title: Socially-assigned race, healthcare discrimination and preventive healthcare services.
abstract: BACKGROUND
  Race and ethnicity, typically defined as how individuals self-identify, are complex social constructs. Self-identified racial/ethnic minorities are less likely to receive preventive care and more likely to report healthcare discrimination than self-identified non-Hispanic whites. However, beyond self-identification, these outcomes may vary depending on whether racial/ethnic minorities are perceived by others as being minority or white; this perception is referred to as socially-assigned race.
  
  
  OBJECTIVE
  To examine the associations between socially-assigned race and healthcare discrimination and receipt of selected preventive services.
  
  
  METHODS
  Cross-sectional analysis of the 2004 Behavioral Risk Factor Surveillance System "Reactions to Race" module. Respondents from seven states and the District of Columbia were categorized into 3 groups, defined by a composite of self-identified race/socially-assigned race: Minority/Minority (M/M, n = 6,837), Minority/White (M/W, n = 929), and White/White (W/W, n = 25,913). Respondents were 18 years or older, with 61.7% under age 60; 51.8% of respondents were female. Measures included reported healthcare discrimination and receipt of vaccinations and cancer screenings.
  
  
  RESULTS
  Racial/ethnic minorities who reported being socially-assigned as minority (M/M) were more likely to report healthcare discrimination compared with those who reported being socially-assigned as white (M/W) (8.9% vs. 5.0%, p = 0.002). Those reporting being socially-assigned as white (M/W and W/W) had similar rates for past-year influenza (73.1% vs. 74.3%) and pneumococcal (69.3% vs. 58.6%) vaccinations; however, rates were significantly lower among M/M respondents (56.2% and 47.6%, respectively, p-values<0.05). There were no significant differences between the M/M and M/W groups in the receipt of cancer screenings.
  
  
  CONCLUSIONS
  Racial/ethnic minorities who reported being socially-assigned as white are more likely to receive preventive vaccinations and less likely to report healthcare discrimination compared with those who are socially-assigned as minority. Socially-assigned race/ethnicity is emerging as an important area for further research in understanding how race/ethnicity influences health outcomes.
authors.affiliation: Department of Emergency Medicine, School of Medicine, Yale University, New Haven, Connecticut, United States of America.
authors.forename: Tracy
authors.initials: T
authors.lastname: Macintosh
authors.forename: Mayur M
authors.initials: MM
authors.lastname: Desai
authors.forename: Tene T
authors.initials: TT
authors.lastname: Lewis
authors.forename: Beth A
authors.initials: BA
authors.lastname: Jones
authors.forename: Marcella
authors.initials: M
authors.lastname: Nunez-Smith
mesh_terms: D000328:Adult; D000368:Aged; D003695:Delivery of Health Care; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008913:Minority Groups; D017063:Outcome Assessment, Health Care; D011314:Preventive Health Services; D044469:Racial Groups; D063505:Racism