Department of Family Medicine, East Carolina University, Greenville, NC.
University of Pittsburgh School of Medicine.
Med Care. 2020 May;58(5):483-490. doi: 10.1097/MLR.0000000000001304.
Experiences of discrimination are associated with poor health behaviors and outcomes. Understanding discrimination in health care informs interventions to improve health care experiences.
Describe the prevalence of, and variables associated with, perceived gender-based discrimination in the Veterans Affairs (VA) Healthcare System among women Veterans.
A cross-sectional, telephone-based survey of a random national sample of young female Veterans.
Female VA primary care patients aged 18-45 years.
The primary outcome was perceived gender-based discrimination in VA health care. Logistic and linear regression models were used to determine associations between any perceived discrimination and cumulative perceived discrimination with patient and health service characteristics.
Among 2294 women Veterans, 33.7% perceived gender-based discrimination in VA. Perceiving gender-based discrimination was associated with medical illness [adjusted odds ratio (aOR)=1.67, 95% confidence interval (CI)=1.34, 2.08], mental illness (aOR=2.06, 95% CI=1.57, 2.69), and military sexual trauma (aOR=2.65, 95% CI=2.11, 3.32). Receiving most health care from the same VA provider (aOR=0.73, 95% CI=0.57, 0.94) and receiving care at a VA site with a women's health clinic (aOR=0.76, 95% CI=0.61, 0.95) were associated with reduced odds of any perceived gender-based discrimination. Among those who perceived gender-based discrimination (n=733), perceived discrimination scores were higher among women with increased age, medical illness, or history of military sexual trauma and lower among those who saw the same VA provider for most medical care.
One third of women Veterans perceived gender-based discrimination in VA. Obtaining most medical care from the same VA provider and having a women's health clinic at one's VA were associated with less perceived discrimination.
歧视经历与不良健康行为和结果有关。了解医疗保健中的歧视情况有助于实施干预措施，以改善医疗保健体验。
描述退伍军人事务部（VA）医疗保健系统中女性退伍军人感知到的基于性别的歧视的流行情况和相关变量。
一项针对年轻女性退伍军人的随机全国样本的横断面、电话调查。
年龄在 18-45 岁之间的 VA 初级保健患者。
主要结果是退伍军人事务部医疗保健中感知到的基于性别的歧视。使用逻辑回归和线性回归模型来确定任何感知到的歧视与累积感知到的歧视与患者和健康服务特征之间的关联。
在 2294 名女性退伍军人中，有 33.7%的人在 VA 中感知到基于性别的歧视。感知到基于性别的歧视与医疗疾病有关（调整后的优势比[aOR]=1.67，95%置信区间[CI]=1.34，2.08），与精神疾病有关（aOR=2.06，95%CI=1.57，2.69），与军事性创伤有关（aOR=2.65，95%CI=2.11，3.32）。从同一名 VA 提供商处获得大部分医疗保健（aOR=0.73，95%CI=0.57，0.94）和在设有妇女健康诊所的 VA 地点获得护理（aOR=0.76，95%CI=0.61，0.95）与降低任何感知到的基于性别的歧视的可能性相关。在那些感知到基于性别的歧视的退伍军人中（n=733），感知到的歧视评分在年龄较大、患有医疗疾病或有军事性创伤史的女性中较高，而在那些主要从同一名 VA 提供商获得医疗保健的女性中较低。
三分之一的女性退伍军人在 VA 中感知到基于性别的歧视。从同一名 VA 提供商处获得大部分医疗保健以及在 VA 中有妇女健康诊所与较少的感知歧视有关。
