Perceived discrimination, communication, and healthcare utilization after gastrointestinal surgery: a moderated...

In the United States, perceived discrimination in healthcare settings (PDHS) has been linked with delayed care. Surgery represents a high-stakes, vulnerable period that can leave a lasting impression on future healthcare utilization. We sought to assess the association between PDHS and delayed care, as well as evaluate the mediating and moderating roles of patient-clinician communication (PCC) and sociodemographic factors on timing of healthcare delivery.

Adults who underwent gastrointestinal procedures before completing the Healthcare Access and Utilization Survey in the All of Us Research Program. Associations were examined using structural equation modeling (SEM). Variance decomposition was used to quantify the contributions of sociodemographic moderators.

Among 1866 participants (46.4% hepatopancreatobiliary, 41.6% colorectal, and 12.0% esophagogastric) included in the study, median age was 62.0 years (IQR, 52.0-70.0). Most participants were female (1306 [70.3%]) and non-Hispanic White (1571 [84.2%]). Participants who delayed care were more often aged 18 to 44 years (39.0% vs 11.6%) and less frequently married (55.5% vs 63.5%) (both P <.05). In adjusted SEM, higher PDHS was associated with worse PCC (β, -0.46 [95% CI, -0.56 to -0.36]) and greater odds of delayed care (adjusted odds ratio [aOR], 1.55 [95% CI, 1.20-2.01]). PCC mediated 14.8% of the PDHS-delayed care association. PDHS (57.9%), age (9.6%), and income (4.3%) contributed most to PCC variance. Delayed care was associated with higher odds of poor quality of life (aOR, 2.65), poor mental health (aOR, 2.65), and poor physical health (aOR, 2.24) (all P <.001).

PCC mediated the relationship between discrimination and healthcare delays with sociodemographic factors influencing this effect. Higher PDHS and worse PCC increased the odds of delayed care, leading to worse health and quality of life.