BACKGROUND: Little is known about the relation between perceptions of health care discrimination and use of health services.
OBJECTIVES: To determine the prevalence of perceived discrimination in health care, its association with use of preventive services, and the contribution of perceived discrimination to disparities in these services by race/ethnicity, gender, and insurance status.
DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional study of 54,968 respondents to the 2001 California Health Interview Survey.
MEASUREMENTS: Subjects were asked about experience with discrimination in receiving health care and use of 6 preventive health services, all within the previous 12 months.
METHODS: We used multivariate logistic regression with propensity-score methods to examine the adjusted relationship between perceived discrimination and receipt of preventive care.
RESULTS: Discrimination was reported by 4.7% of respondents, and among these respondents the most commonly reported reasons were related to type of insurance (27.6%), race or ethnicity (13.7%), and income (6.7%). In adjusted analyses, persons who reported discrimination were less likely to receive 4 preventive services (cholesterol testing for cardiovascular disease, hemoglobin A1c testing and eye exams for diabetes, and flu shots), but not 2 other services (aspirin for cardiovascular disease, prostate specific antigen testing). Adjusting for perceived discrimination did not significantly change the relative likelihood of receipt of preventive care by race/ethnieity, gender, and insurance status.
CONCLUSIONS: Persons who report discrimination may be less likely to receive some preventive health services. However, perceived discrimination is unlikely to account for a large portion of observed disparities in receipt of preventive care.
discrimination disparities preventive care quality of care
Krieger N. Discrimination and health. In: Berkman L, Kawachi I, eds. Social Epidemiology. Oxford: Oxford University Press; 2000;36–75.Google Scholar
James SA, La Croix AZ, Kleinbaum DG, Strogatz DS. John Henryism and blood pressure differences among black men: the role of occupational stressors. J Behav Med. 1984;7:259–75.CrossRefPubMedGoogle Scholar
Krieger N. Racial and gender discrimination: risk factors for high blood pressure? Soc Sci Med. 1990;30:1273–81.CrossRefPubMedGoogle Scholar
Krieger N, Sidney S. Racial discrimination and blood pressure: the CARDIA study of young black and white adults. Am J Public Health. 1996;86:1370–8.CrossRefPubMedGoogle Scholar
Din-Dzietham R, Nembhard WN, Collins R, Davis SK. Perceived stress following race-based discrimination at work is associated with hypertension in African-Americans. The metro Atlanta heart disease study, 1999–2001. Soc Sci Med. 2004;58:449–61.CrossRefPubMedGoogle Scholar
Steffen PR, McNeilly M, Anderson N, Sherwood A. Effects of perceived racism and anger inhibition on amblatory blood pressure in African Americans. Psychosom Med. 2003;65:746–50.CrossRefPubMedGoogle Scholar
Ladrine H, Klonoff EA. The schedule of racist events: a measure of racial discrimination and study of its negative physical and mental health consequences. J Black Psychol. 1996;22:144–68.CrossRefGoogle Scholar
Williams DR, Yu Y, Jackson J, Anderson NB. Racial differences in physical and mental health: socioeconomic status, stress, and discrimination. J Health Psychol. 1997;2:335–51.CrossRefGoogle Scholar
Stuber J, Galea S, Ahern J, Blaney S, Fuller C. The association between multiple domains of discrimination and self-assessed health: a multilevel analysis of Latinos and blacks in four low-income New York City neighborhoods. Health Serv Res. 2003;38:1735–59.CrossRefPubMedGoogle Scholar
Mays VM, Cochran SD. Mental health correlates of perceived discrimination among lesbian, gay, and bisexual adults in the United States. Am J Public Health. 2001;91:1869–76.CrossRefPubMedGoogle Scholar
