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Perceived Discrimination Among Refugees in the USA: Determinants and Associations with Healthcare Utilization and

Kiran Thapa^1,2, Altaf Saadi^3,4

¹Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.

Journal of General Internal Medicine

|August 12, 2025

Abstract

Background:

Discrimination adversely impacts health outcomes for many populations, including refugees. But existing literature on discriminatory experiences among US refugees and their health impacts has been limited to qualitative research or regional samples.

Objective:

We examined the prevalence, characteristics, determinants of perceived discrimination, and its association with subjective physical and mental health, usual source of care, and healthcare coverage among a national sample of US refugees.

Design:

Cross-sectional secondary data analysis.

Participants:

Data from the Annual Survey of Refugees (ASR 2020-2022), a national survey of recently resettled refugees.

Main Measures:

Exposure: Self-perceived discrimination, including (1) healthcare-related discrimination; (2) any discrimination across settings (healthcare, workplace, housing, real state, local business, court/law enforcement, street, and other); and (3) cumulative discriminatory experiences across settings. Outcomes: Healthcare use and self-reported health measures: (1) usual source of care; (2) having continuous healthcare coverage in the last 12 months; (3) general physical health; and (4) general mental health.

Key Results:

In this national sample of 4530 refugees, more than one in five refugees (22%) experienced discrimination, with workplace discrimination being the most reported (12%); 3.4% reported healthcare-related discrimination. Female, Hispanic individuals, and those resettled in the US South had greater odds of perceiving healthcare-related and any discrimination. In fully adjusted models, there were greater odds of poor physical health (aOR 1.71 [95%CI 1.17, 2.49]), higher among those reporting healthcare-related discrimination compared to those who did not. Similarly, the odds of poor physical health (aOR 1.85 [95%CI 1.53, 2.23]) and mental health (aOR 1.72 [1.45, 2.05]) were higher for those reporting any discrimination compared to those who did not. Cumulative discriminatory experiences were associated with worse mental health in a dose-dependent manner.

Conclusions:

Discrimination is prevalent among US refugees, particularly workplace discrimination, with significant variation by socio-demographic groups. Discrimination in any setting may be detrimental to refugees' health.

Keywords:

discrimination health disparities.health outcomes healthcare access refugee

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