The link between perceived racism and healthcare utilization among older adults: a health equity analysis
Abstract
Patient discrimination in healthcare settings is a growing concern in the United States. In healthcare settings, discrimination based on age, gender, sexuality, race, ethnicity, socioeconomic status, geographic region, and insurance status is well-documented. Nearly one-in-five US adults have experienced discrimination at least once when visiting the health system. While the scholarship on discrimination and its association with health outcomes is well established, there remains a dearth of literature that compares this across countries. Such comparisons could provide valuable information for policy makers.
In this study, our purpose was to conduct a secondary analysis of the 2021 Commonwealth Fund International Health Policy (IHP) Survey of Older Adults—a nationally representative, self-reported, and cross-sectional survey of adults from 11 high-income countries. We examined the relationship between the perception of racial/ethnic discrimination in the health system and its association with visits to different healthcare providers and frequency of emergency room visitations.
We employed a two-part multivariable hurdle model for the healthcare provider and ER visits. The adjusted odds ratios (OR) and risk ratios (RR) were estimated for the hurdle and count part, respectively. Separate analyses were performed for the United States by including additional socioeconomic variables.
Perceived discrimination was associated with reduced odds of meeting at least one primary care provider (OR:0.82; 95%CI: 0.68,0.99). Among those who have visited at least one provider, older adults who perceive discrimination were more likely to visit different providers when compared with those who did not perceive discrimination (RR:1.06; 95%CI: 1.01,1.11). Perceived racism was associated with first (OR:1.13; 95%CI: 1.01,1.27) and frequent (RR:1.14; 95%CI: 1.01,1.29) ER visits. Similar but attenuated results were obtained for the USA sample.
Perceived racial and ethnic discrimination significantly affects health service utilization among the elderly living in high-income countries. Healthcare provider sensitization should be the cornerstone when devising related policies and interventions.
Keywords
Healthcare Discrimination, Perceived Racism, Health Equity, Survey Data, Secondary Analysis, Commonwealth Fund
The link between perceived racism and healthcare utilization among older adults: a health equity analysis
Patient discrimination in healthcare settings is a growing concern in the United States. In healthcare settings, discrimination based on age, gender, sexuality, race, ethnicity, socioeconomic status, geographic region, and insurance status is well-documented. Nearly one-in-five US adults have experienced discrimination at least once when visiting the health system. While the scholarship on discrimination and its association with health outcomes is well established, there remains a dearth of literature that compares this across countries. Such comparisons could provide valuable information for policy makers.
In this study, our purpose was to conduct a secondary analysis of the 2021 Commonwealth Fund International Health Policy (IHP) Survey of Older Adults—a nationally representative, self-reported, and cross-sectional survey of adults from 11 high-income countries. We examined the relationship between the perception of racial/ethnic discrimination in the health system and its association with visits to different healthcare providers and frequency of emergency room visitations.
We employed a two-part multivariable hurdle model for the healthcare provider and ER visits. The adjusted odds ratios (OR) and risk ratios (RR) were estimated for the hurdle and count part, respectively. Separate analyses were performed for the United States by including additional socioeconomic variables.
Perceived discrimination was associated with reduced odds of meeting at least one primary care provider (OR:0.82; 95%CI: 0.68,0.99). Among those who have visited at least one provider, older adults who perceive discrimination were more likely to visit different providers when compared with those who did not perceive discrimination (RR:1.06; 95%CI: 1.01,1.11). Perceived racism was associated with first (OR:1.13; 95%CI: 1.01,1.27) and frequent (RR:1.14; 95%CI: 1.01,1.29) ER visits. Similar but attenuated results were obtained for the USA sample.
Perceived racial and ethnic discrimination significantly affects health service utilization among the elderly living in high-income countries. Healthcare provider sensitization should be the cornerstone when devising related policies and interventions.
