Everyday Discrimination Linked to Health Care Access Barriers, Lower Preventive Care

Patients who reported experiencing everyday discrimination were also more likely to experience health care access barriers, greater reliance on emergency services, and reduced use of preventive screenings and physician visits, according to a new study published in JAMA Network Open.¹

Health access barriers across minority patient demographics are a persistent issue in health care. Extensive data links disparities in health care access to a range of social determinants of health.² In this study, researchers examined everyday discrimination as a potential factor associated with health care access and utilization. Prior research has shown that between 21% and 37% of adults in the US reported experiencing discrimination in a health care setting, particularly Black, Hispanic, Latino, or multiracial individuals. Previous research has shown that 21% to 37% of US adults report experiencing discrimination in health care settings, particularly Black, Hispanic or Latino, and multiracial individuals. The current study examined whether broader experiences of everyday discrimination were associated with health care access and utilization after accounting for demographic, socioeconomic, and health-related factors.¹

The researchers used the Andersen behavioral model to examine how everyday discrimination—measured as repeated experiences of subtle disrespect, unfair treatment, or social slights—was associated with health care utilization and access.

The cross-sectional study used the 2023 National Health Interview Survey (NHIS)—the most recent National Health Interview Survey to include the Everyday Discrimination Scale. Individuals aged 18 years and older were included in the analysis. The overall NHIS response rate was 47%.

A 5-item Everyday Discrimination Scale (EDS) was used to measure the primary outcomes. Patients reported the frequency with which they experienced the following events, rating them on a scale of 0 to 4 (with 0 indicating never to 4 indicating at least once weekly). The experiences were less courtesy or respect, poorer service, being treated as unintelligent, others acting as though they were afraid of the respondent, or threats or harassment.

The EDS results were cross-examined with self-reported binary health care access and use outcomes across 4 categories: delayed or forgone care due to financial barriers; health care use (urgent care, emergency department visits, hospitalizations, therapy, mental health services, medications, wellness visits, and usual care source); cancer screenings (Papanicolaou tests, mammograms, colonoscopies, and prostate-specific antigen tests); and preventive services (influenza, pneumonia, shingles, and hepatitis B vaccinations and diabetes, blood pressure, and cholesterol screenings).

Everyday Discrimination Was Linked to Delayed Care and Greater Emergency Department Use

The final analysis included 27,384 participants with a mean age of 48.1 years, of whom 51.2% were female. Of them, 1.3% are American Indian or Alaska Native, 6.2% Asian, 17.5% Hispanic, 11.5% non-Hispanic Black, 62.4% non-Hispanic White, and 1.2% other or multiple races.

The mean EDS score was 2.48. The most commonly reported experience was being treated with less respect or courtesy (45.2%; 95% CI, 44.3%-46.2%); the least common was others acting afraid of them (13.7%; 95% CI, 13.2%-14.3%).

Mean EDS scores were higher among younger individuals (3.10 [3.70] for age 30 years vs 1.40 [2.40] for age 65 years; P < .001).

Each 1-point increase in EDS score was associated with greater odds of delaying or forgoing care because of cost. Higher scores were also associated with increased use of antidepressants, anxiolytics, emergency departments, urgent care, and physical or rehabilitative therapy, as well as lower odds of physician visits.

These findings suggest that experiences of everyday discrimination are independently associated with barriers to accessing health care, even after adjustment for demographic, socioeconomic, and health-related factors.

“Long-term exposure to discrimination activates stress pathways that increase chronic disease risk and health care needs, consistent with the minority stress model,” the study authors wrote. “Discrimination may also serve as an effective proxy for unequal care due to practitioner- or system-related biases.”

Addressing Bias May Improve Health Care Access

Despite the efforts of larger health institutions and organizations developing programs and dedicated initiatives to screen for social determinants of health, tools like clinician checklists may limit patient input, potentially excluding nonclinical concerns and priorities that might inhibit patients from engaging in their own care.² Thus perpetuating the “clinicians’ dominance” perception, which could potentially contribute to unequal care.

The current findings suggest experiences of everyday discrimination may represent another barrier that traditional social needs screening fails to capture. As health systems continue investing in programs to improve health equity and access, addressing interpersonal bias and strengthening patient trust may be just as important as expanding clinical services.

Despite its findings affirming established connotations of health care discrimination, the study was limited, and EDS could not fully capture the setting of discrimination.¹ Causality could not be inferred due to the cross-sectional design of the study, as all outcomes were self-reported.

“This study’s results suggest that addressing interpersonal and structural dimensions of discrimination is essential to achieving equitable health care access and improving population health,” the study authors concluded.

References

1. Lin JC, Zhu DT, Aysola J. Everyday discrimination and health Care utilization among US adults. JAMA Netw Open. 2026;9(7):e2624373. doi:10.1001/jamanetworkopen.2026.24373

2. Sherman BW, Fendrick AM. Addressing patients’ unmet social needs: checklists are a means, trust is foundational. AJMC^®. 2024; 30(3):110-113. doi:10.37765/ajmc.2024.89511