Perceived Discrimination in Health Care Settings and Care Delays in Patients With Diabetes and Hypertension

Importance: Some US populations experience perceived discrimination in health care settings (PDHS) that may lead to delaying health care and worse health outcomes. It is crucial to understand potential mechanisms, such as patient-clinician communication (PCC), that may reduce these disparities. Objective: To examine PCC as a mediating pathway between PDHS and health care delays due to nervousness about seeing a health care professional while considering the moderating roles of age and race and ethnicity. Design, Setting, and Participants: This cross-sectional study examined data from the All of Us Research Program between May 31, 2017, and April 30, 2022. Included participants were adults aged 18 years or older with type 2 diabetes and/or hypertension. The data analysis was performed between February 20 and April 29, 2024. Exposure: Perceived discrimination in the health care setting. Main Outcome and Measures: The study outcome was health care delays due to being nervous about seeing a health care professional. The association between PDHS and health care delays was examined through PCC using a structural equation model with moderated mediation analysis. Results: The analytic sample comprised 25 581 participants (mean [SD] age, 62.4 [12.8] years; 58.1% women; and 9.5% of Black, 6.3% of Hispanic, 81.3% of White, and 2.9% of other race and ethnicity). Delaying health care due to feeling nervous about seeing a health care professional was reported by 2300 participants (8.9%). Patient-clinician communication mediated the association between PDHS and delayed care. Mediation proportions decreased with age across all racial and ethnic groups, with the highest proportions observed among participants aged 18 to 44 years (Black participants, 19.5% [95% CI, 14.9%-24.1%]; Hispanic participants, 20.3% [95% CI, 15.6%-25.1%]; White participants, 19.0% [95% CI, 14.7%-23.2%]; participants of other race and ethnicity, 18.3% [95% CI, 13.2%-23.5%]). Within each age group, the highest mediation proportions were observed among Hispanic participants, followed by Black and White participants, and participants of other race and ethnicity. Conclusions and Relevance: These findings suggest that higher PDHS is positively associated with delaying health care due to nervousness about seeing a health care professional. The largest mediation proportion observed was among younger adults and racial and ethnic minority groups. By prioritizing better PCC, health care delays associated with patient apprehension related to perceived discrimination may be reduced.