Abstract
Background
Perceived discrimination and medical mistrust are barriers to care that impact both individual and population health.
Objective
This study aims to characterize the prevalence of perceived racial or ethnic discrimination in healthcare as well as mistrust in the medical system and explore their associations with race and ethnicity.
Design
Cross-sectional study of nationally representative data from the Health Information National Trends Survey (fielded March–November 2022).
Participants
Non-institutionalized US adults (n = 6252; weighted household response rate = 28.1%).
Main Measures
Outcomes were perceived racial or ethnic discrimination in healthcare and medical mistrust. The independent variable was race or ethnicity.
Key Results
An estimated 7.1% (95%CI, 6.0–8.2%) of the US adult population report experiencing racial or ethnic discrimination in healthcare. Perceived discrimination is most prevalent among individuals identifying as Black (18.8% [95%CI, 14.8–22.8%]), followed by Asian (15.1% [95%CI, 4.8–25.4%]) and Hispanic individuals (9.8% [95%CI, 7.4–12.2%]). Medical mistrust is reported by an estimated 62.3% (95%CI, 60.4–64.2%) of the US population, with the highest prevalence among Hispanic (68.9% [95%CI, 64.8–73.0%]) and Black individuals (67.8% [95%CI, 62.7–72.9]). In a multivariable Poisson regression, the prevalence of medical mistrust was significantly higher among Hispanic (adjusted prevalence ratio (aPR), 1.12 [95%CI, 1.04–1.21]) and Black (aPR, 1.10 [95%CI, 1.01–1.20]) respondents relative to White respondents, after adjusting for age, sex, and sexual orientation. Additionally, when adjusting for race and ethnicity, age, sex, and sexual orientation, medical mistrust was significantly more prevalent among those reporting perceived discrimination (aPR, 1.38 [95%CI, 1.30–1.47]).
Conclusions
Perceived discrimination in healthcare and medical mistrust are prevalent at the national scale, with racial and ethnic groups of color bearing the brunt. System-wide efforts are needed to improve health equity for marginalized patient populations.
Supplementary Information
The online version contains supplementary material available at 10.1007/s11606-025-09369-x.
KEY WORDS: discrimination, medical mistrust, disparities, inclusion
INTRODUCTION
In 2021, the Centers for Disease Control and Prevention identified racism as a severe threat to public health,1 emphasizing how discrimination not only contributes to individual-level disease but also causes systemic health inequities.2–4 Similar to other sectors of society, discrimination is widespread in healthcare, with patients frequently reporting experiences of bias and unjust treatment from medical providers.5,6 The repercussions of medical discrimination are extensive, leading to distrust of medical providers and institutions, reduced utilization of preventative health services, and worse health outcomes.7–10 Moreover, these effects are particularly concentrated among groups that have been historically marginalized due to factors such as sexual identity, age, sexual orientation, race, and ethnicity.5
Though often associated, medical mistrust can arise from sources beyond discrimination, impacting non-marginalized groups as well. Substantial levels of mistrust might have contributed to skepticism toward COVID-19 protective measures among White populations, even without discriminatory experiences in healthcare.11,12 Despite the critical importance of understanding and addressing both medical discrimination and mistrust, there is a lack of research examining their prevalence and distribution across racial and ethnic lines at the national level.
Therefore, this cross-sectional study assessed the prevalence of perceived racial and ethnic discrimination in healthcare and medical mistrust among the United States (US) population. Further, the prevalences across different racial and ethnic groups were compared to explore the associations between race and ethnicity and perceived discrimination and medical mistrust.
METHODS
This study of deidentified and publicly available data was exempt from institutional review board approval and follows the Strength and Reporting of Observational Studies in Epidemiology (STROBE) guidelines for cross-sectional studies.
