Changes in Perceptions of Discrimination in Health Care in California, 2003 to 2017

Key Points Question Have perceptions of discrimination in health care changed in California over the last decade? Findings This repeated cross-sectional study of a racially, ethnically, and linguistically diverse adult population using results from the California Health Interview Survey found a significant overall decrease in perceptions of discrimination in health care (from 6.0% to 4.0%). In subanalyses this finding was significant among Latino respondents, immigrants, and those with limited English proficiency; however, perceptions of discrimination in health care among African American individuals have not improved and remain relatively high. Meaning This study suggests that perceptions of discrimination in health care have improved for some populations, but interventions to reduce discrimination in health care are still necessary.
This cross-sectional study investigates changes in perceptions of discrimination in health care on the basis of race/ethnicity, immigration status, and English proficiency in California from 2003 to 2017.
Importance Research in the early 2000s in California demonstrated that racial and ethnic minorities, immigrants, and those with limited English proficiency (LEP) experienced high rates of discrimination in health care. Less is known about how patients’ perceptions of discrimination in health care have changed since then. Objective To determine whether perceptions of discrimination in health care have changed overall and for specific vulnerable populations. Design, Setting, and Participants This cross-sectional study used data from the California Health Interview Survey for state residents aged 18 years and older for 2 periods, 2003 to 2005 and 2015 to 2017. χ2 analyses and multivariate logistic regression were performed to compare recent discrimination in health care in late vs early periods controlling for race/ethnicity, poverty level, education, insurance status, usual source of care, self-reported health, and LEP. Additional subanalyses were performed by race/ethnicity, immigrant status, and LEP status. Jackknife replicate weights were provided by the California Health Interview Survey. Exposure Survey year was dichotomized as combined 2003 to 2005 and combined 2015 to 2017. Main Outcomes and Measures Survey respondents were identified as having experienced recent discrimination in health care if they responded “yes” to the question, “Was there ever a time when you would have gotten better medical care if you had belonged to a different race or ethnic group?” and reported that this occurred within the last 5 years. Results There were 84 088 participants in 2003 to 2005 (51.0% female; 14.7% aged ≥65 years) and 63 242 participants in 2015 to 2017 (51.1% female; 18.0% aged ≥65 years). Rates of recent discrimination in health care decreased from 6.0% to 4.0% (difference, 2.0%; 95% CI, 1.5%-2.5%; P