Healthcare Discrimination Trends and Associations With Chronic Illnesses, Depression, and Biomarkers Among Hispanic Older Adults Using Data From the Health and Retirement Study, 2010-2020

TitleHealthcare Discrimination Trends and Associations With Chronic Illnesses, Depression, and Biomarkers Among Hispanic Older Adults Using Data From the Health and Retirement Study, 2010-2020
Publication TypeThesis
Year of Publication2023
AuthorsOlmos, B
Academic DepartmentProQuest Dissertations and Theses
Number of Pages143
Thesis Typephd
ISBN Number9798380130257
Keywords0344:Social research, 0566:Health sciences, 0569:Nursing, Biomarkers, Chronic illness, Diabetes, Discrimination, Health sciences, Hispanic, Nursing, Racism, Social research

Introduction: As of 2020, approximately 1 in 5 Americans reported experiencing discrimination in healthcare settings. Unfair treatment in everyday environments has been measured extensively, especially differences between White and Black adults, but older adults’ and Hispanics’ experiences with discrimination in healthcare institutions are not well known. Older adults of all races/ethnicities are at higher risk for chronic illness, so this study aimed to address the experiences of healthcare discrimination (HCD) among those who are older (age 50+), minoritized (specifically Hispanic), and living with chronic illness (including, but not limited to, type 2 diabetes). A review of the literature on HCD in Hispanic adults revealed that there is no consensus on a definition of HCD, most research on it is not backed by a theoretical framework, and Hispanics are often studied as a monolithic group rather than a heterogenous racial-ethnic identity. This project was based on a newly developed whole-person model that identifies the concepts most relevant to Latinx older adults who function at multiple levels of intersectionality. The integrated model depicts possible pathways of physiological and psychological embodiment of lived experiences of minoritized older persons managing chronic illness who are living in a society deeply embedded with structural racism and oppression. Associations between HCD and chronic illnesses as well as biomarkers related to the chronic illnesses were addressed. Trends of HCD over time were explored and racial-ethnic groups’ odds of reporting HCD were compared. Methods: We used 2010–2020 data (collected every 2 years) from the Health and Retirement Study, a nationally representative study of US non-institutionalized adults ages 50+ (n=15,278 participants contributing up to 27,655 observations) to examine associations between patient-reported experiences of HCD and chronic illnesses (i.e., type 2 diabetes, hypertension, heart conditions, stroke, depression, dementia, and Alzheimer’s disease, depressive symptoms scores, and cognition scores) as well as biomarkers of cardiometabolic risk (i.e., hemoglobin A1c, high-density lipoprotein, and total cholesterol), and whether relationships were modified by age, gender, race-ethnicity (non-Hispanic White, non-Hispanic Black, or Hispanic) and other social determinants of health. We fit generalized estimating equation models (GEE) specifying a binomial distribution and logit link for categorical outcomes and a normal distribution for continuous outcomes. We performed GEE to assess linear trends of HCD from 2010-2020. We also performed Cochran’s Q test to assess statistically significant differences between HCD prevalence in individual year pairs. Finally, we used GEE again to appraise which racial-ethnic group had the highest odds of reporting HCD.Results: In the unadjusted model, self-reported HCD was associated with higher odds of type 2 diabetes, stroke, depression, depressive symptom (CESD) scores, cognition (TCSI) scores, hemoglobin A1c, and high-density lipoprotein levels. In the adjusted model, the associations were between HCD and stroke, depression, CESD scores, hemoglobin A1c, and high-density lipoprotein. The prevalence of HCD among all participants ranged from the lowest in 2020 (15.4%) to the highest in 2016 (19.5%). There was a statistically significant overall decreasing trend in HCD among the full analytic sample, among Whites only, and among Hispanics only. There was a statistically significant difference in HCD prevalence between 2016 and 2020. Of the 3 racial-ethnic groups, Black older adults had an association between race-ethnicity and reporting HCD.Conclusions: Among all 3 race-ethnicity groups together, HCD was associated with higher risk for type 2 diabetes, stroke, depression, more depressive symptoms, lower cognition (TCSI) scores, higher hemoglobin A1c, and lower high-density lipoprotein levels. Among Hispanic older adults, HCD was not associated with any outcomes. Prevalence of HCD decreased for Whites and peaked in 2016 for Hispanics and Black Americans, but the decreasing trend was statistically significant among the entire sample, among Whites as a separate group, and among Hispanics as a separate group. Additionally, there was a statistically significant difference in HCD prevalence between 2016 and 2020, signaling that timing and sociopolitical climate towards minoritized groups and immigrants may influence HCD prevalence and reporting. The theoretical framework was supported by the findings; HCD was shown to affect chronic illness outcomes in older adults living at multiple layers of intersectionality.


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Citation Key13472