Relationships between discrimination in health care and health care outcomes among four race/ethnic groups
Relationships between discrimination in health care and health care outcomes among four race/ethnic groups
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DOI：
10.1007/s10865-013-9496-7
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发表时间：
2014-06-01
影响因子：
3.1
通讯作者：
Whitman, Steven
中科院分区：
文献类型：
--
作者：
Benjamins, Maureen R.;Whitman, Steven
人们发现歧视有害健康，但对歧视在保健方面的影响却知之甚少。为了解决这个问题，本研究（1）比较了四个种族/民族群体在医疗保健中的种族/民族歧视水平;（2）确定了这种歧视与医疗保健结果之间的关联;（3）评估了先前研究建议的潜在中介者和调节者。在1，699名白色、非裔美国人、墨西哥人和波多黎各人的人群样本中使用多变量逻辑回归模型。总体而言，23%的样本报告了医疗保健方面的歧视，其程度因种族/族裔而大不相同。在调整后的模型中，这种类型的歧视与未满足医疗保健需求的可能性增加（OR = 2.48，CI = 1.57-3.90）和感知优质护理的可能性降低（OR = 0.43，CI = 0.28-0.66）相关，但与未患病时使用医生或使用替代药物无关。观察到心理健康因素的中介作用不一致，并且种族/民族没有调节这种关系。这些发现扩展了文献，并提供了初步证据，最终可以为干预措施的制定和卫生保健提供者的培训提供信息。
Discrimination has been found to be detrimental to health, but less is known about the influence of discrimination in health care. To address this, the current study (1) compared levels of racial/ethnic discrimination in health care among four race/ethnic groups; (2) determined associations between this type of discrimination and health care outcomes; and (3) assessed potential mediators and moderators as suggested by previous studies. Multivariate logistic regression models were used within a population-based sample of 1,699 White, African American, Mexican, and Puerto Rican respondents. Overall, 23 % of the sample reported discrimination in health care, with levels varying substantially by race/ethnicity. In adjusted models, this type of discrimination was associated with an increased likelihood of having unmet health care needs (OR = 2.48, CI = 1.57-3.90) and lower odds of perceiving excellent quality of care (OR = 0.43, CI = 0.28-0.66), but not with the use of a physician when not sick or use of alternative medicine. The mediating role of mental health factors was inconsistently observed and the relationships were not moderated by race/ethnicity. These findings expand the literature and provide preliminary evidence that can eventually inform the development of interventions and the training of health care providers.