Causal pathways between race, SES, and health: Does provider discrimination really affect health status?

Background. Inadequate and problematic medical care is one of the key pathways through which racism affects health. Researchers have directed relatively little attention toward specific pathways and mechanisms to examine discrimination's effect on health so that it is difficult to explain characteristics of individuals or situations that modify the effects of the perceived discrimination on health. The main methodological limitations of previous research are the following: 1) small sample sizes; 2) a limited statistical analyses;3) inadequate controls for potential confounding variables; and 4) inadequate assessment of discrimination and health status.

Objective. The objective of this study is to explore whether provider discrimination directly contributes to the disparities in health outcomes. We explore how being a racial/ethnic minority is associated with poor health status through the effect of both provider discrimination and SES.

Methods. Data for this study were drawn from the 2001 Survey on Disparities in Quality of Care, sponsored by the Commonwealth Fund. Structural equation modeling was used to account for the causal pathways of race, SES and health. Compared to Non-Hispanic Whites, minority groups such as Blacks, Hispanics, and Asians were analyzed separately. A total sample size of this study was 4,359.

Results. The poor health status of racial/ethnic minorities, such as Blacks and Hispanics, was partially explained by lower SES and provider discrimination. Compared to Blacks, Hispanics' health status was more substantially influenced by SES rather than provider discrimination. Asians were different from Blacks and Hispanics. Even though higher levels of provider discrimination were negatively related to Asians' health status, Asians' higher social economic status reduced health risks from provider discrimination.

Conclusion. This study analyzed the causal pathways of race, SES and health using structural equation modeling. Racial/ethnic minorities had negative health outcomes through provider discrimination. Poor health status among Hispanics and Blacks was caused not only by socio-economic status but also by provider discrimination, which in turn may induce a double burden of health outcomes of these racial/ethnic minorities. Providers may both intentionally or unintentionally treat disadvantaged patients with lower expectations because of patients' disadvantaged social positions due to their race/ethnicity, income, education, and insurance type. However, even though Asians experienced similar or higher levels of provider discrimination as compared to other minority groups, high levels of SES protected Asians from having the same health risks and poor health outcomes. SES works as a buffer for preventing Asians from feeling the effects of provider discrimination.