Akinade Temitope, Kheyfets Anna, Piverger Naissa, Layne Tracy M, Howell Elizabeth A, Janevic Teresa
Departments of Obstetrics, Gynecology, and Reproductive Science, and Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, Blavatnik Family Women's Health Research Institute, New York, NY, USA.
Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Soc Sci Med. 2023 Jan;316:114983. doi: 10.1016/j.socscimed.2022.114983. Epub 2022 Apr 22.
In the U.S, a wide body of evidence has documented significant racial-ethnic disparities in women's health, and growing attention has focused on discrimination in health care as an underlying cause. Yet, there are knowledge gaps on how experiences of racial-ethnic health care discrimination across the life course influence the health of women of color. Our objective was to summarize existing literature on the impact of racial-ethnic health care discrimination on health care outcomes for women of color to examine multiple health care areas encountered across the life course.
We systematically searched three databases and conducted study screening, data extraction, and quality assessment. We included quantitative and qualitative peer-reviewed literature on racial-ethnic health care discrimination towards women of color, focusing on studies that measured patient-perceived discrimination or differential treatment resulting from implicit provider bias. Results were summarized through narrative synthesis.
In total, 84 articles were included spanning different health care domains, such as perinatal and cancer care. Qualitative studies demonstrated the existence of racial-ethnic discrimination across care domains. Most quantitative studies reported a mix of positive and null associations between discrimination and adverse health care outcomes, with variation by the type of health care outcome. For instance, over three-quarters of the studies exploring associations between discrimination/bias and health care-related behaviors or beliefs found significant associations, whereas around two-thirds of the studies on clinical interventions found no significant associations.
This review shows substantial evidence on the existence of racial-ethnic discrimination in health care and its impact on women of color in the U.S. However, the evidence on how this phenomenon influences health care outcomes varies in strength by the type of outcome investigated. High-quality, targeted research using validated measures that is grounded in theoretical frameworks on racism is needed. This systematic review was registered [PROSPERO ID: CRD42018105448].
在美国，大量证据表明女性健康方面存在显著的种族差异，人们越来越关注医疗保健中的歧视是一个潜在原因。然而，关于种族医疗保健歧视经历如何在整个生命过程中影响有色人种女性的健康，仍存在知识空白。我们的目标是总结现有关于种族医疗保健歧视对有色人种女性医疗保健结果影响的文献，以研究在整个生命过程中遇到的多个医疗保健领域。
我们系统地搜索了三个数据库，并进行了研究筛选、数据提取和质量评估。我们纳入了关于对有色人种女性的种族医疗保健歧视的定量和定性同行评审文献，重点关注测量患者感知的歧视或由隐性提供者偏见导致的差别待遇的研究。结果通过叙述性综合进行总结。
总共纳入了84篇涵盖不同医疗保健领域的文章，如围产期和癌症护理。定性研究表明，各护理领域都存在种族歧视。大多数定量研究报告了歧视与不良医疗保健结果之间既有正向关联也有零关联，且因医疗保健结果类型而异。例如，超过四分之三探索歧视/偏见与医疗保健相关行为或信念之间关联的研究发现了显著关联，而约三分之二关于临床干预的研究未发现显著关联。
本综述显示了大量证据表明医疗保健中存在种族歧视及其对美国有色人种女性的影响。然而，关于这一现象如何影响医疗保健结果的证据，其强度因所研究的结果类型而异。需要高质量、有针对性的研究，使用基于种族主义理论框架的经过验证的测量方法。本系统综述已注册[PROSPERO编号：CRD42018105448]。
