Casagrande Sarah Stark, Gary Tiffany L, LaVeist Thomas A, Gaskin Darrell J, Cooper Lisa A
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
J Gen Intern Med. 2007 Mar;22(3):389-95. doi: 10.1007/s11606-006-0057-4.
Past research indicates that access to health care and utilization of services varies by sociodemographic characteristics, but little is known about racial differences in health care utilization within racially integrated communities.
To determine whether perceived discrimination was associated with delays in seeking medical care and adherence to medical care recommendations among African Americans and whites living in a socioeconomically homogenous and racially integrated community.
A cross-sectional analysis from the Exploring Health Disparities in Integrated Communities Study.
Study participants include 1,408 African-American (59.3%) and white (40.7%) adults (> or =18 years) in Baltimore, Md.
An interviewer-administered questionnaire was used to assess the associations of perceived discrimination with help-seeking behavior for and adherence to medical care.
For both African Americans and whites, a report of 1-2 and >2 discrimination experiences in one's lifetime were associated with more medical care delays and nonadherence compared to those with no experiences after adjustment for need, enabling, and predisposing factors (odds ratio [OR] = 1.8, 2.6; OR = 2.2, 3.3, respectively; all P < .05). Results were similar for perceived discrimination occurring in the past year.
Experiences with discrimination were associated with delays in seeking medical care and poor adherence to medical care recommendations INDEPENDENT OF NEED, ENABLING, AND PREDISPOSING FACTORS, INCLUDING MEDICAL MISTRUST; however, a prospective study is needed. Further research in this area should include exploration of other potential mechanisms for the association between perceived discrimination and health service utilization.
以往研究表明，获得医疗保健服务的机会和服务利用情况因社会人口特征而异，但对于种族融合社区内医疗保健利用方面的种族差异知之甚少。
确定在社会经济同质化且种族融合的社区中生活的非裔美国人和白人中，感知到的歧视是否与寻求医疗护理的延迟以及遵循医疗护理建议有关。
综合社区健康差异探索研究的横断面分析。
研究参与者包括马里兰州巴尔的摩市1408名非裔美国成年人（59.3%）和白人成年人（40.7%）（年龄≥18岁）。
采用由访谈员实施的问卷来评估感知到的歧视与寻求医疗护理行为及遵循医疗护理之间的关联。
对于非裔美国人和白人，在调整了需求、促成因素和易患因素后，与无一生经历歧视的人相比，报告一生中经历过1 - 2次及超过2次歧视经历的人出现更多医疗护理延迟和不遵循医嘱的情况（优势比[OR]分别为1.8、2.6；OR分别为2.2、3.3；所有P <.05）。过去一年中感知到的歧视情况结果类似。
歧视经历与寻求医疗护理的延迟以及不遵循医疗护理建议有关，且独立于需求、促成因素和易患因素，包括医疗不信任；然而，需要进行前瞻性研究。该领域的进一步研究应包括探索感知到的歧视与卫生服务利用之间关联的其他潜在机制。
