Racism and health service utilisation: A systematic review and meta-analysis

Abstract

Although racism has been posited as driver of racial/ethnic inequities in healthcare, the relationship between racism and health service use and experience has yet to be systematically reviewed or meta-analysed. This paper presents a systematic review and meta-analysis of quantitative empirical studies that report associations between self-reported racism and various measures of healthcare service utilisation. Data were reviewed and extracted from 83 papers reporting 70 studies. Studies included 250,850 participants and were conducted predominately in the U.S. The meta-analysis included 59 papers reporting 52 studies, which were analysed using random effects models and mean weighted effect sizes. Racism was associated with more negative patient experiences of health services (HSU-E) (OR = 0.351 (95% CI [0.236,0.521], k = 19), including lower levels of healthcare-related trust, satisfaction, and communication. Racism was not associated with health service use (HSU-U) as an outcome group, and was not associated with most individual HSU-U outcomes, including having had examinations, health service visits and admissions to health professionals and services. Racism was associated with health service use outcomes such as delaying/not getting healthcare, and lack of adherence to treatment uptake, although these effects may be influenced by a small sample of studies, and publication bias, respectively. Limitations to the literature reviewed in terms of study designs, sampling methods and measurements are discussed along with suggested future directions in the field.

Experience of racism and associations with unmet need and healthcare satisfaction: the 2011/12 adult New Zealand Health Survey

“…While we cannot rule out the potential for reverse causality with this cross‐sectional design, there is little support for reverse causality when considering these findings in the context of the wider literature on racism and health. This is the case for studies looking at healthcare experiences/quality outcomes 9 as well as the wider literature on racism as a health determinant 2 . A recent meta‐analysis on experience of racism and health outcomes showed that in studies on experience of racism and mental health, cross‐sectional study designs tended to demonstrate stronger associations with negative mental health measures than longitudinal study designs, although this did not apply to all types of mental health measures 2 .…”

“…In this study it would underestimate the association with unmet need and overestimate the association with satisfaction. Similarly, the validity of self‐reported outcome measures of healthcare such as reported satisfaction and unmet need could be strengthened in future research in New Zealand through the objective measurement of outcomes from actual healthcare encounters, 41 and the use of recorded health data for measures of quality of healthcare such as appropriate and timely treatment and management of health problems 9 . These studies would require substantially different study designs.…”

“…We chose one health service utilisation variable (unmet need to see a general practitioner [GP]) and one patient experience variable (overall satisfaction with usual medical centre). These both focus on primary healthcare in New Zealand and represent the two types of healthcare measures identified in a recent review of racism and health service utilisation 9 …”

“…Experience of racism has been linked to various mental and physical health outcomes in many studies to date, as summarised in a recent systematic review, 2 and is largely thought to affect health as a chronic stressor 1,7,8 . The negative impact of racism on people's experiences and use of healthcare has also been examined, albeit to a lesser extent 1,9 . Racial discrimination experienced in both broader society and specifically in healthcare services can influence perceptions of healthcare by patients, as well as how people engage with and access services 10 .…”

New research directions on disparities in obesity and type 2 diabetes

“…For example, physicians can write "prescriptions" for healthy food (with an accompanying voucher or coupon) at a neighborhood Farmer's Market or a participating Walgreens store. [36][37][38][39][40] The many ways that unmet social needs influence the effectiveness of treatments was a key workshop theme. Patients who completed the diabetes education classes were more likely to participate in the community-based programs the team has created (e.g., grocery store tours and community exercise programs) than other patients in the health centers.…”