title: The association of cumulative discrimination on quality of care, patient-centered care, and dissatisfaction with care in adults with type 2 diabetes.
abstract: Discrimination is linked to negative health outcomes, but little research has investigated how the cumulative effect of discrimination impacts perceptions of care. This study investigated the influence of cumulative perceived discrimination on quality of care, patient-centeredness, and dissatisfaction with care in adults with type 2 diabetes.
  
  
  
  Six hundred two patients from two primary care clinics in Charleston, SC. Linear regression models assessed associations between perceived discrimination and quality of care, patient-centered care, and dissatisfaction with care. The models control for race, site, age, gender, marital status, duration of diabetes, education, hours worked weekly, income, and health status.
  
  
  
  The mean age was 61.5years, with 66.3% non-Hispanic blacks, and 41.9% earning less than $20,000 annually. In final adjusted analyses, lower patient-centered care was associated with a higher discrimination score (β=-0.28; p=0.006), reporting at least 1 category of discrimination (β=-1.47; p=0.002), and reporting at least 2 categories of discrimination (β=-1.34; p=0.004). Dissatisfaction with care was associated with at least 2 categories of discrimination (β=0.45; p=0.002). No significant associations were seen with quality of care indicators.
  
  
  
  Increased cumulative discrimination was associated with decreased feeling of patient-centeredness and increased dissatisfaction with care. However, these perceptions of discrimination were not significantly associated with quality indicators.
authors: Center for Health Disparities Research, Medical University of South Carolina, 135 Rutledge Avenue, P.O. Box 250593, Charleston, SC 29425, USA; Department of Medicine, Division of General Internal Medicine and Geriatrics, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 803, MSC 623, Charleston, SC 29425, USA. Electronic address: david.cykert@gmail.com.
authors: David M
authors: DM
authors: Cykert
authors: Center for Health Disparities Research, Medical University of South Carolina, 135 Rutledge Avenue, P.O. Box 250593, Charleston, SC 29425, USA; Department of Medicine, Division of General Internal Medicine and Geriatrics, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 803, MSC 623, Charleston, SC 29425, USA. Electronic address: stromjl@musc.edu.
authors: Joni S
authors: JS
authors: Williams
authors: Center for Health Disparities Research, Medical University of South Carolina, 135 Rutledge Avenue, P.O. Box 250593, Charleston, SC 29425, USA; Department of Medicine, Division of General Internal Medicine and Geriatrics, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 803, MSC 623, Charleston, SC 29425, USA; Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson VA Medical Center, 109 Bee Street, Charleston, SC 29401, USA. Electronic address: walkerrj@musc.edu.
authors: Rebekah J
authors: RJ
authors: Walker
authors: Department of Medicine, Division of General Internal Medicine and Geriatrics, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 803, MSC 623, Charleston, SC 29425, USA. Electronic address: davisks@musc.edu.
authors: Kimberly S
authors: KS
authors: Davis
authors: Center for Health Disparities Research, Medical University of South Carolina, 135 Rutledge Avenue, P.O. Box 250593, Charleston, SC 29425, USA; Department of Medicine, Division of General Internal Medicine and Geriatrics, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 803, MSC 623, Charleston, SC 29425, USA; Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson VA Medical Center, 109 Bee Street, Charleston, SC 29401, USA. Electronic address: egedel@musc.edu.
authors: Leonard E
authors: LE
authors: Egede
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000523:psychology / Q000628:therapy*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D018802:Patient-Centered Care; D011320:Primary Health Care; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D057566:Self Report; D000073278:Self-Management / Q000523:psychology; D063508:Social Discrimination / Q000523:psychology; D013022:South Carolina; D013315:Stress, Psychological / Q000150:complications* / Q000523:psychology
keywords: Adults; Cumulative discrimination; Diabetes; Dissatisfaction with care; Patient-centered care; Quality of care