20% of Elderly Patients Report Health Care Discrimination

Thu Nguyen, ScD, MSPH

New analysis from the University of California at San Francisco (UCSF), Stanford University, and UC Berkley has found that an estimated 1 in 5 older patients with chronic illness reported feeling health care discrimination in some form between 2008 and 2014.

Led by Thu Nguyen, ScD, MSPH, a UCSF researcher, the suited examined biannual responses from 13,897 participants aged 54 or older within the University of Michigan’s Health and Retirement Study. All participants had at least 1 chronic condition (hypertension, diabetes, cancer, lung disease, heart disease, and stroke). The study population was limited to Black, White, and Hispanic Americans.

“This result indicates that discrimination is an important issue, and more attention is needed,” Nguyen told MD Magazine. “Greater awareness of how common these experiences are for patients may help clinicians provide more appropriate, patient-centered care.”

The analysis found that in 2008, 27% of Black Americans reported experiencing discrimination, with the main 3 reasons being on the basis of race or ancestry (48%), age (29%), and financial status (20%). In 2014, the percentage of Black Americans reporting discrimination dropped to 20%.

Among White Americans in 2008, 17% reported experiencing discrimination, with the top reasons being age (29%), weight or physical appearance (16%), gender (10%), and financial status (10%). In 2014, the percentage of White Americans reporting discrimination held at 17%.

No trend was shown for Hispanic Americans from 2008 to 2014 as the percentage experiencing discrimination began around 16%, increased over time and then dropped below its starting point. The most common reason for discrimination was reported as age (27%), race or ancestry (23%), weight or physical appearance (14%), and financial status (14%).

“The study does not specifically inform health care providers about the way they administer care, but the study findings do have potential implications for patient-provider relationships, utilization of health care, and health outcomes,” Nguyen said. “The study found patient-reported discrimination in the health care setting to be common, and discrimination in the health care setting has been previously associated with worse health, lower satisfaction with health care, and lower utilization of health services.”

Nguyen noted that the differences between reported discrimination of Black and White Americans declined from 8.2% in 2008 to 2.5% in 2014. She suggested that continual monitoring of this discrimination will allow for a better determination of whether or not reported discrimination continues to decline for Black Americans.

“While the likelihood of reporting discrimination in the health care setting tended to decline with increasing wealth for Whites, it remained nearly the same regardless of wealth for Blacks,” Nguyen said. “These results suggest that although higher wealth was associated with fewer reports of discrimination among Whites, it had no benefit for Blacks.”

As far as the provider-patient relationship is concerned, Nguyen said that despite it not being the focus of the study, it is very important to consider in the context of the data. "The provider-patient relationship is a component of the quality of care a patient receives so it’s important to consider. Prior studies show that provider bias impacts utilization of and satisfaction with care," she said.

"If people believe they have received unfair treatment in the health care setting, that experience could negatively affect their experience with their providers, their willingness to go to their providers, and their adherence with their treatment, and thereby affect their health," Nguyen said in a statement. "It's still very common, and there's a long way to go."

The study, "Trends for Reported Discrimination in Health Care in a National Sample of Older Adults with Chronic Conditions," was published in the Journal of Internal Medicine.