Van Houtven CH, Voils CI, Oddone EZ, et al. Perceived discrimination and reported delay of pharmacy prescriptions and medical tests. J Gen Intern Med. 2005;20:578–83.CrossRefPubMedGoogle Scholar
O’Malley AS, Sheppard VB, Schwartz M, Mandelblatt J. The role of trust in use of preventive services among low-income African-American women. Prev Med. 2004;38:777–85.CrossRefPubMedGoogle Scholar
Schulman KA, Berlin JA, Harless W, et al. The effect of race and sex on physicians’ recommendations for cardiac catheterization. N Engl J Med. 1999;340:848–57.CrossRefGoogle Scholar
California Health Interview Survey. Technical paper no 1. Available at: http://www.chis.ucla.edu/pdf/2001_response_representativeness.pdf. Accessed December 9, 2005.Google Scholar
Behavioral Risk Factor Surveillance System. Technical information and data. 2004 summary data quality report. Available at: http://www.cdc.gov/brfss/technical_infodata/2004QualityReport.htm. Accessed December 9, 2005.Google Scholar
U.S. Preventive Services Task Force. Aspirin for the primary prevention of cardiovascular events: recommendations and rationale. Ann Intern Med. 2002;136:157–60.Google Scholar
Hayden M, Pignone M, Phillips C, Mulrow C. Aspirin for the primary prevention of cardiovascular events: a summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2002;136:157–60.Google Scholar
Smith RA, Cokkinides V, Eyre HJ. American Cancer Society guidelines for the early detection of cancer. CA Cancer J Clin. 2003;53:27–43.CrossRefPubMedGoogle Scholar
Centers for Disease Control and Prevention. Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2003;52:1–36.Google Scholar
American Diabetes Association. Standards of medical care for patients with diabetes mellitus. Diabetes Care. 2003;26:S33–50.CrossRefGoogle Scholar
CHIS 2001 Methodology Series. Report 2. Data collection methods. Available at: http://www.chis.ucla.edu/pdf/CHIS2001_method2.pdf. Accessed December 9, 2005.Google Scholar
Rubin DB. Estimating causal effects from large data sets using propensity scores. Ann Intern Med. 1997;127:757–63.PubMedGoogle Scholar
LaVeist TA, Rolley NC, Diala C. Prevalence and patterns of discrimination among U.S. Health Care Consumers. Intl J Health Serv. 2003;33:331–44.CrossRefGoogle Scholar
Blanchard J, Lurie N. Respect: patient reports of disrespect in the health care setting and its impact on care. J Fam Pract. 2004;53:721–30.PubMedGoogle Scholar
Heisler M, Smith DM, Hayward RA, Krein SL, Kerr EA. Racial disparities in diabetes care processes, outcomes, and treatment intensity. Med Care. 2003;41:1221–32.CrossRefPubMedGoogle Scholar
National Center for Health Statistics. Health, United States, 2004 with Chartbook on Trends in the Health of Americans. Washington, DC: U.S. Government Printing Office; 2004.Google Scholar
Nelson K, Norris K, Mangione CM. Disparities in the diagnosis and pharmacologic treatment of high serum cholesterol by race and ethnicity: data from the third National Health and Nutrition Examination Survey. Arch Intern Med. 2002;162:929–35.CrossRefPubMedGoogle Scholar
Persell SD, Baker DW. Aspirin use among adults with diabetes: recent trends and emerging sex disparities. Arch Intern Med. 2004;164:2492–9.CrossRefPubMedGoogle Scholar
Ward E, Jemal A, Cokkinides V, et al. Cancer disparities by race and socioeconomic status. CA Cancer J Clin. 2004;54:78–93.CrossRefPubMedGoogle Scholar
Kaiser Family Foundation. State Health Facts. Available at: www.statehealthfacts.org. Accessed December 6, 2005.Google Scholar
Blank RM, Dabady M, Citro CF, eds. Measuring Racial Discrimination. Washington, DC: National Academy Press; 2004.Google Scholar
Krieger N, Smith K, Naishadham D, Hartman C, Barbeau EM. Experiences of discrimination: validity and reliability of a self-report measure for population health research on racism and health. Soc Sci Med. 2005;61:1576–96.CrossRefPubMedGoogle Scholar