Prior experiences of racial discrimination and racial differences in health care system distrust.
Prior experiences of racial discrimination and racial differences in health care system distrust.
复制标题
DOI：
10.1097/mlr.0b013e31827310a1
复制
发表时间：
2013-02
期刊：
影响因子：
3
通讯作者：
Shea JA
中科院分区：
文献类型：
--
作者：
Armstrong K;Putt M;Halbert CH;Grande D;Schwartz JS;Liao K;Marcus N;Demeter MB;Shea JA
导致医疗保健系统不信任（HCSD）种族差异的因素目前尚不清楚。提出的潜在促成因素是以前的种族歧视和种族居住隔离经历。随机数字拨号调查的762名非洲裔美国人和1267名白色成年人生活在40个美国大都市统计区（MSA）。措施包括修订后的医疗保健系统不信任量表，歧视规模的经验，获得护理的指标，社会人口特征，以及城市的种族居住隔离水平（使用隔离指数）。在未经调整的分析中，非裔美国人有更高水平的HCSD，特别是价值观不信任，以及更多的歧视经历。受歧视的经历也与HCSD密切相关。调整社会人口特征，医疗保健和居住隔离对非裔美国人种族和整体HCSD或价值观不信任之间的关联影响不大。相比之下，调整种族歧视的经历扭转了这种关联，使非裔美国人的不信任低于白人（整体措施的OR 0.53，95%CI 0.33 - 0.85）。中介作用的Sobel检验非常显著（p <0.001）。非裔美国人的HCSD较高的原因是种族歧视经历的负担比白人更大。在调整种族歧视经历后，白人更不信任的原因尚不清楚。必须努力消除种族歧视，恢复对先前歧视的信任。
Factors contributing to racial differences in health care system distrust (HCSD) are currently unknown. Proposed potential contributing factors are prior experiences of racial discrimination and racial residential segregation. Random digit dialing survey of 762 African-American and 1267 White adults living in 40 US Metropolitan Statistical Areas (MSAs). Measures included the Revised Health Care System Distrust scale, the Experiences of Discrimination scale, metrics of access to care, sociodemographic characteristics, and the level of racial residential segregation in the city (using the isolation index). In unadjusted analyses, African Americans had higher levels of HCSD, particularly values distrust, and greater experiences of discrimination. Experience of discrimination was also strongly associated with HCSD. Adjusting for sociodemographic characteristics, health care access and residential segregation had little effect on the association between African-American race and overall HCSD or values distrust. In contrast, adjusting for experiences of racial discrimination reversed the association so that distrust was lower among African Americans than Whites (OR 0.53, 95% CI 0.33–0.85 for the overall measure). The Sobel test for mediation was strongly significant (p<0.001). Higher HCSD among African Americans is explained by a greater burden of experiences of racial discrimination than Whites. Reasons for higher distrust among Whites after adjusting for experiences of racial discrimination are not known. Efforts to eliminate racial discrimination and restore trust given prior discrimination are needed.