Perceived Discrimination and Adherence to Medical Care in a Racially Integrated Community |
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Authors: | Sarah Stark Casagrande Tiffany L Gary Darrell J Gaskin " target="_blank">Lisa A Cooper |
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Institution: | (1) Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA;(2) Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA;(3) Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA;(4) Morgan-Hopkins Center for Health Disparities and Solutions, Baltimore, MD, USA;(5) Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD, USA |
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Abstract: | Background Past research indicates that access to health care and utilization of services varies by sociodemographic characteristics,
but little is known about racial differences in health care utilization within racially integrated communities.
Objective To determine whether perceived discrimination was associated with delays in seeking medical care and adherence to medical
care recommendations among African Americans and whites living in a socioeconomically homogenous and racially integrated community.
Design A cross-sectional analysis from the Exploring Health Disparities in Integrated Communities Study.
Participants Study participants include 1,408 African-American (59.3%) and white (40.7%) adults (≥18 years) in Baltimore, Md.
Measurements An interviewer-administered questionnaire was used to assess the associations of perceived discrimination with help-seeking
behavior for and adherence to medical care.
Results For both African Americans and whites, a report of 1–2 and >2 discrimination experiences in one’s lifetime were associated
with more medical care delays and nonadherence compared to those with no experiences after adjustment for need, enabling,
and predisposing factors (odds ratio OR] = 1.8, 2.6; OR = 2.2, 3.3, respectively; all P < .05). Results were similar for perceived discrimination occurring in the past year.
Conclusions Experiences with discrimination were associated with delays in seeking medical care and poor adherence to medical care recommendations
INDEPENDENT OF NEED, ENABLING, AND PREDISPOSING FACTORS, INCLUDING MEDICAL MISTRUST; however, a prospective study is needed.
Further research in this area should include exploration of other potential mechanisms for the association between perceived
discrimination and health service utilization. |
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Keywords: | discrimination health care utilization health disparities adherence |
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