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Changes in Perceptions of Discrimination in Health Care in California, 2003 to 2017.

ABSTRACT: Importance:Research in the early 2000s in California demonstrated that racial and ethnic minorities, immigrants, and those with limited English proficiency (LEP) experienced high rates of discrimination in health care. Less is known about how patients' perceptions of discrimination in health care have changed since then. Objective:To determine whether perceptions of discrimination in health care have changed overall and for specific vulnerable populations. Design, Setting, and Participants:This cross-sectional study used data from the California Health Interview Survey for state residents aged 18 years and older for 2 periods, 2003 to 2005 and 2015 to 2017. ?2 analyses and multivariate logistic regression were performed to compare recent discrimination in health care in late vs early periods controlling for race/ethnicity, poverty level, education, insurance status, usual source of care, self-reported health, and LEP. Additional subanalyses were performed by race/ethnicity, immigrant status, and LEP status. Jackknife replicate weights were provided by the California Health Interview Survey. Exposure:Survey year was dichotomized as combined 2003 to 2005 and combined 2015 to 2017. Main Outcomes and Measures:Survey respondents were identified as having experienced recent discrimination in health care if they responded "yes" to the question, "Was there ever a time when you would have gotten better medical care if you had belonged to a different race or ethnic group?" and reported that this occurred within the last 5 years. Results:There were 84?088 participants in 2003 to 2005 (51.0% female; 14.7% aged ?65 years) and 63?242 participants in 2015 to 2017 (51.1% female; 18.0% aged ?65 years). Rates of recent discrimination in health care decreased from 6.0% to 4.0% (difference, 2.0%; 95% CI, 1.5%-2.5%; P?

SUBMITTER: Schulson LB

PROVIDER: S-EPMC6613287 | biostudies-literature | 2019 Jul

REPOSITORIES: biostudies-literature

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Changes in Perceptions of Discrimination in Health Care in California, 2003 to 2017.

Schulson Lucy B LB Paasche-Orlow Michael K MK Xuan Ziming Z Fernandez Alicia A

JAMA network open 20190703 7

<h4>Importance</h4>Research in the early 2000s in California demonstrated that racial and ethnic minorities, immigrants, and those with limited English proficiency (LEP) experienced high rates of discrimination in health care. Less is known about how patients' perceptions of discrimination in health care have changed since then.<h4>Objective</h4>To determine whether perceptions of discrimination in health care have changed overall and for specific vulnerable populations.<h4>Design, setting, and ...[more]

PMID: 31268540

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Project description:BACKGROUND:Trend data on hypertension prevalence and attainment indicators at each step of the care cascade (awareness, treatment, control) are required in Chile. This study aims to quantify trends (2003-2017) in prevalence and in the proportion of individuals with hypertension attaining each step of the care cascade among adults aged 17?years or older, and to assess the impact of lowering the blood pressure (BP) thresholds used to define elevated BP on these indicators. METHODS:We used data from 2003, 2010, and 2017 Chilean national health surveys. Each year we assessed levels of (1) mean systolic (SBP) and diastolic (DBP) blood pressure, (2) hypertension prevalence (BP???140/90?mmHg or use of antihypertensive treatment), and (3) awareness, treatment, and control. Logistic regression on pooled data was used to assess trends in binary outcomes; linear regression was used to assess trends in continuous SBP and DBP. We compared levels of hypertension prevalence using two sources to ascertain antihypertensive treatment (self-reported versus medicine inventory). The 2017 American College of Cardiology/American Heart Association (ACC/AHA) guidelines were used to re-define hypertension using lower thresholds (BP???130/80?mmHg). RESULTS:Hypertension prevalence was 34.0, 32.0 and 30.8% in 2003, 2010 and 2017, respectively. Levels of treated- and controlled-hypertension were significantly higher in 2017 than in 2003 (65% versus 41% for treatment, P?<?0.001; 34% versus 14% for control, P?<?0.001), while levels of awareness were stable (66% versus 59%, P?=?0.130). Awareness, treatment, and control levels were higher among females in 2003, 2010, and 2017 (P?<?0.001). Mean SBP and DBP decreased over the 15-year period, except for SBP among females on treatment. Adopting the 2017 ACC/AHA guidelines would increase hypertension prevalence by 17 and 55% in absolute and relative terms, respectively. CONCLUSIONS:Chile has experienced a positive population-wide lowering in blood pressure distribution which may be explained partly by a significant rise in levels of treated- and controlled-hypertension since 2003. Lowering the thresholds used to define elevated BP would substantially increase the financial public health challenge of further improving attainment levels at each step of the care cascade. Innovative and collaborative strategies are needed to improve hypertension management, especially among males.

Project description:BackgroundExperiences of discrimination harm mental and physical health, with the strongest penalty on mental health. Among immigrants, it remains unclear how acculturation-the process by which immigrants acquire the beliefs and practices of a host culture-influences the mental health burden of navigating discrimination. On the one hand, acculturation can be associated with upward social mobility. Conversely, the acculturative process may increase exposure to, and recognition of, discrimination.ObjectivesWe examined the relationship between discrimination and mental illness across racial/ethnic groups, and pathways by which acculturation and age relate to the discrimination-mental health relationship.DesignA secondary data analysis using population data from the 2015-2016 California Health Interview Survey.Main measuresThe Kessler 6-item Psychological Distress Scale (K6) assessed symptoms of psychological distress, with K6 score ≥ 13 associated with severe mental illness. Discrimination was measured using a self-reported measure of lifetime experience of unfair treatment in getting medical care. We used a 5-point acculturation index (constructed by measures of nativity, years living in the USA, and home language use). A weighted logistic regression model predicted mental illness as a function of discrimination. We ran mediational analysis using the Karlson-Holm-Breen method and used predictive margins to present predicted probabilities of mental illness for people reporting discrimination at different acculturation and age levels.Key resultsThere were independent effects on mental illness associated with increased discrimination (OR 3.85, 95% CI = 2.46, 6.03, p < 0.001) and increased acculturation (OR 1.72, 95% CI = 1.24, 2.38, p = 0.001), including when stratified across racial/ethnic groups. Higher levels of acculturation led to a significant increase in discrimination's association with mental illness. There was a higher probability of mental illness in younger age groups than in older age groups.ConclusionsWhile discrimination is associated with poor mental health, a stronger link between discrimination and mental illness exists among younger immigrants and immigrants with increased acculturation. Health practitioners should not overlook the mental health needs of younger immigrants and immigrants who may seem more integrated into US society.

Dataset Information

Changes in Perceptions of Discrimination in Health Care in California, 2003 to 2017.

Publications

Changes in Perceptions of Discrimination in Health Care in California, 2003 to 2017.

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