Association between Discrimination in Healthcare and Doctor Visits Over Time

Objective Discrimination in healthcare can disrupt trust. However, it is unknown whether discrimination is associated with the frequency and distribution of healthcare utilization. We assessed how perceived discrimination in healthcare settings is associated with longitudinal patterns of doctor visits among middle-aged and older adults in the United States. Study Setting and Design Prospective cohort study of US adults who were followed every 2 years for up to 12 years. Discrimination in healthcare was self-reported at baseline (“receiving poorer treatment than others from doctors or hospitals”) and dichotomized (any vs. never). The primary outcome was the patterns of doctor visits over follow-up identified using group-based trajectory models (GBTM). Data source Health and Retirement Study (HRS) from 2008-2020. Principle findings Among 13,422 participants (mean age 63.0 years [±8.0]), approximately 19.4%, reported experiencing discrimination in healthcare at baseline. Discrimination in healthcare was more prevalent among participants with more visits, greater disease burden, and greater social vulnerability. Five major patterns of doctor visits over time were identified: “Low-Stable” (∼2 visits/year, 35.5%), “Moderate-Stable” (∼4.5 visits/year, 33.3%), “Increasing” (∼4.5 to 9 visits/year, 13.7%), “Decreasing” (∼13.5 to 6 visits/year, 10.3%), and “Persistently-High” (∼11+ visits/year, 6.3%). Compared to participants with Low-Stable doctor visits, those who reported discrimination were significantly more likely to exhibit Decreasing (relative risk ratio [RRR]=1.38; 95% CI, 1.17–1.63) and Persistently-High (RRR=1.62; 95% CI, 1.30–2.03) patterns of doctor visits. Conclusions Discrimination in healthcare settings is associated with greater numbers of doctor visits, indicating potential opportunities to improve quality of care. What is known on this topic Perceived discrimination in healthcare is a potential barrier to quality care and is frequently associated with poor health outcomes and patient mistrust in clinical care. What this study found Middle-aged and older adults who perceived discrimination in healthcare settings were significantly more likely to have high-frequency patterns of doctor visits. This association persisted after accounting for sociodemographic factors, behavioral factors, and health status.