Socially-Perceived Race, Perceived Healthcare Discrimination and Receipt of Preventive Health Services

Context: Self-identified racial/ethnic minorities are less likely to receive preventive care and more likely to report healthcare discrimination than whites. However, these outcomes may vary depending on whether racial/ethnic minorities are socially-perceived as minority versus white. Objectives: To investigate the associations between the socially-perceived race of racial/ethnic minorities and self-reported healthcare discrimination and receipt of selected preventive services. Design and Participants: Cross-sectional analysis of the 2004 Behavioral Risk Factor Surveillance System. Respondents were categorized into 3 groups, defined by self-identified/socially-perceived race: Minority/Minority (n=6,837), Minority/White (n=929), and White/White (n=25,913). Main Outcomes: Having a personal physician, perceived healthcare discrimination, and receipt of recommended vaccinations and age-appropriate cancer screening. Results: Compared with the Minority/Minority group, minorities socially-perceived as white tended to be older and were more likely to be married (52.4% vs. 34.7%, p<0.0001). Although the Minority/White group was less likely to be employed (53.9% vs. 58.6%), they were more likely to have completed high school (84.4% vs. 80.6%,) and tended to have higher annual household incomes than the Minority/Minority group (p-values <0.05). The Minority/Minority and Minority/White groups were equally likely to report having a physician (80.4% vs. 79.9%), yet Minority/White respondents were less likely to report experiencing healthcare discrimination (5.0% vs. 9.4%, p<0.0001). Relative to self-identified minorities, the White/White group was significantly more likely to have a physician (86.9%) and less likely to report discrimination (1.9%, p-values <0.05). The Minority/White and White/White groups had similar rates for past-year influenza (69.7% vs. 72.5%) and pneumococcal (60.4% vs. 68.2%) vaccinations; corresponding rates were significantly lower among minorities socially-perceived as minorities (54.5% influenza and 48.2% pneumococcal, p-values <0.05). However, the Minority/White group did not have significantly higher rates of breast, cervical, colorectal or prostate cancer screening than the Minority/Minority group. Results were unchanged in multivariable analyses controlling for age, health insurance, marital status, education, employment, income and sex where appropriate. Conclusions: Minorities who are socially-perceived as minorities are equally likely to have a personal physician as those who are socially-perceived as white, but are less likely to receive preventive vaccinations and more likely to report healthcare discrimination. In contrast, socially-perceived race was not associated with cancer screening rates. This study highlights the complexity of race/ethnicity in America and suggests the need to re-evaluate the appropriateness of classification based on self-identification alone.