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. 2015 Oct;30(10):1413-20.
doi: 10.1007/s11606-015-3233-6. Epub 2015 Mar 13.

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

Stephanie E Rogers  1 , Angela D Thrasher  2 , Yinghui Miao  3 , W John Boscardin  3 , Alexander K Smith  3   4
Affiliations

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

Stephanie E Rogers et al. J Gen Intern Med. 2015 Oct.

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.

Keywords: disability; discrimination; geriatrics.

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Figures

Figure 1.
Figure 1.
Reasons for discrimination reported by those experiencing healthcare discrimination.* *Legend: Given the high degree of overlap between healthcare discrimination and affirmative responses to other items on the Everyday Discrimination Scale, reasons for discrimination should be interpreted as general reasons for discrimination, rather than reasons specific to the healthcare setting.
Figure 2.
Figure 2.
Change in functional status of participants 2 and 4 years after reporting healthcare discrimination.
Figure 3.
Figure 3.
Legend: Follow-up interviews were conducted every 2 years, in 2010 and 2012, although not precisely at 2-year intervals. The two plateaus in the plot correspond to the time between participant interviews.
See this image and copyright information in PMC

Comment in

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