Patient-Reported Experiences of Discrimination in the US Health Care System.
Patient-Reported Experiences of Discrimination in the US Health Care System.
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患者报告的美国医疗保健系统中的歧视经历。
DOI：
10.1001/jamanetworkopen.2020.29650
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发表时间：
2020-12-01
影响因子：
13.8
通讯作者：
Platt JE
中科院分区：
文献类型：
--
作者：
Nong P;Raj M;Creary M;Kardia SLR;Platt JE
在美国的医疗保健系统中，成年患者报告的歧视的全国流行率、频率和主要类型是什么？在这项具有全国代表性的横断面调查研究中，2137名美国成年受访者中有21%表示他们在医疗保健系统中经历过歧视，72%经历过歧视的人报告说经历过不止一次。种族/族裔歧视是受访者报告最多的歧视类型。卫生保健系统中的歧视现象似乎比以前认识到的更为普遍，值得给予相当大的关注。虽然有大量证据表明负面健康结果与日常歧视经历之间存在关联，但对国家一级卫生保健系统中的此类经历知之甚少。至关重要的是，必须衡量和解决医疗保健系统中的歧视问题，以减轻对患者的伤害，并作为应对卫生不公平现象的更大持续项目的一部分。目的：（1）确定全国范围内患者报告的医疗保健系统中歧视经历的普遍程度、发生频率以及经历的主要歧视类型;（2）检查不同人口统计学群体中歧视发生率的差异。这项于2019年5月在线进行的跨部门全国调查使用了国家民意研究中心AmeriSpeak小组的一般人群样本。调查对象为3253名21岁或以上的美国成年人，包括非裔美国人受访者、西班牙裔受访者和家庭年收入低于联邦贫困线200%的受访者。分析借鉴了3个调查项目，衡量患者报告的歧视经历，经历的主要类型的歧视，他们发生的频率，以及受访者的人口和健康相关的特征。进行加权双变量和多变量logistic回归，以评估歧视经历与几个人口统计学和健康相关特征之间的关联。在完成调查的2137名美国成年受访者中（66.3%的回复率;未加权的51.0%为女性;平均[SD]年龄为49.6 [16.3]岁），458名（21.4%）报告称他们在医疗保健系统中经历过歧视。在应用权重生成人口水平估计值后，大多数经历过歧视的人（330人[72.0%]）报告经历过不止一次。在458例报告的歧视经历中，种族/民族歧视是最常见的类型（79例[17.3%]），其次是基于教育或收入水平（59例[12.9%]）、体重（53例[11.6%]）、性别（52例[11.4%]）和年龄（44例[9.6%]）的歧视。在多变量分析中，女性受访者遭受歧视的几率更高（比值比[OR]，1.88; 95% CI，1.50-2.36），老年受访者更低（OR，0.98; 95% CI，0.98-0.99），家庭年收入至少为5万美元的受访者（OR，0.76; 95%CI，0.60-0.95），以及报告健康状况良好（OR，0.59; 95%CI，0.46-0.75）或极佳（OR，0.41; 95%CI，0.31-0.56）与健康状况较差或一般的患者相比。这项研究的结果表明，在卫生保健系统中的歧视的经验似乎比以前认识到的更常见，值得相当重视。这些研究结果有助于了解人际歧视在美国医疗保健系统中发生的规模，并为评估这种歧视的风险和后果的下一步措施提供关键证据。调查结果还表明，需要进一步分析人际歧视如何与结构性不平等和健康的社会决定因素相互作用，以制定有效的应对措施。这项横断面研究探讨了最近的国家民意研究中心的调查，以评估的患病率，频率和主要类型的歧视经历的成年患者在美国医疗保健系统的反应。
What are the national prevalence, frequency, and main types of discrimination that adult patients report experiencing in the US health care system? In this nationally representative cross-sectional survey study, 21% of 2137 US adult survey respondents indicated that they had experienced discrimination in the health care system, and 72% of those who had experienced discrimination reported experiencing it more than once. Racial/ethnic discrimination was the most frequently reported type of discrimination respondents experienced. Experiences of discrimination in the health care system appear to be more common than previously recognized and deserve considerable attention. Although considerable evidence exists on the association between negative health outcomes and daily experiences of discrimination, less is known about such experiences in the health care 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. To (1) 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 (2) examine differences in the prevalence of discrimination across demographic groups. This cross-sectional national survey fielded online in May 2019 used a general population sample from the National Opinion Research Center’s AmeriSpeak Panel. Surveys were sent to 3253 US adults aged 21 years or older, including oversamples of African American respondents, Hispanic respondents, and respondents with annual household incomes below 200% of the federal poverty level. Analyses drew on 3 survey items measuring patient-reported experiences of discrimination, the primary types of discrimination experienced, the frequency with which they occurred, and the demographic and health-related characteristics of the respondents. Weighted bivariable and multivariable logistic regressions were conducted to assess associations between experiences of discrimination and several demographic and health-related characteristics. Of 2137 US adult respondents who completed the survey (66.3% response rate; unweighted 51.0% female; mean [SD] age, 49.6 [16.3] years), 458 (21.4%) 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%]) reported experiencing it more than once. Of 458 reporting experiences of discrimination, racial/ethnic discrimination was the most common type (79 [17.3%]), followed by discrimination based on educational or income level (59 [12.9%]), weight (53 [11.6%]), sex (52 [11.4%]), and age (44 [9.6%]). In multivariable analysis, the odds of experiencing discrimination were higher for respondents who identified as female (odds ratio [OR], 1.88; 95% CI, 1.50-2.36) and lower for older respondents (OR, 0.98; 95% CI, 0.98-0.99), respondents earning at least $50 000 in annual household income (OR, 0.76; 95% CI, 0.60-0.95), and those reporting good (OR, 0.59; 95% CI, 0.46-0.75) or excellent (OR, 0.41; 95% CI, 0.31-0.56) health compared with poor or fair health. 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. This cross-sectional study examines the responses to a recent National Opinion Research Center survey to assess the prevalence, frequency, and main types of discrimination experienced by adult patients in the US health care system.
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影响因子：
3.4
作者：
LaVeist, TA;Rolley, NC
通讯作者：
Rolley, NC
影响因子：
3.4
作者：
LaVeist TA;Isaac LA;Williams KP
通讯作者：
Williams KP
影响因子：
2.8
作者：
Abramson, Corey M;Hashemi, Manata;Sanchez-Jankowski, Martin
通讯作者：
Sanchez-Jankowski, Martin
影响因子：
3
作者：
Armstrong K;Putt M;Halbert CH;Grande D;Schwartz JS;Liao K;Marcus N;Demeter MB;Shea JA
通讯作者：
Shea JA
DOI：
10.1146/annurev-soc-073014-112142
发表时间：
2015-01-01
期刊：
ANNUAL REVIEW OF SOCIOLOGY, VOL 41
影响因子：
--
作者：
Collins, Patricia Hill
通讯作者：
Collins, Patricia Hill