Barrier or stressor? The role of discrimination experiences in health service use

Billy Gazard,Lisa Harber-Aschan,Ioannis Bakolis,Zoe Chui,Matthew Hotopf,Shirlee Maccrimmon,Katharine Rimes,Stephani L Hatch

doi:10.1186/s12889-018-6267-y

Abstract

BackgroundDiscrimination is a well-established stressor that is substantially associated with poor health and a known contributor to health inequalities. However, the role of discrimination in health service use is less explored. This study will take an intersectional approach to investigate differences in health service use and examine the role of discrimination experiences.MethodsData on health service use were assessed in a diverse inner London sample of 1052 participants in the South East London Community Health (SELCoH) Study. Latent class analysis (LCA) was used to define classes of intersectional social status using multiple indicators of socioeconomic status (SES), ethnicity and migration status. Adjusted associations between intersectional social status and discrimination experiences with health service use indicators are presented.ResultsUsing latent class analysis allowed us to identify an intersectional social status characterized by multiple disadvantage that was associated with decreased secondary physical health service use and a class characterized by both privilege and disadvantage that was associated with increased health service use for mental disorder after controlling for age, gender and health status. Anticipated discrimination was also associated with increased service use for mental disorder in adjusted models. There was no evidence to suggest that discrimination experiences were acting as a barrier to health service use.ConclusionsThis study highlights the complex ways in which discrimination experiences may increase the need for health services whilst also highlighting differences in health service use at the intersection of ethnicity, migration status and SES. Findings from this study illustrate the importance of measuring multiple levels of discrimination and taking an intersectional approach for health service use research.

Highlights

Discrimination is a well-established stressor that is substantially associated with poor health and a known contributor to health inequalities
Such responses to discrimination experienced in healthcare settings or across other life domains can lead to anticipated discrimination and avoidance of services [15, 16]
Intersectional approaches have predominantly been used in qualitative research, it has been used in quantitative research as a framework for data reduction to understand health differences at the intersection of multiple social statuses in diverse populations. In utilizing approaches such as stratification and latent class analysis (LCA) to derive classes of intersectional social status, we have found health inequalities at the intersection of ethnicity, migration status and socioeconomic status (SES) [24, 25] that were not identified when considering single indicators alone [26]

Summary

Introduction

Discrimination is a well-established stressor that is substantially associated with poor health and a known contributor to health inequalities. In the UK, where secondary health services include planned hospital care, such as inpatient stays or outpatient appointments for treatment or check-ups, both experienced and anticipated discrimination are likely to play an important role in service use as patients are often required to negotiate access with healthcare providers [17] This may provide an explanation for the observed decrease in secondary health service use for marginalized groups e.g. ethnic minorities, migrants and low SES groups, after accounting for need (e.g. health status) in universal healthcare contexts across the UK and Europe more widely [18,19,20,21,22]

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