Data Source and Sampling Strategy
This study utilized self-reported data from wave 6 of the Health Information National Trends Survey (HINTS), conducted by the National Cancer Institute from March to November 2022 via paper or online questionnaire.13 HINTS is a nationally representative survey of civilian, non-institutionalized US adults, intended to gauge the general population’s access to and utilization of health-related information.14 Previous iterations of HINTS followed an annual survey administration schedule, before shifting to a biennial schedule with HINTS 6.15 Additionally, HINTS 6 uniquely featured survey questions related to social risk factors, including perceived medical discrimination and mistrust.13,16
The HINTS 6 sampling method, described previously, is summarized as follows: first, a stratified random sample of nonvacant US residential addresses was selected from the Marketing Systems Group database. Then, one adult per sampled household was selected to complete the survey. Sampling strata were defined based on the adult racial or ethnic minority population density and rurality of the area. Both rural and urban areas with high racial or ethnic minority population density were oversampled.13 The final sample for HINTS 6 comprised 6252 respondents with a weighted household response rate of 28.1% (20.8% in high racial or ethnic minority strata; 31.0% in low racial or ethnic minority strata).13
Study Outcomes
Perceived Racial or Ethnic Discrimination in the Healthcare Setting
For each respondent, experiences of perceived discrimination were ascertained through the survey question: “Have you ever been treated unfairly or been discriminated against when getting medical care because of your race or ethnicity?” Those responding “Yes” were classified as having been discriminated against. Throughout this text “perceived discrimination” specifically refers to racial or ethnic discrimination in the healthcare setting, unless specified otherwise.
Medical Mistrust
Medical mistrust was ascertained through the survey question: “How much do you trust the health care system (for example, hospitals, pharmacies, and other organizations involved in health care)?” Respondents answering “Very” were classified as having “No medical mistrust,” while those responding “Not at all,” “A little,” or “Somewhat” were categorized as having “medical mistrust.”
Independent Variables
Sociodemographic independent variables were categorized as follows: age (younger than 65 years, 65 years or older); race and ethnicity (White, Black, Hispanic, Asian, and Other Race—due to low individual representation, Native American or Alaska Native, Native Hawaiian or Other Pacific Islander, and Multiple Races were classified together as Other Race); sex assigned at birth (male, female); and sexual orientation (heterosexual, non-heterosexual). A full list of operational definitions is provided in eTable 1.
Statistical Analysis
All population-based analyses were weighted to provide nationally representative estimates, following HINTS 6 Survey data analysis recommendations.13 Taylor’s Series variance estimation was utilized to calculate standard errors. The prevalences of perceived discrimination and medical mistrust were estimated for the total study population and reported as weighted percentages with corresponding 95% confidence intervals (CIs).
Poisson regression was utilized to assess the association between race and ethnicity and perceived discrimination, as well as race and ethnicity and mistrust. Both unadjusted prevalence ratios (PR) and adjusted prevalence ratios (aPR), respectively, with corresponding 95% CIs, are presented. Notably, the addition of potential mediators to standard regression models may attenuate main effects. Therefore, we decided a priori to adjust for age, sex assigned at birth, and sexual orientation, as these covariates conceptually are not mediators of the associations between race and ethnicity and the main outcomes. Sensitivity analyses were performed with additional adjustments for potential mediators such as health insurance status, highest attained education, and household income. Additionally, an exploratory analysis evaluating the association between perceived discrimination and mistrust utilizing Poisson regression was conducted.
For weighted percentage estimates, all participants were included in the analyses, and those with missing data for a given variable, including outcome variables, were categorized as “Missing.” For multivariable analyses, those with missing outcome data were excluded from the respective analyses.
We chose to utilize Poisson regression due to the high reported frequency of both perceived discrimination and medical mistrust by race and ethnicity in the study sample.17 Two-sided P-values less than or equal to 0.05 were considered statistically significant. All analyses were performed using Stata software version 18.0 (Stata Corporation, College Station, TX, USA), and figures were generated using Microsoft Excel version 16.85 (Microsoft Corporation, Redmond, WA, USA).
RESULTS
Sample Characteristics
A total of 6252 respondents were included in the final survey sample, representing 258.4 million US adults (Table 1). The estimated mean age of the weighted-population is 48.1 years old (standard deviation, 18.9 years). Moreover, an estimated 47.4% of the population self-identify as female at birth, 45.9% as male at birth, and 6.7% do not report birth sex. Most individuals self-identify as White (55.4%), followed by Hispanic (15.4%), Black (14.2%), and Asian (5.2%). Other races and ethnicities comprise 4.6% of the population and 9.6% do not report their race or ethnicity.
Table 1.
