Perceptions of racism in healthcare among patients with systemic lupus erythematosus: a cross-sectional study
Perceptions of racism in healthcare among patients with systemic lupus erythematosus: a cross-sectional study
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DOI：
10.1136/lupus-2015-000110
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发表时间：
2015-03-01
影响因子：
3.9
通讯作者：
Kwoh, C. Kent
中科院分区：
文献类型：
--
作者：
Vina, Ernest R.;Hausmann, Leslie R. M.;Kwoh, C. Kent
背景：系统性红斑狼疮（SLE）的临床结局存在种族差异。感知种族歧视可能会导致差异health.Objectives：要确定是否感知种族主义在医疗保健不同的种族SLE患者之间，并评估其贡献的种族差异SLE相关outcomes.Methods：163非洲裔美国人（AA）和180白色（WH）SLE患者参加。进行结构化访谈和图表审查，以确定种族主义的看法，SLE相关的结果（系统性狼疮国际合作诊所（SLICC）损害指数，SLE疾病活动，流行病学抑郁症中心（CES-D）），以及其他可能影响种族主义看法的变量。进行了系列分层多变量logistic回归模型。结果：56.0%的AA患者与32.8%的WH患者相比，在医疗保健方面有很高的歧视意识（p= 17），AA患者也高于WH患者（粗OR 1.94（95%CI 1.26至2.98））。当调整社会人口统计学和临床特征，疾病损害和抑郁症的种族差异不再显着。在AA患者中，较高的种族主义感知与中度至重度抑郁症（调整OR 1.23（95%CI 1.05至1.43）），即使调整后的社会人口和临床variables.Conclusions：种族主义在医疗保健的看法更常见于AA患者比WH患者与SLE和抑郁症。针对可变因素（如对提供者的信任）的干预可能会降低SLE患者对种族歧视的感知。
Background: Racial disparities in the clinical outcomes of systemic lupus erythematosus (SLE) exist. Perceived racial discrimination may contribute to disparities in health.Objectives: To determine if perceived racism in healthcare differs by race among patients with SLE and to evaluate its contribution to racial disparities in SLE-related outcomes.Methods: 163 African-American (AA) and 180 white (WH) patients with SLE were enrolled. Structured interviews and chart reviews were done to determine perceptions of racism, SLE-related outcomes (Systemic Lupus International Collaborating Clinics (SLICC) Damage Index, SLE Disease Activity, Center for Epidemiologic Studies-Depression (CES-D)), and other variables that may affect perceptions of racism. Serial hierarchical multivariable logistic regression models were conducted. Race-stratified analyses were also performed.Results: 56.0% of AA patients compared with 32.8% of WH patients had high perceptions of discrimination in healthcare (p= 17) were also higher in AA patients than in WH patients (crude OR 1.94 (95% CI 1.26 to 2.98)). When adjusted for sociodemographic and clinical characteristics, racial disparities in disease damage and depression were no longer significant. Among AA patients, higher perceived racism was associated with having moderate to severe depression (adjusted OR 1.23 (95% CI 1.05 to 1.43)) even after adjusting for sociodemographic and clinical variables.Conclusions: Perceptions of racism in healthcare were more common in AA patients than in WH patients with SLE and were associated with depression. Interventions aimed at modifiable factors (eg, trust in providers) may reduce higher perceptions of race-based discrimination in SLE.