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. Purpose 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.
References
[1]
Smedley BD, Stith AY, Nelson AR, editors (2003) Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC:National Academies Press.764 p.
[2]
Agency for Healthcare Research and Quality (2008) 2007 National Healthcare Disparities Report. Rockville, MD:U.S. Department of Health and Human Services.
[3]
Ulmer C, McFadden B, Nerenz DR (2009) Race, Ethnicity, and Language Data. Standardization for Health Care Quality Improvement. Washington, D.C.:The National Academies Press. pp. 264.
[4]
Jones CP, Truman BI, Elam-Evans LD, Jones CA, Jones CY, et al. (2008) Using "socially assigned race" to probe white advantages in health status. Ethn Dis 18: 496–504.
[5]
Bonito AJ, Lenfestey NF, Eicheldinger C, Iannacchione VG, Campbell L (2004) Disparities in immunizations among elderly Medicare beneficiaries, 2000 to 2002. Am J Prev Med 27: 153–160.
[6]
Centers for Disease Control and Prevention (CDC) (2009) Early Release of Selected Estimates Based on Data from the January-June 2009 National Health Interview Survey. Hyattsville, MD:National Center for Health Statistics .pp. 109.
[7]
O′Malley AS, Forrest CB (2006) Immunization disparities in older Americans: determinants and future research needs. Am J Prev Med 31: 150–158.
[8]
Hebert PL, Frick KD, Kane RL, McBean AM (2005) The causes of racial and ethnic differences in influenza vaccination rates among elderly Medicare beneficiaries. Health Serv Res 40: 517–537.
[9]
Winston CA, Wortley PM, Lees KA (2006) Factors associated with vaccination of medicare beneficiaries in five U.S. communities: Results from the racial and ethnic adult disparities in immunization initiative survey, 2003. J Am Geriatr Soc 54: 303–310.
[10]
Lees KA, Wortley PM, Coughlin SS (2005) Comparison of racial/ethnic disparities in adult immunization and cancer screening. Am J Prev Med 29: 404–411.
[11]
Feresu SA, Zhang W, Puumala SE, Ullrich F, Anderson JR (2008) Breast and cervical cancer screening among low-income women in Nebraska: findings from the Every Woman Matters program, 1993–2004. J Health Care Poor Underserved 19: 797–813.
[12]
Bazargan M, Bazargan SH, Farooq M, Baker RS (2004) Correlates of cervical cancer screening among underserved Hispanic and African-American women. Prev Med 39: 465–473.
[13]
Smith-Bindman R, Miglioretti DL, Lurie N, Abraham L, Barbash RB, et al. (2006) Does utilization of screening mammography explain racial and ethnic differences in breast cancer?.[Summary for patients in Ann Intern Med. 2006 Apr 18;144(8):I18; PMID: 16618948]. Ann Intern Med 144: 541–553.
[14]
Carpenter WR, Godley PA, Clark JA, Talcott JA, Finnegan T, et al. (2009) Racial differences in trust and regular source of patient care and the implications for prostate cancer screening use. Cancer 115: 5048–5059.
[15]
Gilligan T, Wang PS, Levin R, Kantoff PW, Avorn J (2004) Racial differences in screening for prostate cancer in the elderly. Arch Intern Med 164: 1858–1864.
[16]
Cooper GS, Koroukian SM (2004) Racial disparities in the use of and indications for colorectal procedures in Medicare beneficiaries. Cancer 100: 418–424.
[17]
Selvin E, Brett KM (2003) Breast and cervical cancer screening: sociodemographic predictors among White, Black, and Hispanic women. Am J Public Health 93: 618–623.
[18]
Trivedi AN, Ayanian JZ (2006) Perceived discrimination and use of preventive health services. J Gen Intern Med 21: 553–558.
[19]
Perez D, Sribney WM, Rodriguez MA (2009) Perceived discrimination and self-reported quality of care among Latinos in the United States. J Gen Intern Med 24 Suppl 3548–554.
[20]
Casagrande SS, Gary TL, LaVeist TA, Gaskin DJ, Cooper LA (2007) Perceived discrimination and adherence to medical care in a racially integrated community. J Gen Intern Med 22: 389–395.
[21]
Van Houtven CH, Voils CI, Oddone EZ, Weinfurt KP, Friedman JY, et al. (2005) Perceived discrimination and reported delay of pharmacy prescriptions and medical tests. J Gen Intern Med 20: 578–583.
[22]
Gee GC, Ryan A, Laflamme DJ, Holt J (2006) Self-Reported Discrimination and Mental Health Status Among African Descendants, Mexican Americans, and Other Latinos in the New Hampshire REACH 2010 Initiative: The Added Dimension of Immigration. Am J Public Health 96: 1821–1828.
[23]
Wagner J, Abbott G (2007) Depression and depression care in diabetes: relationship to perceived discrimination in African Americans. Diabetes Care 30: 364–366.
[24]
Jones CP (2000) Levels of racism: a theoretic framework and a gardener's tale. Am J Public Health 90: 1212–1215.
[25]
Centers for Disease Control and Prevention (CDC) (2004) Behavioral Risk Factor Surveillance System Survey Data.Atlanta, Georgia:U.S. Department of Health and Human Services.
[26]
Centers for Disease Control and Prevention (CDC) (2005) 2004 Behavioral Risk Factor Surveillance System - Summary Data Quality Report. Atlanta, Georgia:U.S. Department of Health and Human Services.pp . 38.
