Many patients report experiencing discrimination in health care

Approximately one-fifth of patients may be experiencing discrimination in the United States health care system, according to a survey published in JAMA Network Open.

“Clinical care informed by and sensitive to the reality of discrimination in the health system is crucial,” Paige Nong, a doctoral candidate at the University of Michigan School of Public Health, told Healio Primary Care. “Prior work has identified a relationship between discrimination and distrust in the health system. Responding to the threat of discrimination can improve relationships between clinicians and patients by removing a key barrier to patient engagement and access.”

Nong and colleagues conducted a cross-sectional national survey using a population sample from the National Opinion Research Center’s AmeriSpeak Panel.

The researchers analyzed survey items that measured patient-reported experiences of discrimination, the type of discrimination they experienced, how often these incidents occurred, and participants’ demographic and health characteristics.

A total of 2,137 respondents completed the survey. Of those, 21.4% reported experiencing discrimination within the U.S. health care system.

After weighing for general population level estimates, Nong and colleagues determined that the majority of those who experienced discrimination — 72% — reported that they experienced discrimination on more than one occasion.

Among those who reported experiencing discrimination, 17.3% reported racial or ethnic discrimination, 12.9% reported discrimination based on education or income levels, 11.6% reported discrimination based on weight, 11.4% reported discrimination based on sex, and 9.6% reported discrimination based on age.

Nong and colleagues determined that the odds of experiencing discrimination were highest among women (OR = 1.88; 95% CI, 1.50-2.36).

They also determined that the odds of experiencing discrimination were lower among respondents who were older (OR = 0.98; 95% CI, 0.98-0.99) and those who earned an annual household income of $50,000 (OR = 0.76; 95% CI, 0.60-0.95) or more. Additionally, compared with those who reported poor or fair health, the odds of experiencing discrimination were lower in those who reported having good health (OR = 0.59; 95% CI, 0.46-0.75) or excellent health (OR = 0.41; 95% CI, 0.31-0.56).

“Prior work has identified that patients who experience discrimination may avoid or delay needed care,” Nong said. “This is critically important because it poses an additional barrier to care in the context of existing inequality. As we work to address health inequity, it is fundamentally necessary that we combat discrimination in the health care system itself.”