David M Cykert1, Joni S Williams2, Rebekah J Walker3, Kimberly S Davis4, Leonard E Egede5. 1. Center for Health Disparities Research, Medical University of South Carolina, 135 Rutledge Avenue, P.O. Box 250593, Charleston, SC 29425, USA; Department of Medicine, Division of General Internal Medicine and Geriatrics, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 803, MSC 623, Charleston, SC 29425, USA. Electronic address: david.cykert@gmail.com. 2. Center for Health Disparities Research, Medical University of South Carolina, 135 Rutledge Avenue, P.O. Box 250593, Charleston, SC 29425, USA; Department of Medicine, Division of General Internal Medicine and Geriatrics, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 803, MSC 623, Charleston, SC 29425, USA. Electronic address: stromjl@musc.edu. 3. Center for Health Disparities Research, Medical University of South Carolina, 135 Rutledge Avenue, P.O. Box 250593, Charleston, SC 29425, USA; Department of Medicine, Division of General Internal Medicine and Geriatrics, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 803, MSC 623, Charleston, SC 29425, USA; Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson VA Medical Center, 109 Bee Street, Charleston, SC 29401, USA. Electronic address: walkerrj@musc.edu. 4. Department of Medicine, Division of General Internal Medicine and Geriatrics, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 803, MSC 623, Charleston, SC 29425, USA. Electronic address: davisks@musc.edu. 5. Center for Health Disparities Research, Medical University of South Carolina, 135 Rutledge Avenue, P.O. Box 250593, Charleston, SC 29425, USA; Department of Medicine, Division of General Internal Medicine and Geriatrics, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 803, MSC 623, Charleston, SC 29425, USA; Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson VA Medical Center, 109 Bee Street, Charleston, SC 29401, USA. Electronic address: egedel@musc.edu.
Abstract
AIMS: Discrimination is linked to negative health outcomes, but little research has investigated how the cumulative effect of discrimination impacts perceptions of care. This study investigated the influence of cumulative perceived discrimination on quality of care, patient-centeredness, and dissatisfaction with care in adults with type 2 diabetes. METHODS: Six hundred two patients from two primary care clinics in Charleston, SC. Linear regression models assessed associations between perceived discrimination and quality of care, patient-centered care, and dissatisfaction with care. The models control for race, site, age, gender, marital status, duration of diabetes, education, hours worked weekly, income, and health status. RESULTS: The mean age was 61.5years, with 66.3% non-Hispanic blacks, and 41.9% earning less than $20,000 annually. In final adjusted analyses, lower patient-centered care was associated with a higher discrimination score (β=-0.28; p=0.006), reporting at least 1 category of discrimination (β=-1.47; p=0.002), and reporting at least 2 categories of discrimination (β=-1.34; p=0.004). Dissatisfaction with care was associated with at least 2 categories of discrimination (β=0.45; p=0.002). No significant associations were seen with quality of care indicators. CONCLUSIONS: Increased cumulative discrimination was associated with decreased feeling of patient-centeredness and increased dissatisfaction with care. However, these perceptions of discrimination were not significantly associated with quality indicators.
AIMS: Discrimination is linked to negative health outcomes, but little research has investigated how the cumulative effect of discrimination impacts perceptions of care. This study investigated the influence of cumulative perceived discrimination on quality of care, patient-centeredness, and dissatisfaction with care in adults with type 2 diabetes. METHODS: Six hundred two patients from two primary care clinics in Charleston, SC. Linear regression models assessed associations between perceived discrimination and quality of care, patient-centered care, and dissatisfaction with care. The models control for race, site, age, gender, marital status, duration of diabetes, education, hours worked weekly, income, and health status. RESULTS: The mean age was 61.5years, with 66.3% non-Hispanic blacks, and 41.9% earning less than $20,000 annually. In final adjusted analyses, lower patient-centered care was associated with a higher discrimination score (β=-0.28; p=0.006), reporting at least 1 category of discrimination (β=-1.47; p=0.002), and reporting at least 2 categories of discrimination (β=-1.34; p=0.004). Dissatisfaction with care was associated with at least 2 categories of discrimination (β=0.45; p=0.002). No significant associations were seen with quality of care indicators. CONCLUSIONS: Increased cumulative discrimination was associated with decreased feeling of patient-centeredness and increased dissatisfaction with care. However, these perceptions of discrimination were not significantly associated with quality indicators.
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