Green Michael D, Farmer Heather R, Xu Hanzhang, Dhingra Radha, Yang Qing, Thorpe Roland J, Glover LáShauntá M, Dupre Matthew E
Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St, Durham, NC, 27701, USA.
Department of Human Development and Family Sciences, University of Delaware, Newark, DE, USA.
J Gen Intern Med. 2025 Aug 5. doi: 10.1007/s11606-025-09796-w.
Discrimination in healthcare settings impedes quality care, leading to poorer health outcomes.
To examine racial differences in perceived discrimination in healthcare settings across age among middle-aged and older adults and identify factors associated with these experiences.
Longitudinal cohort data from the Health and Retirement Study collected between 2008 and 2020.
The sample included 17,478 United States adults aged 50 and older who had at least one doctor visit or hospitalization in the prior two years.
Self-reported perceived discrimination in healthcare settings, measured using an item from the Everyday Discrimination Scale and categorized as "never" versus "any" experienced discrimination. Generalized linear mixed models were used to identify factors associated with experiencing discrimination. Assessed factors included sociodemographic (age, gender, marital status, education, wealth, insurance status, employment) and clinical characteristics (depressive symptoms, difficulty with activities of daily living [ADLs], number of doctor visits, hospitalizations, body mass index [BMI], and comorbidities).
Black adults were significantly more likely to experience discrimination in healthcare settings than White adults, and these disparities were most pronounced at younger ages. Factors associated with higher odds of reporting discrimination included Black race, male gender, not being married, being uninsured, higher educational attainment, depressive symptoms, difficulty with ADLs, history of arthritis, and higher BMI. In race-stratified analyses, unemployment was associated with higher odds of reporting discrimination among Black adults. Among White adults, being unmarried and uninsured were significant factors associated with discrimination.
Black adults reported higher rates of perceived discrimination in healthcare settings than White adults, especially during middle adulthood. Multiple sociodemographic and clinical factors were associated with these experiences. These findings underscore the need to address discrimination in healthcare to improve patient-provider relationships among middle-aged and older adults.
医疗环境中的歧视阻碍了优质医疗服务，导致更差的健康结果。
研究中年及老年成年人在医疗环境中所感受到的歧视的种族差异，并确定与这些经历相关的因素。
2008年至2020年期间收集的来自健康与退休研究的纵向队列数据。
样本包括17478名50岁及以上的美国成年人，他们在过去两年中至少有过一次看医生或住院经历。
使用日常歧视量表中的一项来衡量自我报告的在医疗环境中感受到的歧视，分为“从未”经历过歧视和“任何”经历过歧视。使用广义线性混合模型来确定与经历歧视相关的因素。评估的因素包括社会人口统计学因素（年龄、性别、婚姻状况、教育程度、财富、保险状况、就业情况）和临床特征（抑郁症状、日常生活活动困难、看医生次数、住院次数、体重指数和合并症）。
黑人成年人在医疗环境中比白人成年人更有可能经历歧视，并且这些差异在较年轻年龄段最为明显。与报告歧视几率较高相关的因素包括黑人种族、男性、未婚、未参保、较高的教育程度、抑郁症状、日常生活活动困难、关节炎病史和较高的体重指数。在按种族分层的分析中，失业与黑人成年人中报告歧视的较高几率相关。在白人成年人中，未婚和未参保是与歧视相关的重要因素。
黑人成年人报告在医疗环境中感受到的歧视率高于白人成年人，尤其是在中年时期。多种社会人口统计学和临床因素与这些经历相关。这些发现强调了解决医疗环境中歧视问题以改善中年及老年成年人医患关系的必要性。
