagan P, Jones D, et al. The State of Research on Racial/Ethnic Discrimination in The Receipt of Health Care. Am J Public Health. 2012;102(5):953–66.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Piette JD, Bibbins-Domingo K, Schillinger D. Health care discrimination, processes of care, and diabetes patients’ health status. Patient Educ Couns. 2006;60(1):41–8.CrossRefPubMedGoogle Scholar
  38. 38.
    Greer TM. Perceived racial discrimination in clinical encounters among African American hypertensive patients. J Health Care Poor Underserved. 2010;21(1):251–63.CrossRefPubMedGoogle Scholar
  39. 39.
    Hausmann LR, Kressin NR, Hanusa BH, Ibrahim SA. Perceived racial discrimination in health care and its association with patients’ healthcare experiences: does the measure matter? Ethn Dis. 2010;20(1):40–7.PubMedGoogle Scholar
  40. 40.
    Rogers S, Thrasher A, Miao Y, Boscardin WJ, Smith A. Discrimination in Healthcare Settings is Associated with Disability in Older Adults: Health and Retirement Study, 2008–2012. J Gen Intern Med. 2015:1–8.Google Scholar
  41. 41.
    Major B, Feinstein J, Crocker J. Attributional Ambiguity of Affirmative Action. Basic Appl Soc Psych. 1994;15(1–2):113–41.CrossRefGoogle Scholar
  42. 42.
    Chae DH, Nuru-Jeter AM, Adler NE. Implicit racial bias as a moderator of the association between racial discrimination and hypertension: a study of Midlife African American men. Psychosom Med. 2012;74(9):961–4.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Chae DH, Nuru-Jeter AM, Adler NE, et al. Discrimination, racial bias, and telomere length in African-American men. Am J Prev Med. 2014;46(2):103–11.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Society of General Internal Medicine 2017

Authors and Affiliations

  • Thu T. Nguyen
    • 1
  • Anusha M. Vable
    • 2
  • M. Maria Glymour
    • 1
    • 3
  • Amani Nuru-Jeter
    • 4
  1. 1.Department of Epidemiology & Biostatistics University of California, San FranciscoSan FranciscoUSA
  2. 2.Center for Primary Care and Outcome Research and Center for Population Health Sciences, Departments of Medicine and of Health Research and PolicyStanford UniversityStanfordUSA
  3. 3.Department of Social and Behavioral SciencesHarvard T.H. Chan School of Public HealthBostonUSA
  4. 4.Divisions of Community Health Sciences and EpidemiologyUniversity of California, BerkeleyBerkeleyUSA

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