Wang, V. H., Cuevas, A. G., et al. (2024).
American Journal of Preventive Medicine.
Abstract
Introduction
Discrimination in medical settings (DMS) contributes to healthcare disparities in the United States, but few studies have determined the extent of DMS in a large national sample and across different populations. This study estimated the national prevalence of DMS and described demographic and health-related characteristics associated with experiencing DMS in seven different situations.
Methods
Survey data from 41,875 adults participating in the All of Us Research Program collected in 2021–2022 and logistic regression were used to examine the association between sociodemographic and health-related characteristics and self-reported DMS among adults engaged with a healthcare provider within the past 12 months. Statistical analysis was performed in 2023–2024.
Results
About 36.89% of adults reported having experienced at least one DMS situation. Adults with relative social and medical disadvantages had higher prevalence of experiencing DMS. Compared to their counterparts, respondents with higher odds of experiencing DMS in at least one situation identified as female, non-Hispanic Black, having at least some college, living in the South, renter, having other living arrangement, being publicly insured, not having a usual source of care, having multiple chronic conditions, having any disability, and reporting fair or poor health, p<0.05.
Conclusions
The findings indicate a high prevalence of DMS, particularly among some population groups. Characterizing DMS may be a valuable tool for identifying populations at risk within the healthcare system and optimizing the overall patient care experience. Implementing relevant policies remains an essential strategy for mitigating the prevalence of DMS and reducing healthcare disparities.
Here are some thoughts:
A recent national study revealed alarming rates of discrimination in healthcare settings, affecting approximately 37% of U.S. adults. Disproportionately impacted groups include women, Black and Hispanic individuals, those with limited English proficiency, renters, publicly insured or uninsured individuals, and those with chronic conditions or disabilities. These populations face higher odds of experiencing discrimination in healthcare settings, perpetuating existing health disparities.
The study highlights the intersectionality of race/ethnicity and socioeconomic status as a critical factor in exposure to discrimination. Furthermore, specific situations drive experiences of discrimination for certain populations, such as lack of respect or poor communication from healthcare providers.
To address these disparities, healthcare institutions are developing implicit bias training, though research suggests modest effectiveness. Coupling bias training with reflective exercises or perspective-taking may enhance efficacy. Additionally, promoting diversity within the healthcare workforce and policy interventions, such as the Hospital Consumer Assessment of Healthcare Providers and Systems survey, can help monitor and improve patient-provider relationships.
However, the current survey lacks components measuring discrimination. Incorporating these measures can inform national trends, identify vulnerable populations, and guide targeted interventions. Study limitations include data collection during the COVID-19 pandemic and potential underestimation of discrimination due to measurement constraints.
Key Takeaways:
- 37% of U.S. adults experience discrimination in healthcare settings
- Disproportionate impact on vulnerable populations
- Intersectionality of race/ethnicity and socioeconomic status exacerbates disparities
- Targeted interventions and policy changes are necessary to address discrimination
- Measuring discrimination in healthcare settings is crucial for improvement
Recommendations:
- Develop effective bias training programs
- Promote diversity within the healthcare workforce
- Incorporate discrimination measures into national surveys
- Tailor interventions to address specific experiences of discrimination
- Foster patient-centered care to reduce healthcare disparities