Departments of Epidemiology, Health Policy & Management, and Hopkins Center for Health Disparities Solutions at the Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD.
Department of Oncology, Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, MD.
Ethn Dis. 2021 Jul 15;31(3):417-424. doi: 10.18865/ed.31.3.417. eCollection 2021 Summer.
Black/African American people have long reported high, albeit warranted, distrust of the US health care system (HCS); however, Blacks/African Americans are not a homogenous racial/ethnic group. Little information is available on how the subgroup of Black Americans whose families suffered under US chattel slavery, here called Descendants of Africans Enslaved in the United States (DAEUS), view health care institutions. We compared knowledge of unethical treatment and HCS distrust among DAEUS and non-DAEUS.
A cross-sectional random-digit dialing survey was administered in 2005 to Blacks/African Americans, aged 21-75 years, from the University of Pennsylvania Clinical Practices in Philadelphia, Penn.
Blacks/African Americans self-reported a family history of persons enslaved in the US (DAEUS) or no family history of persons enslaved in the US (non-DAEUS).
HCS distrust was measured by a validated scale assessing perceptions of unethical experimentation and active or passive discrimination.
We compared responses to the HCS distrust scale using Fisher's exact and t-tests.
Of 89 respondents, 57% self-reported being DAEUS. A greater percentage of DAEUS reported knowledge of unethical treatment than non-DAEUS (56% vs 21%; P<.001), were significantly more likely to express distrust, and to endorse the presence of covert (eg, insurance-based) than overt forms (eg, race-based) of discrimination by the HCS.
DAEUS express greater HCS distrust than non-DAEUS, patterned by awareness of unethical treatment and passive discrimination. Understanding how long-term exposure to US institutions influences health is critical to resolving disparities for all Black/African American groups. Rectifying past injustices through reparative institutional measures may improve DAEUS' trust and engagement with the US HCS.
长期以来，非裔美国人对美国医疗保健系统（HCS）表现出高度的、尽管有理由的不信任；然而，黑人/非裔美国人并不是一个同质的种族/民族群体。关于在美国被奴役的非裔美国人的后裔（DAEUS）如何看待医疗保健机构的信息很少。我们比较了 DAEUS 和非 DAEUS 对不道德治疗和 HCS 不信任的认识。
2005 年，在宾夕法尼亚大学费城临床实践中，对年龄在 21-75 岁之间的黑人/非裔美国人进行了横断面随机拨号调查。
黑人/非裔美国人自我报告有家庭在美国被奴役的历史（DAEUS）或没有家庭在美国被奴役的历史（非 DAEUS）。
HCS 不信任通过评估对不道德实验和主动或被动歧视的看法的验证量表来衡量。
我们使用 Fisher 的精确检验和 t 检验比较了对 HCS 不信任量表的反应。
在 89 名受访者中，57%的人自我报告为 DAEUS。与非 DAEUS 相比，更多的 DAEUS 报告了对不道德治疗的了解（56%比 21%；P<.001），更有可能表达不信任，并支持 HCS 存在隐蔽（例如，基于保险）而不是公开（例如，基于种族）的歧视形式。
DAEUS 对 HCS 的不信任程度高于非 DAEUS，这与对不道德治疗和被动歧视的认识有关。了解长期接触美国机构如何影响健康，对于解决所有黑人/非裔美国人群体的差异至关重要。通过修复性的机构措施纠正过去的不公正行为，可以改善 DAEUS 对美国 HCS 的信任和参与。