[27]
Centers for Disease Control and Prevention (CDC) (2004) Updated Interim Influenza Vaccination Recommendations - 2004-05 Influenza Season. Morbidity and Mortality Weekly Report. Atlanta, GA:U.S. Department of Health and Human Services. pp. 1183–1184.
[28]
Centers for Disease Control and Prevention (CDC) (2003) Recommended Adult Immunization Schedule - United States, 2003–2004. Morbidity and Mortality Weekly Report. Atlanta, GA:U.S. Department of Health and Human Services . pp. 965–969.
[29]
Smith RA, Cokkinides V, Eyre HJ (2004) American Cancer Society guidelines for the early detection of cancer, 2004. CA Cancer J Clin 54: 41–52.
[30]
SAS. Version 9.2. Copyright ？ 2008 SAS Institute Inc. SAS and all other SAS Institute Inc. product or service names are registered trademarks or trademarks of SAS Institute Inc., Cary, NC, USA.
Burton DC, Flannery B, Bennett NM, Farley MM, Gershman K, et al. (2010) Socioeconomic and racial/ethnic disparities in the incidence of bacteremic pneumonia among US adults. Am J Public Health 100: 1904–1911.
[33]
Biello KB, Rawlings J, Carroll-Scott A, Browne R, Ickovics JR (2010) Racial disparities in age at preventable hospitalization among U.S. Adults. Am J Prev Med 38: 54–60.
[34]
Benjamins MR (2012) Racial/Ethnic discrimination and preventive service utilization in a sample of Whites, Blacks, Mexicans, and Puerto Ricans. Medical Care 50: 870–876.
[35]
Hausmann LRM, Kwonho J, Bost JE, Ibrahim SA (2008) Perceived Discrimination in Health Care and Use of Preventive Health Services. J Gen Int Med 23 (10: 1679–1684.
[36]
Keith VM, Herring C (1991) Skin Tone and Stratification in the Black-Community. Am J Sociol 97: 760–778.
[37]
Goldsmith AH, Hamilton D, Darity Jr W (2007) From Dark to Light: Skin Color and Wages Among African-Americans. J Hum Resour 42: 701–738.
[38]
Borrell LN, Crespo CJ, Garcia-Palmieri MR (2007) Skin color and mortality risk among men: the Puerto Rico Heart Health Program. Ann Epidemiol 17: 335–341.
[39]
Kiang L, Takeuchi DT (2009) Phenotypic Bias and Ethnic Identity in Filipino Americans. Soc Sci Q 90: 428–445.
[40]
Williams DR, Neighbors HW, Jackson JS (2003) Racial/ethnic discrimination and health: findings from community studies. Am J Public Health 93: 200–208.
[41]
Richman LS, Kohn-Wood LP, Williams DR (2007) The role of discrimination and racial identity for mental health service utilization. J Soc Clin Psychol 26: 960–981.
[42]
Penner LA, Dovidio JF, Edmondson D, Dailey RK, Markova T, et al. (2009) The Experience of Discrimination and Black-White Health Disparities in Medical Care. J Black Psychol 35: 180–203.
[43]
Burgess D, van Ryn M, Dovidio J, Saha S (2007) Reducing racial bias among health care providers: lessons from social-cognitive psychology. J Gen Intern Med 22: 882–887.
[44]
Burgess DJ (2010) Are providers more likely to contribute to healthcare disparities under high levels of cognitive load? How features of the healthcare setting may lead to biases in medical decision making. Med Decis Making30: :246–257.PMID:19726783.
[45]
Green AR, Carney DR, Pallin DJ, Ngo LH, Raymond KL, et al. (2007) Implicit bias among physicians and its prediction of thrombolysis decisions for black and white patients. . J Gen Intern Med 22: 1231–1238 PMID:17594129.
[46]
Johnson RL, Saha S, Arbelaez JJ, Beach MC, Cooper LA (2004) Racial and ethnic differences in patient perceptions of bias and cultural competence in health care. J Gen Intern Med 19: 101–110.
[47]
Penner LA, Dovidio JF, West TV, Gaertner SL, Albrecht TL, et al. (2010) Aversive Racism and Medical Interactions with Black Patients: A Field Study. J Exp Soc Psychol 46: 436–440.
[48]
McPhee SJ, Nguyen TT, Shema SJ, Nguyen B, Somkin C, et al. (2002) Validation of recall of breast and cervical cancer screening by women in an ethnically diverse population. Prev Med 35: 463–473.
[49]
Zapka JG, Bigelow C, Hurley T, Ford LD, Egelhofer J, et al. (1996) Mammography use among sociodemographically diverse women: the accuracy of self-report. Am J Public Health 86: 1016–1021.
[50]
Shenson D, Dimartino D, Bolen J, Campbell M, Lu PJ, et al. (2005) Validation of self-reported pneumococcal vaccination in behavioral risk factor surveillance surveys: experience from the sickness prevention achieved through regional collaboration (SPARC) program. Vaccine 23: 1015–1020.
[51]
Kressin NR, Raymond KL, Manze M (2008) Perceptions of race/ethnicity-based discrimination: a review of measures and evaluation of their usefulness for the health care setting. J Health Care Poor Underserved 19: 697–730.
[52]
Shariff-Marco S, Gee GC, Breen N, Willis G, Reeve BB, et al. (2009) A mixed-methods approach to developing a self-reported racial/ethnic discrimination measure for use in multiethnic health surveys. Ethn Dis 19: 447–453.
