Experienced Discrimination and Medical Mistrust Among Patients With Cirrhosis: Survey Results From a Multicenter...

Medical mistrust and experiences of discrimination contribute to racial and ethnic disparities in clinical outcomes for several health conditions; however, the prevalence of these constructs remain understudied in patients with cirrhosis.

We prospectively enrolled patients with cirrhosis to complete surveys at 4 large U.S. health systems. We administered validated surveys including the Experiences of Discrimination measure and the Group-Based Medical Mistrust Scale (GBMMS). Univariable and multivariable regression models were used to examine associations of race and ethnicity with patient-reported discrimination and medical mistrust.

Among 3357 patients, 1037 (30.9%) completed the survey (43.4% White, 22.4% Black, 30.2% Hispanic; median age 61.3 years, 63.0% men). Overall, 27.1% of patients reported experiencing discrimination and 9.8% reported high medical mistrust (GBMMS ≥3). More Black patients reported frequent discrimination (40.5%) compared with Hispanic (22.2%) and White (18.7%) patients (P < .001). In multivariable analysis, compared with White race, Black race (odds ratio [OR], 4.37; 95% confidence interval [CI], 2.49-7.67) and Hispanic ethnicity (OR, 1.85; 95% CI, 1.06-3.25) were associated with the top quartile of discrimination scores. Similarly, 22.3% of Black patients reported high mistrust compared with 6.8% and 4.2% of White and Hispanic patients, respectively (P < .001). Black patients continued to be more likely than White patients to report high mistrust in multivariable models (OR, 3.59; 95% CI, 2.05-6.29). There were no statistically significant associations between higher levels of discrimination or mistrust and the composite outcome of hospitalization, decompensation, or death.

Experienced discrimination and medical mistrust are common among Black patients with cirrhosis. Addressing these factors may mitigate racial and ethnic inequities in care, reduce barriers to care, and improve outcomes for patients with cirrhosis.