自我衰老感知与感知到的医疗歧视。

Self-perception of aging and perceived medical discrimination.

机构信息

Department of Sociology and Gerontology, Miami University, Oxford, Ohio, USA.

Center of Innovation in Long-Term Services and Supports, U.S. Department of Veterans Affairs Healthcare System, Providence, Rhode Island, USA.

出版信息

J Am Geriatr Soc. 2023 Oct;71(10):3049-3058. doi: 10.1111/jgs.18517. Epub 2023 Aug 18.

DOI:10.1111/jgs.18517

PMID:37596097

Abstract

BACKGROUND

Individuals who perceive medical discrimination often face adverse consequences. How individuals perceive their own aging experiences may influence perceived medical discrimination due to age by generating expectations that they will receive poor treatment from clinicians, which may be amplified for individuals who also perceive discrimination because of race. This study explored the relationship between self-perceptions of aging (SPA) and perceived medical discrimination due to age, race, and other reasons.

METHODS

We used three waves (2008, 2012, 2016) from the nationally representative Health and Retirement Study (HRS) data. Our sample included 10,188 community-residing individuals aged 51 and over. SPA were measured by two domains: positive SPA and negative SPA. Multinomial logistic regression that adjusted for demographic, health characteristics, and year-fixed effects was conducted to estimate the relationship between SPA and categories of perceived medical discrimination (age, race, age and race, and other).

RESULTS

Approximately 11% of the population perceived discrimination because of age or race in the medical setting from 2008 to 2016. Older adults who had a positive SPA were 15% [Adjusted relative risk ratio (ARR): 0.85, 95% CI: 0.79-0.91], 13% [ARRR: 0.87, 95% CI: 0.76-1.00], and 20% [ARRR: 0.80, 95% CI: 0.74-0.88] less likely to experience perceived medical discrimination due to age, race, and the intersection of age and race, respectively, than those who did not, holding other factors constant. Those who held a negative SPA were 38% [ARRR: 1.38, 95% CI: 1.28-1.48] more likely to report perceived medical discrimination due to age and 12% [ARRR: 1.12, 95% CI: 1.03-1.21] more likely to report perceived medical discrimination due to other reasons.

CONCLUSIONS

Holding a positive perception of aging may help reduce perceived medical discrimination because of age and race, which may in turn improve communication and lead to timely and appropriate treatment.

摘要

背景

感知到医疗歧视的个体往往会面临不良后果。个体对自身衰老体验的感知方式可能会影响到他们因年龄而感知到的医疗歧视，因为这种感知会产生他们将从临床医生那里得到不佳治疗的预期，而对于那些因为种族而感知到歧视的个体来说，这种预期可能会被放大。本研究探讨了自我衰老感知（SPA）与因年龄、种族和其他原因而感知到的医疗歧视之间的关系。

方法

我们使用了来自全国代表性的健康与退休研究（HRS）数据的三个波次（2008 年、2012 年和 2016 年）。我们的样本包括了 10188 名居住在社区、年龄在 51 岁及以上的个体。SPA 通过两个领域进行衡量：积极 SPA 和消极 SPA。我们进行了多项逻辑回归分析，调整了人口统计学、健康特征和年份固定效应，以估计 SPA 与因年龄、种族、年龄和种族以及其他原因而感知到的医疗歧视类别之间的关系。

结果

在 2008 年至 2016 年期间，大约有 11%的人口在医疗环境中因年龄或种族而感知到歧视。与没有积极 SPA 的个体相比，拥有积极 SPA 的老年人因年龄、种族以及年龄和种族的交叉因素而感知到医疗歧视的可能性分别降低了 15%[调整后的相对风险比（ARR）：0.85，95%置信区间（CI）：0.79-0.91]、13%[ARR：0.87，95% CI：0.76-1.00]和 20%[ARR：0.80，95% CI：0.74-0.88]，其他因素保持不变。而那些持有消极 SPA 的个体则更有可能报告因年龄而感知到医疗歧视，可能性增加了 38%[ARR：1.38，95% CI：1.28-1.48]，更有可能报告因其他原因而感知到医疗歧视，可能性增加了 12%[ARR：1.12，95% CI：1.03-1.21]。