# Factors Associated with Perceived Discrimination in Healthcare Among Middle-Aged and Older Adults

## TL;DR

This study finds that Black adults in the U.S. face higher rates of perceived discrimination in healthcare, especially when younger, and identifies factors like race, insurance status, and mental health that contribute to these experiences.

## Contribution

The study reveals age-specific racial disparities in perceived healthcare discrimination and identifies sociodemographic and clinical factors associated with these disparities.

## Key findings

- Black adults are significantly more likely to experience healthcare discrimination than White adults, with the largest disparities observed at younger ages.
- Factors like being Black, unmarried, uninsured, or having depressive symptoms are linked to higher odds of reporting discrimination.
- Unemployment is associated with discrimination among Black adults, while being unmarried and uninsured are significant for White adults.

## Abstract

Discrimination in healthcare settings impedes quality care, leading to poorer health outcomes.

To examine racial differences in perceived discrimination in healthcare settings across age among middle-aged and older adults and identify factors associated with these experiences.

Longitudinal cohort data from the Health and Retirement Study collected between 2008 and 2020.

The sample included 17,478 United States adults aged 50 and older who had at least one doctor visit or hospitalization in the prior two years.

Self-reported perceived discrimination in healthcare settings, measured using an item from the Everyday Discrimination Scale and categorized as “never” versus “ever” experienced discrimination. Generalized linear mixed models were used to identify factors associated with experiencing discrimination. Assessed factors included sociodemographic (age, gender, marital status, education, wealth, insurance status, employment) and clinical characteristics (depressive symptoms, difficulty with activities of daily living [ADLs], number of doctor visits, hospitalizations, body mass index [BMI], and comorbidities).

Black adults were significantly more likely to experience discrimination in healthcare settings than White adults, and these disparities were most pronounced at younger ages. Factors associated with higher odds of reporting discrimination included Black race, male gender, not being married, being uninsured, higher educational attainment, depressive symptoms, difficulty with ADLs, history of arthritis, and higher BMI. In race-stratified analyses, unemployment was associated with higher odds of reporting discrimination among Black adults. Among White adults, being unmarried and uninsured were significant factors associated with discrimination.

Black adults reported higher rates of perceived discrimination in healthcare settings than White adults, especially during middle adulthood. Multiple sociodemographic and clinical factors were associated with these experiences. These findings underscore the need to address discrimination in healthcare to improve patient-provider relationships among middle-aged and older adults.