Prevalence Of Health Care Discrimination Among Stroke Survivors: Data From A National Longitudinal Study Of Older Americans

Background: On-going management and follow-up care is important to ensure optimal outcomes among stroke survivors. Previous encounters with discrimination in health care settings can deter patients from pursuing care, compromise management of risk factors, and increase the risk of poor functional outcomes and recurrent stroke. However, little is known about how frequently stroke patients encounter discrimination in health care settings. Methods: We use data from the 2008 and 2010 Health and Retirement Study, a national longitudinal study of US residents age 50+, to examine the experience of health care discrimination among those reporting a history of stroke (N=1,338). Health care discrimination was assessed using two items. Respondents were asked how often they received poorer service or treatment from doctors or hospitals (six item response ranging from “every day” to “never”). A follow-up question asked participants what they think are the reasons for these experiences (i.e., race, gender, physical disability, and financial status). Participants are instructed to mark all that apply. The second health care discrimination item asked if they had ever been unfairly denied health care or treatment (yes/no). We describe the prevalence of self-reported health care discrimination overall and stratified by race/ethnicity, applying weights to represent the US non-institutionalized population age 50+ in 2008. Results: Approximately 20% of respondents with a history of stroke report receiving poorer service or treatment from doctors or hospitals, and 4% report ever being denied health care. Among people who reported receiving poorer service or treatment, age was the most commonly reported reason for experiencing health care discrimination (33%) followed by physical disability (19%). Among African Americans, race was the most common reason (42%) followed by age (33%). Conclusion: Perceived discrimination in health care settings -- related to age, disability, and race -- are common among stroke survivors. These experiences may impact receipt of health care, adherence to clinical recommendations, and long term outcomes. Future research should assess relationships between perceived health care discrimination and clinical outcomes.