Correlates of patient-reported racial/ethnic health care discrimination in the Diabetes Study of Northern California (DISTANCE)

Abstract

Objectives: We examined possible determinants of self-reported health care discrimination.

Methods: We examined survey data from the Diabetes Study of Northern California (DISTANCE), a race-stratified sample of Kaiser diabetes patients. Respondents reported perceived discrimination, and regression models examined socioeconomic, acculturative, and psychosocial correlates.

Results: Subjects (n=17,795) included 20% Blacks, 23% Latinos, 13% East Asians, 11% Filipinos, and 27% Whites. Three percent and 20% reported health care and general discrimination. Health care discrimination was more frequently reported by minorities (ORs ranging from 2.0 to 2.9 compared with Whites) and those with poorer health literacy (OR=1.10, 95% CI: 1.04-1.16), limited English proficiency (OR=1.91, 95% CI: 1.32-2.78), and depression (OR=1.53, 95% CI: 1.10-2.13).

Conclusions: In addition to race/ethnicity, health literacy and English proficiency may be bases of discrimination. Evaluation is needed to determine whether patients are treated differently or more apt to perceive discrimination, and whether depression fosters and/or follows perceived discrimination.

Fig 1. Reports of Racial/Ethnic Discrimination, By Race/Ethnicity

Note: “Weighted” refers to proportions in overall Kaiser Diabetes Registry, “Sample” refers to DISTANCE survey respondents. Denominators are as follows: 16,463 respondents to general discrimination item: 3,180 Black, 1,821 Filipino, 3,730 Latino, 2,024 Asian, and 4.465 White; 12,151 respondents to health care discrimination item: 2,435 Black, 1,321 Filipino, 2,446 Latino, 1,470 Asian, and 3,668 White