Scott Shelby B, Gaska Karie A, Knopp Kayla, Do Quyen A, Yang Joyce P
Department of Psychology, University of Texas at San Antonio, San Antonio, Texas.
Department of Clinical Foundations, Ross University School of Medicine, Bridgetown, Barbados.
Womens Health Issues. 2023 Mar-Apr;33(2):160-166. doi: 10.1016/j.whi.2022.10.007. Epub 2022 Dec 12.
Health care discrimination contributes to medical mistrust among marginalized communities. Sexual minority women of color (SM-WOC) are marginalized because of the intersection of their sexual orientation, gender, and race/ethnicity and regularly report poor health care experiences at the intersection of these identities. However, research has yet to quantify differences in the prevalence of reported health care discrimination across SM women of various racial/ethnic backgrounds. As such, this study compared the rates of discriminatory treatment during the most recent medical appointment between SM-WOC (Black, Hispanic, Asian American, Native American) and White SM women.
We used nationally representative data from the Association of American Medical Colleges survey of health care services. Data were collected from 2010 to 2019 from N = 1,499 SM women (n = 458 SM-WOC). Binary logistic regressions compared frequencies of reported identity-based discrimination between each minoritized racial/ethnic group to White SM women.
Across the sample, 33% of SM-WOC reported discrimination during their last medical appointment compared with 19% of White SM women. Discriminatory treatment was more common among every minoritized racial/ethnic group of SM women compared with White SM women, with variability in frequency of specific forms of identity-based discrimination across minoritized racial/ethnic groups.
Although discriminatory treatment during the last medical appointment was common for all SM women, prevalence was higher for SM-WOC compared with White SM women. Findings have important implications for policy and practice to reduce health disparities, such as targeted interventions for SM-WOC and provider trainings in cultural humility, implicit bias, and common microaggressions.
医疗保健歧视加剧了边缘化社区对医疗的不信任。有色人种性少数女性（SM-WOC）由于其性取向、性别和种族/民族的交叉而被边缘化，她们经常报告在这些身份交叉点上有糟糕的医疗保健经历。然而，研究尚未量化不同种族/民族背景的SM女性报告的医疗保健歧视发生率的差异。因此，本研究比较了SM-WOC（黑人、西班牙裔、亚裔美国人、美洲原住民）和白人SM女性在最近一次就诊时受到歧视性对待的比率。
我们使用了美国医学院协会医疗保健服务调查中的全国代表性数据。数据收集于2010年至2019年，来自N = 1499名SM女性（n = 458名SM-WOC）。二元逻辑回归比较了每个少数族裔/种族群体与白人SM女性之间基于身份的歧视报告频率。
在整个样本中，33%的SM-WOC报告在她们上次就诊时受到了歧视，而白人SM女性这一比例为19%。与白人SM女性相比，每个少数族裔/种族群体的SM女性受到歧视性对待更为常见，不同少数族裔/种族群体基于身份的特定形式歧视频率存在差异。
尽管上次就诊时受到歧视性对待在所有SM女性中都很常见，但SM-WOC的发生率高于白人SM女性。研究结果对减少健康差距的政策和实践具有重要意义，例如针对SM-WOC的有针对性干预措施以及对医疗服务提供者进行文化谦逊、隐性偏见和常见微侵犯方面的培训。
