Department of Foundations of Medicine, Center for Population Health and Health Services Research, New York University Grossman Long Island School of Medicine, New York, New York.
Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, New York; Center for Anti-Racism, Social Justice and Public Health, New York University School of Global Public Health, New York, New York.
Am J Prev Med. 2024 Oct;67(4):568-580. doi: 10.1016/j.amepre.2024.05.018. Epub 2024 Jun 4.
Discrimination in medical settings (DMS) contributes to healthcare disparities in the United States, but few studies have determined the extent of DMS in a large national sample and across different populations. This study estimated the national prevalence of DMS and described demographic and health-related characteristics associated with experiencing DMS in seven different situations.
Survey data from 41,875 adults participating in the All of Us Research Program collected in 2021-2022 and logistic regression were used to examine the association between sociodemographic and health-related characteristics and self-reported DMS among adults engaged with a healthcare provider within the past 12 months. Statistical analysis was performed in 2023-2024.
About 36.89% of adults reported having experienced at least one DMS situation. Adults with relative social and medical disadvantages had higher prevalence of experiencing DMS. Compared to their counterparts, respondents with higher odds of experiencing DMS in at least one situation identified as female, non-Hispanic Black, having at least some college, living in the South, renter, having other living arrangement, being publicly insured, not having a usual source of care, having multiple chronic conditions, having any disability, and reporting fair or poor health, p<0.05.
The findings indicate a high prevalence of DMS, particularly among some population groups. Characterizing DMS may be a valuable tool for identifying populations at risk within the healthcare system and optimizing the overall patient care experience. Implementing relevant policies remains an essential strategy for mitigating the prevalence of DMS and reducing healthcare disparities.
医疗环境中的歧视（DMS）导致了美国的医疗保健差距，但很少有研究确定在大型全国样本和不同人群中 DMS 的程度。本研究估计了 DMS 的全国流行率，并描述了在七种不同情况下经历 DMS 与人口统计学和健康相关特征的关系。
使用 2021-2022 年参与 All of Us 研究计划的 41875 名成年人的调查数据，采用逻辑回归分析了过去 12 个月内与医疗保健提供者接触的成年人的社会人口统计学和健康相关特征与自我报告的 DMS 之间的关系。统计分析于 2023-2024 年进行。
约 36.89%的成年人报告至少经历过一种 DMS 情况。具有相对社会和医疗劣势的成年人更有可能经历 DMS。与对照组相比，在至少一种情况下经历 DMS 的可能性更高的受访者为女性、非西班牙裔黑人、至少有一些大学学历、居住在南部、租房者、有其他居住安排、有公共保险、没有常规医疗来源、有多种慢性疾病、有任何残疾和报告健康状况一般或较差，p<0.05。
研究结果表明，DMS 的流行率很高，尤其是在一些人群中。对 DMS 进行特征描述可能是识别医疗保健系统中处于风险中的人群并优化整体患者护理体验的有价值工具。实施相关政策仍然是减少 DMS 流行率和减少医疗保健差距的重要策略。
