Primary Submission Category: Health equity
Everyday and Healthcare Discrimination at the Intersection of Socioeconomic Status Factors
Authors: Meman Diaby, Delvon T. Mattingly, Luis Zavala Arciniega, Shyanika W. Rose, Carrie B. Oser,
Presenting Author: Meman Diaby*
Background: Discrimination is the unjust treatment of individuals based on identity characteristics, such as socioeconomic status (SES). It occurs across various settings, including healthcare and public spaces, and is recognized as a social determinant of health.
Method: We analyzed imputed data from the All of Us Research Program (version 7) to examine the prevalence of the Everyday Discrimination Scale (EDS) (range: 0–5) and Healthcare Discrimination Scale (HDS) (range: 0–4) at the intersection of SES factors (n=117,688). We assessed mean discrimination scores across every possible combination of SES, or homeownership (home owner, renting), annual household income (high income, middle income, low income), employment status (employed, unemployed), and educational attainment (advance degree, college graduate, some college, high school graduate/less than high school), conducted ANOVA to compare inter-group differences, and used a visualization tool to display these complex patterns.
Results: Mean discrimination scores were low (EDS = 0.80; HDS = 0.57), but differences across intersecting SES groups were statistically significant (p<0.001). Renters, lower-income, unemployed, and lower educated (high school graduate/less than high school for EDS and some college for HDS) adults reported higher discrimination on average. A four-way intersectional analysis revealed that unemployed renters with some college education and low incomes reported the highest discrimination (EDS: 1.44, 95% CI: 1.39-1.48; HDS: 0.97, 95% CI: 0.94-1.00), while retired homeowners with lower education and high incomes reported the lowest discrimination (EDS: 0.45, 95% CI: 0.37-0.52; HDS: 0.39, 95% CI: 0.37-0.41).
Conclusion: Discrimination is most common among renters, the unemployed, and those with lower income or education. Healthcare discrimination reflects everyday discrimination, exposing structural inequities across settings and emphasizing the need for systemic change.