Discrimination in Healthcare Settings is Associated with Disability in Older Adults: Health and Retirement Study, 2008–2012

• Published in: Journal of general internal medicine : JGIM 2015-10, Vol.30 (10), p.1413-1420
• Main Authors: Rogers, Stephanie E., Thrasher, Angela D., Miao, Yinghui, Boscardin, W. John, Smith, Alexander K.
• Format: Article
• Language: English
• Subjects: Activities of daily living; Activities of Daily Living - psychology; Adults; Age; Aged; Ageism - psychology; Ageism - trends; Aging; Aging - psychology; Blood pressure; Cancer; Coronary artery disease; Data processing; Diabetes mellitus; Disabled Persons - psychology; Discrimination; Female; Follow-Up Studies; Hazards; Health care; Health Status; Heart; Heart diseases; Humans; Hypertension; Internal Medicine; Longitudinal Studies; Lung cancer; Lung diseases; Male; Medical personnel; Medicine; Medicine & Public Health; Mental depression; Middle Aged; Minority & ethnic groups; Older people; Original Research; Physicians; Retirement; Retirement - psychology; Retirement - trends; Statistical models; Surveys and Questionnaires
• ISSN: 0884-8734; 1525-1497
• DOI: 10.1007/s11606-015-3233-6

ABSTRACT BACKGROUND As our society ages, improving medical care for an older population will be crucial. Discrimination in healthcare may contribute to substandard experiences with the healthcare system, increasing the burden of poor health in older adults. Few studies have focused on the presence of healthcare discrimination and its effects on older adults. OBJECTIVE We aimed to examine the relationship between healthcare discrimination and new or worsened disability. DESIGN This was a longitudinal analysis of data from the nationally representative Health and Retirement Study administered in 2008 with follow-up through 2012. PARTICIPANTS Six thousand and seventeen adults over the age of 50 years (mean age 67 years, 56.3 % female, 83.1 % white) were included in this study. MAIN MEASURES Healthcare discrimination assessed by a 2008 report of receiving poorer service or treatment than other people by doctors or hospitals (never, less than a year=infrequent; more than once a year=frequent). Outcome was self-report of new or worsened disability by 2012 (difficulty or dependence in any of six activities of daily living). We used a Cox proportional hazards model adjusting for age, race/ethnicity, gender, net worth, education, depression, high blood pressure, diabetes, cancer, lung disease, heart disease, stroke, and healthcare utilization in the past 2 years. KEY RESULTS In all, 12.6 % experienced discrimination infrequently and 5.9 % frequently. Almost one-third of participants (29 %) reporting frequent healthcare discrimination developed new or worsened disability over 4 years, compared to 16.8 % of those who infrequently and 14.7 % of those who never experienced healthcare discrimination ( p