Abstract P335: Health Care Discrimination and C-Reactive Protein in US Adults

Abstract

Background: Healthcare discrimination has been documented and remains common in the US. However, little is known about the association between healthcare discrimination and objective health indicators such as C-reactive protein (CRP), a marker of inflammation and a correlate of cardiovascular outcomes. Methods: We used 2008-2012 data from the Health and Retirement Study, a nationally representative study of US adults ages 54+, to examine the association between self-reported experiences of healthcare discrimination and high sensitivity CRP among those reporting a history of chronic disease (N=12,110). Dried blood spots were assayed for CRP. Respondents were asked how often they received poorer service or treatment than other people from doctors or hospitals (six-point likert scale ranging from “almost every day” to “never.”) Participants reporting any healthcare discrimination were compared to those reporting “never.” We used Generalized Estimate Equation (GEE) models to examine the associations between healthcare discrimination and CRP (< vs. ≥ 3 g/L), specifying a compound symmetry working correlation structure to take account of the dependency of repeated measures of the biomarker. To examine whether the relationship differs across the outcome distribution, quantile regression models were fitted, examining the 10 th , 25 th , 50 th , 75 th , and 90 th percentiles of the CRP distribution, and accounting for repeated measurements. All models were adjusted for age, sex, race/ethnicity, education, log-household size adjusted wealth and income, current employment, marital status, and year indicators. Results: In 2008, 18% of participants reported past experiences of health care discrimination. Report of healthcare discrimination was associated with increased odds of CRP ≥ 3 g/L (OR: 1.12, 95% CI: 1.02, 1.24), similar in magnitude to a 6-year age difference. Health care discrimination was not associated with CRP at the 10 th (β=0.01; 95% CI: -0.04, 0.06) or 25 th percentile (β=0.05; 95% CI: -0.03, 0.14). At the 50 th percentile (~2.1 g/L) and at 75 th percentile of CRP (~4.5 g/L), participants who reported experiencing health care discrimination had 0.14 g/L (95% CI: 0.01, 0.26) and 0.32 g/L (95% CI: -0.04, 0.61) higher CRP, respectively, than participants who did not report health care discrimination. Conclusion: Adults reporting prior healthcare discrimination have elevated levels of CRP. The estimated effect was largest for people at the higher end of the CRP distribution, who would be at greater risk of adverse cardiovascular outcomes.