Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #113262

Diana Burgess, PhD¹, Margaret Hargreaves, MPP², Michelle Van Ryn, PhD, MPH³, Yingmei Ding, MD, MS², Michelle Chiezah, MPH, MA², and Sheldon Swaney, BA². (1) Department of Medicine, University of Minnesota, Center for Chronic Disease Outcomes, MVAMC, One Veterans Drive, 2E, Minneapolis, MN 55417, 612-467-1591, diana.burgess@med.va.gov, (2) Hennepin County Human Services and Public Health Department, 525 Portland Ave. S, Minneapolis, MN 55415, (3) Department of Family Medicine and Community Health and Division of Epidemiology, University of Minnesota, 925 Delaware Street SE, Minneapolis, MN 55414

Background: There is a growing body of evidence documenting racial/ethnic disparities in the use of healthcare services and patient satisfaction with care, even after controlling for potential cofounders such as socio-economic status and insurance coverage.

Research suggests exposure to discrimination may be a contributor of racial and ethnic differences in the use of healthcare services. For example, a recent study found that Chinese Americans who reported higher levels of discrimination were less likely to seek professional mental health services for emotional problems (Spencer & Chen 2004). There also is ample research demonstrating that perceived discrimination has negative effects on the physical and mental health of minorities. However, there is scant research exploring the relationship between discrimination and the willingness or ability to seek healthcare services.

Objective: The purpose of this study was to explore the relationship between perceived acute and chronic discrimination and unmet medical needs among a representative sample of Whites, Hispanics, U.S.-born Blacks, American Indians and Southeast Asian Americans.

Methods: Data were derived from the Survey of the Health of Adults, the Population, and the Environment (SHAPE), a telephone survey of 10,098 adults in Hennepin County Minnesota conducted in 2002, using geographically strata random sampling. Respondents who self-identified as non-Hispanic White (N = 4565), U.S.-born Black (N=363), American Indian (N=138), Hispanic (N = 322), or Southeast Asian American (N=195), were included in our analyses. Survey respondents were considered to have unmet medical needs if they said that they delayed or did not get the care they needed in the past year.

Results: As expected, planned contrasts revealed that whites were significantly less likely than Hispanics, U.S.-born Blacks, and American Indians to experience chronic discrimination [t (9417) = 28.47, p < .0005] and acute discrimination [t (8838) = 19.56, p < .0005]. Racial and ethnic group specific analysis show that, after controlling for socio-demographic characteristics and insurance coverage, Whites, U.S.-born Blacks, and American Indians who experienced acute and chronic discrimination, and Hispanics who experienced acute discrimination, were significantly more likely to report having unmet medical needs. Discrimination was not predictive of unmet medical needs for Southeast Asian Americans.

Conclusion: Acute and chronic discrimination were predictive of unmet medical needs. This implies that higher risk of discrimination among racial and ethnic discrimination may contribute to racial/ethnic disparities in appropriate use of healthcare services. Potential solutions to this problem include the provision of more culturally and linguistically appropriate health care.

Learning Objectives: