Benjamins Maureen R, Whitman Steven
Sinai Urban Health Institute, Mt. Sinai Hospital, 1500 S. California Ave, Chicago, IL, 60608, USA,
J Behav Med. 2014 Jun;37(3):402-13. doi: 10.1007/s10865-013-9496-7. Epub 2013 Mar 1.
Discrimination has been found to be detrimental to health, but less is known about the influence of discrimination in health care. To address this, the current study (1) compared levels of racial/ethnic discrimination in health care among four race/ethnic groups; (2) determined associations between this type of discrimination and health care outcomes; and (3) assessed potential mediators and moderators as suggested by previous studies. Multivariate logistic regression models were used within a population-based sample of 1,699 White, African American, Mexican, and Puerto Rican respondents. Overall, 23% of the sample reported discrimination in health care, with levels varying substantially by race/ethnicity. In adjusted models, this type of discrimination was associated with an increased likelihood of having unmet health care needs (OR = 2.48, CI = 1.57-3.90) and lower odds of perceiving excellent quality of care (OR = 0.43, CI = 0.28-0.66), but not with the use of a physician when not sick or use of alternative medicine. The mediating role of mental health factors was inconsistently observed and the relationships were not moderated by race/ethnicity. These findings expand the literature and provide preliminary evidence that can eventually inform the development of interventions and the training of health care providers.
研究发现，歧视对健康有害，但关于医疗保健领域歧视的影响，人们了解得较少。为解决这一问题，本研究（1）比较了四个种族/族裔群体在医疗保健方面的种族/族裔歧视程度；（2）确定了此类歧视与医疗保健结果之间的关联；（3）按照先前研究的建议，评估了潜在的中介因素和调节因素。在一个基于人群的样本中，对1699名白人、非裔美国人、墨西哥人和波多黎各受访者使用了多变量逻辑回归模型。总体而言，23%的样本报告在医疗保健方面受到歧视，不同种族/族裔的歧视程度差异很大。在调整后的模型中，此类歧视与未满足医疗保健需求的可能性增加（比值比=2.48，置信区间=1.57-3.90）以及认为医疗质量极佳的几率降低（比值比=0.43，置信区间=0.28-0.66）相关，但与未生病时看医生或使用替代药物无关。心理健康因素的中介作用观察结果不一致，且这些关系不受种族/族裔的调节。这些发现丰富了文献，并提供了初步证据，最终可为干预措施的制定和医疗保健提供者的培训提供参考。
