Impact of Perceived Racial Discrimination in Healthcare On Use of Health Services, Florida BRFSS 2010

BACKGROUND:   Recent studies have documented disparities in specific health services provided to African American and Hispanic individuals when compared with White individuals. Some propose that these disparities may be due to racial/ethnic discrimination in health care settings. In 2010, the Florida Behavioral Risk Factor Surveillance System (BRFSS) survey included, for the first time, a question about racism in healthcare. Using this question, we assessed whether perceived racial discrimination in health care impacts the use of preventive health services among women. In addition, we identified which individuals are more likely to report perceived discrimination in healthcare.

METHODS: Data from 3,074 women of childbearing age (18-44 years) were analyzed. We assessed the self-reported use of five preventive health services: routine check up, Pap test, breast exam, diabetes test, and dental visit. Analytic results were weighted to remove any bias produced from the complex sampling design and to provide state-level estimates. We performed chi-square analysis to examine the bivariate association between perceived discrimination and the demographic characteristics and to assess the rates of preventive service use and each demographic characteristic. To assess the impact of perceived discrimination on use of health services, we used Poisson regression to generate unadjusted and adjusted prevalence ratios (ARR) and 95% confidence intervals (CI).

RESULTS:   Overall, 14% of the sample perceived racial discrimination while seeking health care at some point in their lifetime. Women who were overweight (ARR=1.6, 95% CI:1.1–2.4), women with incomes less than 100% federal poverty level (ARR=2.8, 95% CI:1.5–5.2), and those without health coverage (ARR=1.5, 95% CI:1.0–2.1) were significantly more likely to perceive discrimination in health care than their counterparts. In unadjusted analyses, persons who reported discrimination in health care settings were less likely to receive dental health services (RR=0.8, 95% CI:0.6–0.9) than those who did not report discrimination.  However, this association lost statistical significance after adjustment for all demographic characteristics. No associations were observed for other preventive health services (routine check-up, Pap test, breast exam, diabetes test) in unadjusted or adjusted analyses.

CONCLUSIONS:   In Florida, women of childbearing age without insurance, who were overweight and with incomes less than 100% of the Federal Poverty Level were more likely to perceive racial discrimination in health care. Perceived racial discrimination in health care did not significantly impact women’s use of preventive health services. Enhanced trainings on professional ethics and cultural competency to healthcare providers may be necessary to improve the quality of preventive health services.