Respondent Characteristics
| Characteristic | Race and ethnicity | P-value | |||||
|---|---|---|---|---|---|---|---|
| Overall (n = 6252) | White (n = 3203) | Black (n = 889) | Hispanic (n = 1001) | Asian (n = 288) | Other Racea (n = 184) | ||
| Age (years) | <0.001 | ||||||
| <65 | 3951 (77.5) | 1848 (73.6) | 588 (82.7) | 750 (86.8) | 230 (93.0) | 136 (84.7) | |
| ≥65 | 2203 (21.3) | 1337 (26.0) | 296 (17.0) | 240 (12.0) | 57 (6.8) | 47 (15.2) | |
| Missing | 98 (1.1) | 18 (0.4) | 5 (0.3) | 11 (1.3) | 1 (0.2) | 1 (0.1) | |
| Weighted mean (SD) | 48.1 (18.9) | 51.4 (17.6) | 48.5 (19.0) | 42.3 (17.9) | 39.3 (14.5) | 43.3 (12.6) | |
| Sex assigned at birth | <0.001 | ||||||
| Male | 2307 (45.9) | 1337 (49.6) | 288 (44.1) | 367 (48.4) | 145 (58.7) | 67 (48.3) | |
| Female | 3535 (47.4) | 1861 (50.3) | 598 (55.8) | 623 (50.0) | 142 (41.2) | 117 (51.7) | |
| Missing | 410 (6.7) | 5 (0.2) | 3 (0.1) | 11 (1.6) | 1 (0.1) | 0 (0.0) | |
| Sexual orientation | <0.001 | ||||||
| Heterosexual | 5245 (82.9) | 2944 (91.2) | 808 (91.1) | 837 (82.2) | 266 (93.2) | 163 (78.2) | |
| Non-heterosexual | 448 (7.8) | 231 (7.7) | 57 (5.3) | 111 (11.2) | 14 (5.4) | 18 (19.3) | |
| Missing | 559 (9.2) | 28 (1.0) | 24 (3.6) | 53 (6.6) | 8 (1.5) | 3 (2.5) | |
Data are reported as no. (weighted %)
aIncludes individuals identifying as American Indian or Alaska Native, Native Hawaiian or Other Pacific Islander, and more than one race or ethnicity
Perceived Racial or Ethnic Discrimination in the Healthcare Setting
Among the total US population, an estimated 7.1% (95%CI, 6.0–8.2%) report experiencing racial or ethnic discrimination in the healthcare setting (Fig. 1, Table 2). Perceived discrimination is reported by 14.6% (95%CI, 11.9–17.3%) of non-White individuals, compared to 2.5% (95%CI, 1.7–3.3%) of White individuals. Differences were also observed between non-White racial and ethnic groups. Perceived discrimination is reported by 21.5% (95%CI, 10.6–32.4%) of individuals classified as “Other Race,” 18.8% (95%CI, 14.8–22.8%) of Black individuals, 15.1% (95%CI, 4.8–25.4%) of Asian individuals, and 9.8% (95%CI, 7.4–12.2%) of Hispanic individuals.
Figure 1.
Prevalence of perceived racial or ethnic discrimination in healthcare by race and ethnicity. Non-White individuals include those identifying as Black, Hispanic, Asian, or Other Race. The Other Race category includes individuals identifying as American Indian or Alaska Native, Native Hawaiian or Other Pacific Islander, and Multiple Races. Error bars depict 95% confidence intervals.
Table 2.
