Hausmann Leslie R M, Jeong Kwonho, Bost James E, Ibrahim Said A
VA Pittsburgh Healthcare System, Center for Health Equity Research and Promotion, Pittsburgh, Pennsylvania 15206, USA.
Med Care. 2008 Sep;46(9):905-14. doi: 10.1097/MLR.0b013e3181792562.
Despite the surge of recent research on the association between perceived discrimination and health-related outcomes, few studies have focused on race-based discrimination encountered in health care settings. This study examined the prevalence of such discrimination, and its association with health status, for the 3 largest race/ethnic groups in the United States.
Data were drawn from the 2004 Behavioral Risk Factor Surveillance System survey. The primary variables were perceived racial discrimination in health care and self-reported health status. Multivariable logistic regression was used to compare the prevalence of perceived discrimination for whites, African Americans, and Hispanics, and to examine the association between perceived discrimination and health status, controlling for sex, age, income, education, health care coverage, affordability of medical care, racial salience, and state.
Perceived discrimination was reported by 2%, 5.2%, and 10.9% of whites, Hispanics, and African Americans, respectively. Only the difference between African Americans and whites remained significant in adjusted analyses [odds ratio (OR) = 3.22, 95% confidence interval (CI) = 2.46-4.21]. Racial/ethnic differences in perceived discrimination depended on income, education, health care coverage, and affordability of medical care. Perceived discrimination was associated with worse health status for the overall sample (OR = 1.71, 95% CI = 1.35-2.16). Stratified analyses revealed that this relationship was significant for whites (OR = 2.00, 95% CI = 1.45-2.77) and African Americans (OR = 1.95, 95% CI = 1.39-2.73), but not for Hispanics (OR = 0.55, 95% CI = 0.24-1.22).
Perceived racial discrimination in health care is much more prevalent for African Americans than for whites or Hispanics. Furthermore, such discrimination is associated with worse health both for African Americans and for whites.
尽管近期关于感知到的歧视与健康相关结果之间关联的研究激增，但很少有研究关注在医疗环境中遇到的基于种族的歧视。本研究调查了美国最大的三个种族/族裔群体中这种歧视的发生率及其与健康状况的关联。
数据来自2004年行为危险因素监测系统调查。主要变量是在医疗保健中感知到的种族歧视和自我报告的健康状况。使用多变量逻辑回归来比较白人、非裔美国人和西班牙裔中感知到的歧视的发生率，并检验感知到的歧视与健康状况之间的关联，同时控制性别、年龄、收入、教育、医疗保险覆盖范围、医疗保健可承受性、种族显著性和州。
分别有2%、5.2%和10.9%的白人、西班牙裔和非裔美国人报告了感知到的歧视。在调整分析中，只有非裔美国人和白人之间的差异仍然显著[优势比(OR)=3.22，95%置信区间(CI)=2.46 - 4.21]。感知到的歧视中的种族/族裔差异取决于收入、教育、医疗保险覆盖范围和医疗保健可承受性。对于总体样本，感知到的歧视与较差的健康状况相关(OR = 1.71，95% CI = 1.35 - 2.16)。分层分析显示，这种关系在白人(OR = 2.00，95% CI = 1.45 - 2.77)和非裔美国人(OR = 1.95，95% CI = 1.39 - 2.73)中显著，但在西班牙裔中不显著(OR = 0.55，95% CI = 0.24 - 1.22)。
在医疗保健中，非裔美国人比白人或西班牙裔更普遍地感知到种族歧视。此外，这种歧视与非裔美国人和白人的较差健康状况都相关。
