COVID-Related Discrimination and Health Care Access among a Nationally Representative, Diverse Sample of US Adults

Miciah J Wilkerson; Alexis L Green; Allana T Forde; Stephanie A Ponce; Anita L Stewart; Anna M Nápoles; Paula D Strassle

doi:10.1007/s40615-024-02260-1

COVID-Related Discrimination and Health Care Access among a Nationally Representative, Diverse Sample of US Adults

J Racial Ethn Health Disparities. 2024 Dec 17. doi: 10.1007/s40615-024-02260-1. Online ahead of print.

Authors

Miciah J Wilkerson¹, Alexis L Green¹, Allana T Forde¹, Stephanie A Ponce¹, Anita L Stewart², Anna M Nápoles¹, Paula D Strassle^{3

4}

Affiliations

¹ Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA.
² Center for Aging in Diverse Communities, Institute for Health & Aging, University of California San Francisco, San Francisco, CA, USA.
³ Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA. pdstrass@umd.edu.
⁴ Department of Epidemiology and Biostatistics, University of Maryland, College Park, MD, 20742, USA. pdstrass@umd.edu.

PMID: 39688719
DOI: 10.1007/s40615-024-02260-1

Abstract

Background: In the United States, COVID-related discrimination towards racial and ethnic minority populations is well documented; however, its impact on healthcare access during the pandemic has not been assessed.

Methods: We used data from our nationally representative, online survey of 5,500 American Indian/Alaska Native (AIAN), Asian, Black, Native Hawaiian/Pacific Islander, Latino, White, and multiracial adults conducted between 12/2020-2/2021 (baseline) and 8/2021-9/2021 (6-month follow-up; 35.1% response rate). At baseline, participants were asked how often they experienced discriminatory behaviors "because they think you might have COVID-19" (modified Everyday Discrimination Scale). Participants were asked if they were unable to get needed health care (e.g., cancer screening), or COVID-19 testing at both time-points. Vaccine willingness was assessed at baseline and uptake at follow-up.

Results: Experiencing COVID-related discrimination was associated with not being able to get health care at baseline (OR = 3.66, 95% CI = 2.91-4.59) and follow-up (OR = 1.86, 95% CI = 1.16-2.97) and not being able to get a COVID-19 test at baseline (OR = 2.11, 95% CI = 1.68-2.65) and follow-up (OR = 4.12, 95% CI = 2.20-7.72). Experiencing discrimination was also associated with being less likely to have received a COVID-19 vaccine (OR = 0.52, 95% CI = 0.30-0.90), despite individuals who experienced discrimination being more willing to vaccinate at baseline (OR = 1.56, 95% CI = 1.10-2.22).

Conclusions: COVID-related discrimination was associated with an increased likelihood of being unable to get health care across all racial and ethnic populations, although associations were strongest among Asian, AIAN, and Latino adults. Healthcare providers should be aware of the impact of discrimination on healthcare utilization, delays, and health-seeking behaviors, especially among racial and ethnic minorities.

Keywords: COVID-19; COVID-19 testing; Delayed care COVID-19 vaccine; Discrimination; Health care utilization.

Grants and funding

2 P30 AG015272/AG/NIA NIH HHS/United States