State-Level Sexism and Women's Health Care Access in the United States: Differences by Race/Ethnicity, 2014-2019

Abstract

Objectives. To quantify racial/ethnic differences in the relationship between state-level sexism and barriers to health care access among non-Hispanic White, non-Hispanic Black, and Hispanic women in the United States. Methods. We merged a multidimensional state-level sexism index compiled from administrative data with the national Consumer Survey of Health Care Access (2014-2019; n = 10 898) to test associations between exposure to state-level sexism and barriers to access, availability, and affordability of health care. Results. Greater exposure to state-level sexism was associated with more barriers to health care access among non-Hispanic Black and Hispanic women, but not non-Hispanic White women. Affordability barriers (cost of medical bills, health insurance, prescriptions, and tests) appeared to drive these associations. More frequent need for care exacerbated the relationship between state-level sexism and barriers to care for Hispanic women. Conclusions. The relationship between state-level sexism and women's barriers to health care access differs by race/ethnicity and frequency of needing care. Public Health Implications. State-level policies may be used strategically to promote health care equity at the intersection of gender and race/ethnicity. (Am J Public Health. 2021;111(10):1796-1805. https://doi.org/10.2105/AJPH.2021.306455).

FIGURE 1—

Predicted Probabilities of Experiencing Barriers to Health Care Access by State-Level Sexism Among Non-Hispanic White, Non-Hispanic Black, and Hispanic Women for (a) All Barriers to Care, (b) Availability Barriers to Care, and (c) Affordability Barriers to Care: United States, 2014–2019 Note. The sample size was n = 10 898. Figure 1a shows predicted probabilities of experiencing 4 or more barriers to care (reported by 23% of the sample) for each standard deviation of state-level sexism. Figure 1b shows the predicted probabilities of experiencing 2 or more availability barriers (reported by 14% of the sample) by state-level sexism. Figure 1c shows the predicted probabilities of experiencing 3 or more affordability barriers (reported by 24% of the sample) by state-level sexism.