Primary Submission Category: Social/relational factors
Discrimination in Healthcare is Associated with Myocardial Infarction Risk in Middle-Aged and Older Adults
Authors: Michael Green, Ann Marie Navar, Emily O’Brien, M. Alan Brookhart, Roland Thorpe, Matthew Dupre,
Presenting Author: Michael Green*
Discrimination in healthcare has the potential to strain patient-provider relationships and may negatively impact quality of care across multiple clinical domains. We evaluated the association between discrimination in healthcare and myocardial infarction (MI) risk using data from the Health and Retirement Study (2008-2020), a nationally representative longitudinal dataset of middle-aged and older US adults (mean follow-up=7.3 years). The sample included 17,254 Non-Hispanic Black (18.8%), Hispanic (7.6%), and Non-Hispanic White (73.6%) adults aged 50-90 at baseline. MI events during follow-up were ascertained from participant-reported diagnoses of MI by a doctor (mo/yr). Discrimination in healthcare was assessed by asking respondents how often they received poorer treatment from doctors or hospitals compared to others; for analysis, responses were recoded to a 0–4 scale (higher = more frequent discrimination). Covariates were measured at baseline and included sociodemographic background (gender, race, ethnicity, education), healthcare utilization (doctor visits, hospitalizations), smoking status, and disease diagnoses (diabetes, hypertension, prior mi). Cox proportional hazards models were used to estimate the risk of MI during follow-up (n=765 events, 4.4% of the population). A sensitivity analysis accounting for the competing risk of all-cause mortality was conducted. In adjusted models, perceived discrimination in healthcare was associated with an increased risk of MI (Hazard Ratio=1.14, P=0.002, 95% Confidence Interval=1.05-1.25). This was consistent with results from competing risk models (Subdistributional Hazard Ratio=1.13, P=0.006, 95% Confidence Interval=1.01-1.43). More research is needed to understand the potential mechanisms by which discrimination may increase the risk of MI and ultimately develop effective strategies to mitigate its harm among middle-aged and older adults.