title: Discrimination in Healthcare Settings is Associated with Disability in Older Adults: Health and Retirement Study, 2008-2012.
abstract: BACKGROUND
  As our society ages, improving medical care for an older population will be crucial. Discrimination in healthcare may contribute to substandard experiences with the healthcare system, increasing the burden of poor health in older adults. Few studies have focused on the presence of healthcare discrimination and its effects on older adults.
  
  
  OBJECTIVE
  We aimed to examine the relationship between healthcare discrimination and new or worsened disability.
  
  
  METHODS
  This was a longitudinal analysis of data from the nationally representative Health and Retirement Study administered in 2008 with follow-up through 2012.
  
  
  METHODS
  Six thousand and seventeen adults over the age of 50 years (mean age 67 years, 56.3 % female, 83.1 % white) were included in this study.
  
  
  METHODS
  Healthcare discrimination assessed by a 2008 report of receiving poorer service or treatment than other people by doctors or hospitals (never, less than a year=infrequent; more than once a year=frequent). Outcome was self-report of new or worsened disability by 2012 (difficulty or dependence in any of six activities of daily living). We used a Cox proportional hazards model adjusting for age, race/ethnicity, gender, net worth, education, depression, high blood pressure, diabetes, cancer, lung disease, heart disease, stroke, and healthcare utilization in the past 2 years.
  
  
  RESULTS
  In all, 12.6 % experienced discrimination infrequently and 5.9 % frequently. Almost one-third of participants (29 %) reporting frequent healthcare discrimination developed new or worsened disability over 4 years, compared to 16.8 % of those who infrequently and 14.7 % of those who never experienced healthcare discrimination (p < 0.001). In multivariate analyses, compared to no discrimination, frequent healthcare discrimination was associated with new or worsened disability over 4 years (aHR = 1.63, 95 % CI 1.16-2.27).
  
  
  CONCLUSIONS
  One out of five adults over the age of 50 years experiences discrimination in healthcare settings. One in 17 experience frequent healthcare discrimination, and this is associated with new or worsened disability by 4 years. Future research should focus on the mechanisms by which healthcare discrimination influences disability in older adults to promote better health outcomes for an aging population.
authors.affiliation: Department of Medicine, Division of Geriatrics, University of California, San Francisco, CA, USA. stephanie.rogers@ucsf.edu.
authors.forename: Stephanie E
authors.initials: SE
authors.lastname: Rogers
authors.affiliation: Department of Health Behavior, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA.
authors.forename: Angela D
authors.initials: AD
authors.lastname: Thrasher
authors.affiliation: Department of Medicine, Division of Geriatrics, University of California, San Francisco, CA, USA.
authors.forename: Yinghui
authors.initials: Y
authors.lastname: Miao
authors.affiliation: Department of Medicine, Division of Geriatrics, University of California, San Francisco, CA, USA.
authors.forename: W John
authors.initials: WJ
authors.lastname: Boscardin
authors.affiliation: Department of Medicine, Division of Geriatrics, University of California, San Francisco, CA, USA.|Veterans Affairs Medical Center, San Francisco, CA, USA.
authors.forename: Alexander K
authors.initials: AK
authors.lastname: Smith
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000368:Aged; D063506:Ageism / Q000523:psychology* / Q000639:trends; D000375:Aging / Q000523:psychology*; D006233:Persons with Disabilities / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012179:Retirement / Q000523:psychology* / Q000639:trends; D011795:Surveys and Questionnaires
keywords: disability; discrimination; geriatrics