Discrimination in Healthcare Settings is Associated with Disability in Older Adults: Health and Retirement Study, 2008–2012

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Abstract

BACKGROUND

As our society ages, improving medical care for an older population will be crucial. Discrimination in healthcare may contribute to substandard experiences with the healthcare system, increasing the burden of poor health in older adults. Few studies have focused on the presence of healthcare discrimination and its effects on older adults.

OBJECTIVE

We aimed to examine the relationship between healthcare discrimination and new or worsened disability.

DESIGN

This was a longitudinal analysis of data from the nationally representative Health and Retirement Study administered in 2008 with follow-up through 2012.

PARTICIPANTS

Six thousand and seventeen adults over the age of 50 years (mean age 67 years, 56.3 % female, 83.1 % white) were included in this study.

MAIN MEASURES

Healthcare discrimination assessed by a 2008 report of receiving poorer service or treatment than other people by doctors or hospitals (never, less than a year=infrequent; more than once a year=frequent). Outcome was self-report of new or worsened disability by 2012 (difficulty or dependence in any of six activities of daily living). We used a Cox proportional hazards model adjusting for age, race/ethnicity, gender, net worth, education, depression, high blood pressure, diabetes, cancer, lung disease, heart disease, stroke, and healthcare utilization in the past 2 years.

KEY RESULTS

In all, 12.6 % experienced discrimination infrequently and 5.9 % frequently. Almost one-third of participants (29 %) reporting frequent healthcare discrimination developed new or worsened disability over 4 years, compared to 16.8 % of those who infrequently and 14.7 % of those who never experienced healthcare discrimination ( p < 0.001). In multivariate analyses, compared to no discrimination, frequent healthcare discrimination was associated with new or worsened disability over 4 years (aHR = 1.63, 95 % CI 1.16–2.27).

CONCLUSIONS

One out of five adults over the age of 50 years experiences discrimination in healthcare settings. One in 17 experience frequent healthcare discrimination, and this is associated with new or worsened disability by 4 years. Future research should focus on the mechanisms by which healthcare discrimination influences disability in older adults to promote better health outcomes for an aging population.

Electronic supplementary material

The online version of this article (doi:10.1007/s11606-015-3233-6) contains supplementary material, which is available to authorized users.

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Most cited references 22

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Perceived discrimination and mortality in a population-based study of older adults.

Julia L Bienias, William Evans, S. Barnes … (2008)

We examined the relation of individual-level perceived discrimination to mortality in a biracial, population-based sample. Participants were 4154 older adults from the Chicago Health and Aging Project who underwent up to 2 interviews over 4.5 years. Perceived discrimination was measured at baseline, and vital status was obtained at each follow-up and verified through the National Death Index. During follow-up, 1166 deaths occurred. Participants reporting more perceived discrimination had a higher relative risk of death (hazard ratio [HR]= 1.05; 95% confidence interval [CI]=1.01, 1.09). This association was independent of differences in negative affect or chronic illness and appeared to be stronger among Whites than among Blacks (Whites: HR=1.12; 95% CI=1.04, 1.20; Blacks: HR=1.03; 95% CI=0.99, 1.07). Secondary analyses revealed that the relation to mortality was related to discriminatory experiences of a more demeaning nature and that racial differences were no longer significant when the sample was restricted to respondents interviewed by someone of the same race. Perceived discrimination was associated with increased mortality risk in a general population of older adults. The results suggest that subjective experience of interpersonal mistreatment is toxic in old age. This study adds to a growing literature documenting discrimination as an important social determinant of health.

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Perceived discrimination and use of preventive health services.

