Discrimination in Healthcare Settings is Associated with Disability in Older Adults: Health and Retirement Study, 2008–2012

Abstract

BACKGROUNDAs our society ages, improving medical care for an older population will be crucial. Discrimination in healthcare may contribute to substandard experiences with the healthcare system, increasing the burden of poor health in older adults. Few studies have focused on the presence of healthcare discrimination and its effects on older adults.OBJECTIVEWe aimed to examine the relationship between healthcare discrimination and new or worsened disability.DESIGNThis was a longitudinal analysis of data from the nationally representative Health and Retirement Study administered in 2008 with follow-up through 2012.PARTICIPANTSSix thousand and seventeen adults over the age of 50 years (mean age 67 years, 56.3 % female, 83.1 % white) were included in this study.MAIN MEASURESHealthcare discrimination assessed by a 2008 report of receiving poorer service or treatment than other people by doctors or hospitals (never, less than a year=infrequent; more than once a year=frequent). Outcome was self-report of new or worsened disability by 2012 (difficulty or dependence in any of six activities of daily living). We used a Cox proportional hazards model adjusting for age, race/ethnicity, gender, net worth, education, depression, high blood pressure, diabetes, cancer, lung disease, heart disease, stroke, and healthcare utilization in the past 2 years.KEY RESULTSIn all, 12.6 % experienced discrimination infrequently and 5.9 % frequently. Almost one-third of participants (29 %) reporting frequent healthcare discrimination developed new or worsened disability over 4 years, compared to 16.8 % of those who infrequently and 14.7 % of those who never experienced healthcare discrimination (p < 0.001). In multivariate analyses, compared to no discrimination, frequent healthcare discrimination was associated with new or worsened disability over 4 years (aHR = 1.63, 95 % CI 1.16–2.27).CONCLUSIONSOne out of five adults over the age of 50 years experiences discrimination in healthcare settings. One in 17 experience frequent healthcare discrimination, and this is associated with new or worsened disability by 4 years. Future research should focus on the mechanisms by which healthcare discrimination influences disability in older adults to promote better health outcomes for an aging population.Electronic supplementary materialThe online version of this article (doi:10.1007/s11606-015-3233-6) contains supplementary material, which is available to authorized users.

Trends for Reported Discrimination in Health Care in a National Sample of Older Adults with Chronic Conditions

“…23,[37][38][39] A prior study utilizing data from HRS examined discrimination in the health care setting in 2008 only. 40 Our finding that reports of discrimination are common, especially for Blacks, is consistent with prior literature. [22][23][24] These results, along with previous findings, highlight the pervasiveness of patient-reported discrimination in the health care setting.…”

Detailed Analysis of the Characteristics of Sample Volume in Blood Culture Bottles

“…It was recently reported that one of five adults over the age of 50 years experiences discrimination in health care settings (22). In the present study, the blood volume collected decreased with increasing patient age.…”

Disability discrimination and well-being in the United Kingdom: a prospective cohort study

“…One mechanism could be that perceptions of disability discrimination in healthcare settings serve to impede access to health services. An analysis of HRS found that reports of frequent discrimination in healthcare settings were predictive of new or worsened disability over 4-year follow-up 42. Quantitative38 43 and qualitative44 evidence suggests that those who perceive disability discrimination are less likely to seek healthcare.…”