消化器外科手術後の認識された差別、コミュニケーション、および医療利用：調整された媒介分析

In the US, perceived discrimination in healthcare settings (PDHS) has been linked with delayed care due to nervousness. Surgery represents a high-stakes, vulnerable period leaving lasting impressions on future utilization. We aimed to assess the association between PDHS and delayed care, and evaluate mediating and moderating roles of patient-clinician communication (PCC) and sociodemographic factors, respectively.

We included adults who underwent gastrointestinal (GI) procedures before completing the Healthcare Access & Utilization survey in the All of Us Research Program. Associations were examined using structural equation modeling (SEM); variance decomposition quantified contributions of sociodemographic moderators.

Among 1,866 participants (46.4% hepatopancreatobiliary; 41.6% colorectal; 12.0% esophagogastric), median age was 62.0 years (IQR 52.0-70.0); the majority was female (n=1,306, 70.3%,) and non-Hispanic White (n=1,571, 84.2%). Participants who delayed care were more often 18-44 years (39.0% vs. 11.6%) and less frequently married (55.5% vs. 63.5%) (both p<0.05). In adjusted SEM, higher PDHS was associated with worse PCC (β -0.46, 95%CI -0.56-0.36) and greater odds of delayed care (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<0.001).

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