Abstract P3161: Discrimination in Healthcare is Associated with Increased Stroke Risk among Older Adults in the United States

Introduction: Discrimination in healthcare strains patient-provider relationships and may contribute to disparities in outcomes. When patients feel disrespected, they could be less likely to trust providers or seek follow-up care, which poses a challenge for cardiovascular risk management. We assessed the association between discrimination in healthcare and incidence of stroke.
Methods: We used nationally-representative longitudinal data from the 2008-2020 Health and Retirement Study to examine the association between stroke and discrimination in healthcare. Participants were ages 50-80 at baseline, had no history of stroke, and were followed for up to 12 years (mean follow-up=6.9 years). First occurrence of stroke was ascertained from participant-reported diagnosis of stroke by a doctor during follow-up (month/year). Discrimination in healthcare was assessed at baseline by asking respondents how often they “receive poorer service or treatment than other people from doctors or hospitals.” Cox proportional hazards models were used to estimate the incidence of stroke during the follow-up period (n=518 events). Confounding was controlled through adjustment for baseline covariates that included sociodemographic factors (age, gender, race, ethnicity, education), health status (disease diagnoses [diabetes, hypertension, heart disease]), and prior healthcare utilization (doctor visits and hospitalizations in past 2 years).
Results: Among study participants (n=14,215, median age 62, 41.01% male, 72.68% White, 19.63% Black, 7.69% Hispanic), 19.19% (n=2,728) reported experiencing discrimination in healthcare settings. Those who experienced discrimination were more likely to have a stroke during follow-up compared to participants who did not report discrimination (4.5% vs. 3.4%, P=.010). Unadjusted proportional hazard models showed that discrimination in healthcare was associated with an increased hazard of stroke (hazard ratio [HR]=1.33, 95% confidence interval [CI]= 1.08-1.62). The association persisted after adjusting for all covariates (HR= 1.29, CI=1.05-1.58).
Conclusions: Discrimination in healthcare was associated with increased stroke risk after adjusting for factors which impact both exposure to discrimination and risk of stroke. Future research should consider how changes in health status and/or experiences of discrimination during the course of care may contribute to this association.