Impact of Discrimination in Healthcare on Patterns of Doctor Visits Over Time

ImportanceDiscrimination in healthcare disrupts trust and can negatively influence patients. However, the impact of experiencing discrimination on long-term patterns of healthcare utilization is unknown. ObjectiveTo assess how perceived discrimination in healthcare settings is associated with longitudinal patterns of doctor visits among middle-aged and older adults in the United States. DesignProspective cohort study of US adults in the Health and Retirement Study (HRS) who were followed every 2 years for up to 14 years (2008-2020). SettingUS population-based cohort study. ParticipantsAdults aged 50-80 years at baseline who completed the HRS psychosocial questionnaire, answered the question on discrimination in healthcare settings, had complete covariate information, and had at least two waves of follow-up data. ExposureDiscrimination in healthcare settings was measured at baseline as the self-reported frequency of "receiving poorer treatment than others from doctors or hospitals." Responses were dichotomized to indicate any experience of discrimination. Main Outcomes and MeasuresNumber of doctor visits in the prior two years were reported by participants at each wave. Group-based trajectory models (GBTM) were used to identify distinct longitudinal trajectories (patterns) of doctor visits over time. Multinomial logistic regression models were used to examine associations between discrimination in healthcare and trajectories of doctor visits while adjusting for sociodemographic, behavioral, and health-related factors. ResultsAmong 13,422 participants (mean age [~]63.0 years [{+/-}8.0]), approximately 19.4%, reported experiencing discrimination in healthcare at baseline. Results identified five major patterns of doctor visits over time: "Low" ([~]2 visits/year, 35.5%), "Frequent" ([~]4.5 visits/year, 33.3%), "Frequent-to-High" ([~]4.5 to 9 visits/year, 13.7%), "High-to-Frequent" ([~]13.5 to 6 visits/year, 10.3%), and "High" ([~]11+ visits/year, 6.3%). Discrimination in healthcare was more prevalent among participants with higher-utilization patterns and among those with greater disease burden and social vulnerability. Compared to participants with Low doctor visits, perceived discrimination was significantly greater in those with High-to-Frequent (relative risk ratio [RRR]=1.38; 95% CI, 1.17-1.63; P<.001) and High (RRR=1.62; 95% CI, 1.30-2.03; P<.001) patterns of doctor visits. Conclusions and RelevanceDiscrimination in healthcare settings is associated with greater numbers of doctor visits, possibly indicating it as a marker of poor quality of care. Key PointsO_ST_ABSQuestionC_ST_ABSIs perceived discrimination in healthcare settings associated with long-term patterns of doctor visits among middle-aged and older adults? FindingsIn this prospective cohort study of United States adults aged 50 to 80, perceived discrimination in healthcare was associated with increased likelihood of belonging to high-frequency doctor visit patterns over 14 years of follow-up, even after adjusting for sociodemographic and health-related factors. MeaningDiscrimination in healthcare may contribute to fragmented or intensive healthcare utilization patterns, underscoring the need to address discrimination as part of efforts to improve care quality and equity.