出生地差异对医疗保健导航和优化的影响：种族歧视和社会经济地位的相互作用。
Region of birth differences in healthcare navigation and optimisation: the interplay of racial discrimination and socioeconomic position.
机构信息
University of Luxembourg, Institute for Research on Socio-Economic Inequality (IRSEI), Campus Belval, Maison des Sciences Humaines 11, Porte des Sciences, L-4366, Esch-sur-Alzette, Luxembourg.
The University of Manchester, School of Social Sciences / Manchester Institute for Collaborative Research on Ageing, The Cathie Marsh Institute (CMI), Humanities Bridgeford Street, Oxford Road, Manchester, M13 9PL, UK.
出版信息
Int J Equity Health. 2022 Aug 10;21(1):106. doi: 10.1186/s12939-022-01709-1.
BACKGROUND
While a large body of research has documented socioeconomic and migrant inequities in the effective use of healthcare services, the reasons underlying such inequities are yet to be fully understood. This study assesses the interplay between racial discrimination and socioeconomic position, as conceptualised by Bourdieu, and their contributions to healthcare navigation and optimisation.
METHODS
Using a cross-sectional survey in Luxembourg we collected data from individuals with wide-ranging migration and socioeconomic profiles. We fitted sequential multiple linear and logistic regressions to investigate the relationships between healthcare service navigation and optimisation with perceived racial discrimination and socioeconomic position measured by economic, cultural and social capital. We also investigated whether the ownership of these capitals moderates the experience of racial discrimination in healthcare settings.
RESULTS
We observed important disparities in healthcare navigation among different migrant communities. These differences were explained by accounting for the experience of racial discrimination. Racial discrimination was also negatively related with the extent of healthcare services optimisation. However, the impact of discrimination on both health service navigation and optimisation was reduced after accounting for social capital. Higher volumes of economic and social capital were associated with better healthcare experience, and with a lower probability of perceived racial discrimination.
CONCLUSIONS
Racial discrimination plays a substantial role in accounting for inequality in healthcare service navigation by different migrant groups. This study highlights the need to consider the complex interplay between different forms of economic, cultural and social capital and racial discrimination when examining migrant, and racial/ethnic differences in healthcare. Healthcare inequalities arising from socioeconomic position and racism need to be addressed via multilevel policies and interventions that simultaneously tackle structural, interpersonal, and institutional dimensions of racism.
背景
大量研究记录了医疗服务有效利用方面存在的社会经济和移民不平等现象，但导致这些不平等的原因仍未被充分理解。本研究评估了布迪厄（Bourdieu）所提出的种族歧视和社会经济地位之间的相互作用，以及它们对医疗保健导航和优化的贡献。
方法
我们在卢森堡使用横断面调查收集了具有广泛移民和社会经济背景的个体的数据。我们拟合了顺序多重线性和逻辑回归，以研究医疗服务导航和优化与感知到的种族歧视和经济、文化和社会资本衡量的社会经济地位之间的关系。我们还调查了这些资本的所有权是否会调节医疗保健环境中种族歧视的体验。
结果
我们观察到不同移民群体之间在医疗保健导航方面存在重要差异。这些差异通过考虑种族歧视的经历得到了解释。种族歧视也与医疗保健服务优化的程度呈负相关。然而，在考虑到社会资本后，歧视对医疗服务导航和优化的影响会降低。更多的经济和社会资本与更好的医疗保健体验相关，与感知到的种族歧视的可能性降低相关。
结论
种族歧视在解释不同移民群体在医疗服务导航方面的不平等方面起着重要作用。本研究强调，在研究医疗保健中的移民和种族/族裔差异时，需要考虑不同形式的经济、文化和社会资本与种族歧视之间的复杂相互作用。需要通过同时解决种族主义的结构、人际和制度层面的多层次政策和干预措施来解决因社会经济地位和种族主义导致的医疗保健不平等问题。
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