John Ayanian, Jitin Trivedi (2006)

Little is known about the relation between perceptions of health care discrimination and use of health services. To determine the prevalence of perceived discrimination in health care, its association with use of preventive services, and the contribution of perceived discrimination to disparities in these services by race/ethnicity, gender, and insurance status. Cross-sectional study of 54,968 respondents to the 2001 California Health Interview Survey. Subjects were asked about experience with discrimination in receiving health care and use of 6 preventive health services, all within the previous 12 months. We used multivariate logistic regression with propensity-score methods to examine the adjusted relationship between perceived discrimination and receipt of preventive care. Discrimination was reported by 4.7% of respondents, and among these respondents the most commonly reported reasons were related to type of insurance (27.6%), race or ethnicity (13.7%), and income (6.7%). In adjusted analyses, persons who reported discrimination were less likely to receive 4 preventive services (cholesterol testing for cardiovascular disease, hemoglobin A1c testing and eye exams for diabetes, and flu shots), but not 2 other services (aspirin for cardiovascular disease, prostate specific antigen testing). Adjusting for perceived discrimination did not significantly change the relative likelihood of receipt of preventive care by race/ethnicity, gender, and insurance status. Persons who report discrimination may be less likely to receive some preventive health services. However, perceived discrimination is unlikely to account for a large portion of observed disparities in receipt of preventive care.

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Interpersonal processes of care survey: patient-reported measures for diverse groups.

Amanda Stewart, Timothy Springer, Steven Gregorich … (2007)

To create a patient-reported, multidimensional physician/patient interpersonal processes of care (IPC) instrument appropriate for patients from diverse racial/ethnic groups that allows reliable, valid, and unbiased comparisons across these groups. DATA SOURCE/DATA COLLECTION: Data were collected by telephone interview. The survey was administered in English and Spanish to adult general medicine patients, stratified by race/ethnicity and language (African Americans, English-speaking Latinos, Spanish-speaking Latinos, non-Latino whites) (N=1,664). In this cross-sectional study, items were designed to be appropriate for diverse ethnic groups based on focus groups, our prior framework, literature, and cognitive interviews. Multitrait scaling and confirmatory factor analysis were used to examine measurement invariance; we identified scales that allowed meaningful quantitative comparisons across four race/ethnic/language groups. The final instrument assesses several subdomains of communication, patient-centered decision making, and interpersonal style. It includes 29 items representing 12 first-order and seven second-order factors with equivalent meaning (metric invariance) across groups; 18 items (seven factors) allowed unbiased mean comparison across groups (scalar invariance). Final scales exhibited moderate to high reliability. The IPC survey can be used to describe disparities in interpersonal care, predict patient outcomes, and examine outcomes of quality improvement efforts to reduce health care disparities.

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Author and article information

Contributors

Stephanie E. Rogers: 415-221-4810 , stephanie.rogers@ucsf.edu

Journal

Journal ID (nlm-ta): J Gen Intern Med

Journal ID (iso-abbrev): J Gen Intern Med

Title: Journal of General Internal Medicine

Publisher: Springer US (New York )

ISSN (Print): 0884-8734

ISSN (Electronic): 1525-1497

Publication date (Electronic): 13 March 2015

Publication date PMC-release: 13 March 2015

Publication date (Print): October 2015

Volume: 30

Issue: 10

Pages: 1413-1420

Affiliations

[ ]Department of Medicine, Division of Geriatrics, University of California, San Francisco, CA USA

[ ]Veterans Affairs Medical Center, San Francisco, CA USA

[ ]Department of Health Behavior, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC USA

Article

Publisher ID: 3233

DOI: 10.1007/s11606-015-3233-6

PMC ID: 4579241

PubMed ID: 25773918

SO-VID: 8ecfd6c2-a952-44a5-84f8-7a05d4b18986

License:

Open Access This article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.

History

Date received : 23 April 2014

Date revision received : 3 October 2014

Date accepted : 23 January 2015

Custom metadata

ScienceOpen disciplines: Internal medicine

Keywords: disability,discrimination,geriatrics

Data availability:

ScienceOpen disciplines: Internal medicine

Keywords: disability, discrimination, geriatrics

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Discrimination in Healthcare Settings is Associated with Disability in Older Adults: Health and Retirement Study, 2008–2012

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Abstract

BACKGROUND

OBJECTIVE

DESIGN

PARTICIPANTS

MAIN MEASURES

KEY RESULTS

CONCLUSIONS

Electronic supplementary material

Related collections

Hogrefe Medicine

Most cited references 22

Perceived discrimination and mortality in a population-based study of older adults.

Perceived discrimination and use of preventive health services.

Interpersonal processes of care survey: patient-reported measures for diverse groups.

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Contributors

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Article

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Cited by 27

Most referenced authors 252