Discrimination in health care and biomarkers of cardiometabolic risk in U.S. adults

Abstract

Introduction: Discrimination in health care settings is associated with poor health outcomes and may be especially harmful to older adults who are more likely to have existing risk factors or medical conditions that require on-going care. The purpose of this study is to investigate the associations between patient-reported health care discrimination and biomarkers of cardiometabolic risk. Methods: We used 2008–2014 data from the Health and Retirement Study, a nationally representative study of US adults ages 50+ (n=12,695 participants contributing up to 16,179 observations) to examine the association between patient-reported experiences of health care discrimination and biomarkers of cardiometabolic risk: high sensitivity C-reactive protein (CRP), Hemoglobin A1c (HbAlc), high-density lipoprotein (HDL), total cholesterol, cystatin C and blood pressure and whether relationships were modified by race/ethnicity (non-Hispanic White, non-Hispanic Black, or Hispanic) or gender. We fit generalized estimating equation (GEE) models specifying a binomial distribution and logit link to account for dependency of repeated measures on individuals. Results: Health care discrimination was associated with higher odds of CRP>3 mg/L (OR: 1.20 (95% CI: 1.10, 1.30) and HbA1c>6.5% (OR: 1.23 (95% CI: 1.10, 1.38) but not associated with other biomarkers of cardiometabolic health in the sample as a whole. However, subgroup differences were detected. While health care discrimination was positively associated with elevated HbA1c for non-Hispanics, it was inversely associated with HbA1c for Hispanics. Conclusions: Health care discrimination was associated with increased cardiometabolic risk based on selected biomarkers. Keywords: United States, discrimination, health care, biomarker, cardiometabolic risk factors, cardiovascular disease