Associations between perceived discrimination and health status among frequent Emergency Department users.
OBJECTIVE
Frequent Emergency Department (ED) users are vulnerable individuals and discrimination is usually associated with increased vulnerability. The aim of this study was to investigate frequent ED users' perceptions of discrimination and to test whether they were associated with increased vulnerability.


METHODS
In total, 250 adult frequent ED users were interviewed in Lausanne University Hospital. From a previously published questionnaire, we assessed 15 dichotomous sources of perceived discrimination. Vulnerability was assessed using health status: objective health status (evaluation by a healthcare practitioner including somatic, mental health, behavioral, and social issues - dichotomous variables) and subjective health status [self-evaluation including health-related quality of life (WHOQOL) and quality of life (EUROQOL) - mean-scores]. We computed the prevalence rates of perceived discrimination and tested associations between perceived discrimination and health status (Fischer's exact tests, Mann-Whitney U-tests).


RESULTS
A total of 35.2% of the frequent ED users surveyed reported at least one source of perceived discrimination. Objective health status was not significantly related to perceived discrimination. In contrast, experiencing perceived discrimination was associated with worse subjective health status (P<0.001).


CONCLUSIONS
Frequent ED users are highly likely to report perceived discrimination during ED use, and this was linked to a decrease in their own rating of their health. Hence, discrimination should be taken into account when providing care to such users as it may constitute an additional risk factor for this vulnerable population. Perceived discrimination may also be of concern to professionals seeking to improve practices and provide optimal care to frequent ED users.
aLife Course and Inequality Research Centre, University of Lausanne bServices and Center for Clinical Research cEmergency Department dInstitute of Social and Preventive Medicine eVulnerable Population Unit, Department of Ambulatory Care and Community Medicine, University of Lausanne fHealth Technology Assessment Unit gInstitute of Health Economics and Management, University of Lausanne and Technology Assessment Unit hDepartment of Ambulatory Care and Community Medicine iAlcohol Treatment Center, Lausanne University Hospital, Lausanne, Switzerland.
Stéphanie
S
Baggio
Katia
K
Iglesias
Olivier
O
Hugli
Bernard
B
Burnand
Ornella
O
Ruggeri
Jean-Blaise
JB
Wasserfallen
Karine
K
Moschetti
Philippe
P
Staeger
Séverine
S
Alary
Marina
M
Canepa Allen
Jean-Bernard
JB
Daeppen
Patrick
P
Bodenmann
D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D011287:Prejudice / Q000523:psychology* / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires