Perceived Discrimination and Privilege in Health Care: The Role of Socioeconomic Status and Race
Perceived Discrimination and Privilege in Health Care: The Role of Socioeconomic Status and Race
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DOI：
10.1016/j.amepre.2016.09.024
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发表时间：
2017-01-01
影响因子：
5.5
通讯作者：
Oates, Gabriela R.
中科院分区：
文献类型：
--
作者：
Stepanikova, Irena;Oates, Gabriela R.
前言：本研究探讨了在医疗保健中种族特权和种族歧视的感知如何随种族和社会经济地位（SES）的变化而变化。方法：样本包括行为风险因素监测系统（2005-2013）中在过去12个月内寻求医疗保健的白人、黑人和美洲原住民受访者。对感知到的种族特权和感知到的歧视进行多元logistic回归模型估计。分析于2016年进行。结果：与白人相比，黑人和印第安人对种族特权的看法不那么普遍，而对种族歧视的看法在这些少数民族中更为普遍。在白人中，较高的收入和受教育程度增加了对特权待遇的认识，减少了对歧视的认识。这种模式在黑人身上正好相反，他们的收入和教育水平越高，受到的歧视就越多，特权就越少。在所有种族群体中，报告因费用而放弃医疗服务的受访者认为受到种族歧视的风险更高。只有在白人中，医疗保险才会减少种族歧视，增加特权。结论：社会经济地位是卫生保健中特权感知和歧视感知的重要社会决定因素，但其作用因指标和种族而异。受教育程度低或没有医疗保险的白人、受过良好教育的黑人以及在医疗方面面临与费用有关的障碍的个人，受到明显歧视的风险更高。减少这些观念的政策和干预措施应针对结构性和系统性因素，包括全社会在收入、教育和医疗保健获取方面的不平等，并应根据种族特定的医疗保健经历进行调整。(C) 2016美国预防医学杂志。Elsevier Inc.出版。版权所有。
Introduction: This study examined how perceived racial privilege and perceived racial discrimination in health care varied with race and socioeconomic status (SES).Methods: The sample consisted of white, black, and Native American respondents to the Behavioral Risk Factor Surveillance System (2005-2013) who had sought health care in the past 12 months. Multiple logistic regression models of perceived racial privilege and perceived discrimination were estimated. Analyses were performed in 2016.Results: Perceptions of racial privilege were less common among blacks and Native Americans compared with whites, while perceptions of racial discrimination were more common among these minorities. In whites, higher income and education contributed to increased perceptions of privileged treatment and decreased perceptions of discrimination. The pattern was reversed in blacks, who reported more discrimination and less privilege at higher income and education levels. Across racial groups, respondents who reported foregone medical care due to cost had higher risk of perceived racial discrimination. Health insurance contributed to less perceived racial discrimination and more perceived privilege only among whites.Conclusions: SES is an important social determinant of perceived privilege and perceived discrimination in health care, but its role varies by indicator and racial group. Whites with low education or no health insurance, well-educated blacks, and individuals who face cost-related barriers to care are at increased risk of perceived discrimination. Policies and interventions to reduce these perceptions should target structural and systemic factors, including society-wide inequalities in income, education, and healthcare access, and should be tailored to account for racially specific healthcare experiences. (C) 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.