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J Gen Intern Med. 2018 Mar;33(3):291-297. doi: 10.1007/s11606-017-4209-5. Epub 2017 Dec 15.

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

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Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA.
Center for Primary Care and Outcome Research and Center for Population Health Sciences, Departments of Medicine and of Health Research and Policy, Stanford University, Stanford, CA, USA.
Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA.
Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Divisions of Community Health Sciences and Epidemiology, University of California, Berkeley, Berkeley, CA, USA.



Discrimination in health care settings is associated with poor health outcomes and may be especially harmful to individuals with chronic conditions, who need ongoing clinical care. Although efforts to reduce discrimination are growing, little is known about national trends in discrimination in health care settings.


For Black, White, and Hispanic respondents with chronic disease in the 2008-2014 Health and Retirement Study (N = 13,897 individuals and 21,078 reports), we evaluated trends in patient-reported discrimination, defined based on frequency of receiving poorer service or treatment than other people from doctors or hospitals ("never" vs. all other). Respondents also reported the perceived reason for the discrimination. In addition, we evaluated whether wealth predicted lower prevalence of discrimination for Blacks or Whites. We used generalized estimating equation models to account for dependency of repeated measures on individuals and wave-specific weights to represent the US non-institutionalized population aged 54+ .


The estimated prevalence of experiencing discrimination in health care among Blacks with a major chronic condition was 27% (95% CI: 23, 30) in 2008 and declined to 20% (95% CI: 17, 22) in 2014. Reports of receiving poorer service or treatment were stable for Whites (17%, 95% CI: 16, 19 in 2014). The Black-White difference in reporting any health care discrimination declined from 8.2% (95% CI: 4.5, 12.0) in 2008 to 2.5% (95% CI: -1.1, 6.0) in 2014. There was no clear trend for Hispanics. Blacks reported race and Whites reported age as the most common reason for discrimination.


Findings suggest national declines in patient-reported discrimination in health care among Blacks with chronic conditions from 2008 to 2014, although reports of discrimination remain common for all racial/ethnic groups. Our results highlight the critical importance of monitoring trends in reports of discrimination in health care to advance equity in health care.


discrimination; disparities; epidemiology; health care

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