Association Between Discrimination in Health Care and ASCVD Among Middle-Aged and Older Adults in the United States

Discrimination in health care can influence patient behavior and potentially lead to poor quality care. When patients perceive discrimination, they may disengage from health care, have heightened stress, and identify biased treatment practices. Atherosclerotic cardiovascular disease (ASCVD) is a condition that requires adequate disease prevention. Our objective is to assess the association between discrimination in health care and ASCVD risk.

We examined data from adults aged 50 to 90 years enrolled in the 2008 to 2020 waves of the Health and Retirement Study who were followed for up to 12 years. Participants reported how frequently they perceived receiving poorer treatment than other people from doctors or hospitals; we characterized this as discrimination. Nonfatal ASCVD events were ascertained from dates of a doctor-diagnosed myocardial infarction or stroke during follow-up. Cox models were used to estimate hazards of ASCVD outcomes with experiencing discrimination using propensity score weights to adjust for confounding. Models included covariate adjustment, and differences by sex, race, and ethnicity were examined.

Of the 17 632 study participants (mean age: 65.86, 41.97% male), 3347 (18.9%) reported discrimination in health care at baseline, and 1785 (10.1%) had an ASCVD event over 10 years of follow-up. Among those who did not have an event, 2983 (18.82%) reported discrimination, and among those who had an event, 364 (20.39%) reported discrimination. Discrimination was associated with higher risks of nonfatal ASCVD within the first 2-years of follow-up (hazard ratio [HR], 1.54 [95% confidence interval (CI), 1.24-1.91]) and was partially attenuated after 5 years (HR, 1.29 [CI, 1.11-1.50]) and 10 years (HR, 1.27 [CI, 1.10-1.46]). The associations remained largely unchanged after covariate adjustments (2-year HR, 1.44 [CI, 1.16-1.80]; 5-year HR, 1.24 [CI, 1.06-1.44]; 10-year HR, 1.23 [CI, 1.10-1.46]).

Discrimination in health care was associated with increased risks of nonfatal ASCVD in middle-aged and older adults. The risks persisted over time and suggest that discrimination is an important factor to consider for the prevention of ASCVD.