Abstract
Although considerable evidence exists on the association between negative health outcomes and daily experiences of discrimination, less is known about such experiences in the health care system at the national level. It is critically necessary to measure and address discrimination in the health care system to mitigate harm to patients and as part of the larger ongoing project of responding to health inequities. To (1) identify the national prevalence of patient-reported experiences of discrimination in the health care system, the frequency with which they occur, and the main types of discrimination experienced and (2) examine differences in the prevalence of discrimination across demographic groups. This cross-sectional national survey fielded online in May 2019 used a general population sample from the National Opinion Research Center's AmeriSpeak Panel. Surveys were sent to 3253 US adults aged 21 years or older, including oversamples of African American respondents, Hispanic respondents, and respondents with annual household incomes below 200% of the federal poverty level. Analyses drew on 3 survey items measuring patient-reported experiences of discrimination, the primary types of discrimination experienced, the frequency with which they occurred, and the demographic and health-related characteristics of the respondents. Weighted bivariable and multivariable logistic regressions were conducted to assess associations between experiences of discrimination and several demographic and health-related characteristics. Of 2137 US adult respondents who completed the survey (66.3% response rate; unweighted 51.0% female; mean [SD] age, 49.6 [16.3] years), 458 (21.4%) reported that they had experienced discrimination in the health care system. After applying weights to generate population-level estimates, most of those who had experienced discrimination (330 [72.0%]) reported experiencing it more than once. Of 458 reporting experiences of discrimination, racial/ethnic discrimination was the most common type (79 [17.3%]), followed by discrimination based on educational or income level (59 [12.9%]), weight (53 [11.6%]), sex (52 [11.4%]), and age (44 [9.6%]). In multivariable analysis, the odds of experiencing discrimination were higher for respondents who identified as female (odds ratio [OR], 1.88; 95% CI, 1.50-2.36) and lower for older respondents (OR, 0.98; 95% CI, 0.98-0.99), respondents earning at least $50 000 in annual household income (OR, 0.76; 95% CI, 0.60-0.95), and those reporting good (OR, 0.59; 95% CI, 0.46-0.75) or excellent (OR, 0.41; 95% CI, 0.31-0.56) health compared with poor or fair health. The results of this study suggest that experiences of discrimination in the health care system appear more common than previously recognized and deserve considerable attention. These findings contribute to understanding of the scale at which interpersonal discrimination occurs in the US health care system and provide crucial evidence for next steps in assessing the risks and consequences of such discrimination. The findings also point to a need for further analysis of how interpersonal discrimination interacts with structural inequities and social determinants of health to build effective responses.
Highlights
The odds of experiencing discrimination were higher for respondents who identified as female and lower for older respondents (OR, 0.98; 95% CI, 0.98-0.99), respondents earning at least $50 000 in annual household income (OR, 0.76; 95% CI, 0.60-0.95), and those reporting good (OR, 0.59; 95% CI, 0.46-0.75) or excellent (OR, 0.41; 95% CI, 0.31-0.56) health compared with poor or fair health
The results of this study suggest that experiences of discrimination in the health care system appear more common than previously recognized and deserve considerable attention
These findings contribute to understanding of the scale at which interpersonal discrimination occurs in the US health care system and provide crucial evidence for
Summary
Health systems in the US are increasingly expressing concern about understanding and responding to social determinants of health (ie, the social and environmental conditions that may influence individual health and the differences in health and health outcomes between groups).[1,2,3] Considerable analytical work has identified a range of factors associated with inequities in treatments, outcomes, and mortality across race, sex, socioeconomic status, and various other social identities.[1,4,5,6,7,8,9,10,11] Some of these include patient-clinician discordance, physician bias, and daily experiences of discrimination.[1,3,12,13] Daily experiences of discrimination in other contexts (eg, while shopping, in employment, or in housing) have been studied extensively in association with downstream health outcomes, including but not limited to hypertension, cardiovascular disease, poor sleep, mental health symptoms, lower trust in the health care system, delayed or avoided care, and underuse of mental health services.[14,15,16,17,18,19,20] Despite considerable knowledge about the association between discrimination and health care utilization rates and health outcomes and the relevance of discrimination to health inequity, to our knowledge, experiences of discrimination in the health care system itself are understudied.previous work has provided important insights regarding the association between discrimination and health but has not identified patient-reported lifetime experiences of discrimination in the health care system at a national level in a way that captures the frequency and that allows for a full self-selection of the types of discrimination experienced. Some studies have drawn from narrow regional samples or limited respondent reports to the previous 12 months,[19,21,22,23] whereas other studies have asked participants to report discrimination associated with a single aspect of their identity, such as race or sex, as preselected by the research team.[24,25] In addition, there is limited information on the frequency of different types of discriminatory treatment, which may be a significant risk factor for chronic disease given the association between discrimination and health over the life course.[26,27]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
