JAMA Open Network Study: One-Fifth of Patients of Color Have Experienced Direct Racism in Healthcare
A number of studies have been done of implicit racial biases in care delivery in the U.S. healthcare system, including around such issues as the adequacy of pain management and perceptions about individual people of color. But until now, few have attempted to study direct racial discrimination against Black Americans and other Americans of color.
On Dec. 15, a team of healthcare researchers published an article in JAMA Open Network online, entitled “Patient-Reported Experiences of Discrimination in the US Health Care System.” Paige Nong, Minakshi Rai, Ph.D., Melissa Creary, Ph.D., Sharon L.R. Kardia, Ph.D., and Jodyn E. Platt, Ph.D. authored the article.
As the authors note in their abstract, “Although considerable evidence exists on the association between negative health outcomes and daily experiences of discrimination, less is known about such experiences in the healthcare system at the national level. It is critically necessary to measure and address discrimination in the health care system to mitigate harm to patients and as part of the larger ongoing project of responding to health inequities.” As a result, they write, they wanted to “identify the national prevalence of patient-reported experiences of discrimination in the health care system, the frequency with which they occur, and the main types of discrimination experienced and examine differences in the prevalence of discrimination across demographic groups.” As a result, they conducted an online survey of 2,137 American adults, conducted online in May 2019, from a general population sample from the National Opinion Research Center’s AmeriSpeak Panel. Respondents were Black and Latino, with annual household incomes below 200 percent of the federal poverty level. They wanted to determine “the frequency of different types of discriminatory treatment, which may be a significant risk factor for chronic disease given the association between discrimination and health over the life course.”
The write that, “Of 2137 US adult respondents who completed the survey… 458 (21.4 percent) reported that they had experienced discrimination in the health care system. After applying weights to generate population-level estimates, most of those who had experienced discrimination (330 [72.0 percent]) reported experiencing it more than once. Of 458 reporting experiences of discrimination, racial/ethnic discrimination was the most common type (79 [17.3 percent]), followed by discrimination based on educational or income level (59 [12.9 percent]), weight (53 [11.6 percent]), sex (52 [11.4 percent]), and age (44 [9.6 percent]).”
The authors write that “The results of this study suggest that experiences of discrimination in the health care system appear more common than previously recognized and deserve considerable attention. These findings contribute to understanding of the scale at which interpersonal discrimination occurs in the US health care system and provide crucial evidence for next steps in assessing the risks and consequences of such discrimination. The findings also point to a need for further analysis of how interpersonal discrimination interacts with structural inequities and social determinants of health to build effective responses,” they write.
