Trends for Reported Discrimination in Health Care in a National Sample of Older Adults with Chronic Conditions
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.
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+ .
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.
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 WORDShealth care discrimination disparities epidemiology
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.
- 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
- 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
- 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
- 16.Healthy People 2010. http://www.healthypeople.gov/2010/Document/pdf/uih/uih.pdf. Accessed 23 Jan 2017.
- 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.
- 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.
- 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
- 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