Weighted Prevalence and Prevalence Ratios of Perceived Racial or Ethnic Discrimination in Healthcare and Medical Mistrust by Race and Ethnicity
| Outcome by race and ethnicity | No./total no. | Weighted % (95%CI) | Unadjusted PR (95%CI) | Adjusted PRa (95%CI) |
|---|---|---|---|---|
| Perceived discrimination | ||||
| Overall | 495/6102 | 7.1 (6.0–8.2) | -- | -- |
| White | 82/3184 | 2.5 (1.7–3.3) | 1.00 (reference) | 1.00 (reference) |
| Non-Whiteb | 352/2339 | 14.6 (11.9–17.3) | 5.81 (4.02–8.39)*** | 5.53 (3.82–7.99)*** |
| Black | 182/879 | 18.8 (14.8–22.8) | 7.43 (5.07–10.9)*** | 7.05 (4.78–10.4)*** |
| Hispanic | 114/991 | 9.8 (7.4–12.2) | 3.89 (2.67–5.66)*** | 3.70 (2.54–5.40)*** |
| Asian | 23/287 | 15.1 (4.8–25.4) | 5.97 (2.74–13.0)*** | 5.51 (2.54–12.0)*** |
| Other Racec | 33/182 | 21.5 (10.6–32.4) | 8.60 (4.69–15.8)*** | 8.23 (4.55–14.9)*** |
| Missing | 61/579 | 5.9 (3.3–8.5) | 3.03 (1.74–5.30)*** | 3.88 (1.78–8.48)** |
| Medical mistrust | ||||
| Overall | 3777/6118 | 62.3 (60.4–64.2) | -- | -- |
| White | 1868/3184 | 60.2 (57.5–62.9) | 1.00 (reference) | 1.00 (reference) |
| Non-Whiteb | 1521/2351 | 67.8 (64.6–71.0) | 1.12 (1.05–1.20)** | 1.10 (1.03–1.18)** |
| Black | 567/884 | 67.8 (62.7–72.9) | 1.12 (1.03–1.22)* | 1.10 (1.01–1.20)* |
| Hispanic | 662/996 | 68.9 (64.8–73.0) | 1.14 (1.06–1.23)*** | 1.12 (1.04–1.21)** |
| Asian | 158/288 | 61.2 (51.3–71.1) | 1.01 (0.85–1.20) | 0.98 (0.83–1.17) |
| Other Racec | 134/183 | 71.5 (53.5–89.5) | 1.18 (0.91–1.54) | 1.18 (0.93–1.50) |
| Missing | 388/583 | 53.7 (47.1–60.3) | 1.16 (1.06–1.27)** | 1.05 (0.91–1.21) |
Total no. includes respondents who provided an answer to the outcome of interest (i.e., “yes” or “no” to having perceived medical discrimination, or “not at all,” “a little,” “somewhat,” or “very” to how much do you trust the healthcare system). Weighted percentages were calculated among the total study population (n = 6252)
PR, prevalence ratio
*P < 0.05; **P < 0.01; ***P < 0.001
aAdjustments were made for age, sex, and sexual orientation
bIncludes individuals identifying as Black, Hispanic, Asian, or Other Race; assessed in a separate model from the individual racial and ethnic groups
cIncludes individuals identifying as American Indian or Alaskan Native, Native Hawaiian or Other Pacific Islander, and Multiple Races
After excluding 150 respondents with missing perceived discrimination status, 6102 respondents were included in the multivariable model. In adjusted analyses, the prevalence of perceived discrimination was significantly higher among non-White respondents (aPR, 5.53 [95%CI, 3.82–7.99]). When analyzing by individual racial or ethnic group, the prevalence of perceived discrimination was significantly higher among Other Race (aPR, 8.23 [4.55–14.9]), Black (aPR, 7.05 [95%CI, 4.78–10.4]), Asian (aPR, 5.51 [95%CI, 2.54–12.0]), and Hispanic respondents (aPR, 3.70 [95%CI, 2.54–5.40]), relative to White respondents. Associations between covariates and perceived discrimination are reported in eTable 2. In the sensitivity analysis with additional adjustments for health insurance status, highest attained education, and household income, the prevalence of perceived discrimination remained significantly higher among all non-White groups (eTable 3).
Medical Mistrust
Overall, 62.3% (95%CI, 60.4–64.2%) of the US population report medical mistrust (Fig. 2, Table 2). Mistrust is reported by 67.8% (95%CI, 64.6–71.0%) of non-White individuals, compared to 60.2% (95%CI, 57.5–62.9%) of White individuals. Mistrust is most reported by individuals classified as Other Race (71.5% [95%CI, 53.5–89.5%]), followed by Hispanic (68.9% [95%CI, 64.8–73.0%]), Black (67.8% [62.7–72.9%]), and Asian individuals (61.2% [51.3–71.1%]). eFigure 1 displays the breakdown of levels of medical mistrust by race and ethnicity.
Figure 2.
Prevalence of medical mistrust by race and ethnicity. Non-White individuals include those identifying as Black, Hispanic, Asian, or Other Race. The Other Race category includes individuals identifying as American Indian or Alaska Native, Native Hawaiian or Other Pacific Islander, and Multiple Races. Error bars depict 95% confidence intervals.
After excluding 134 respondents without data on medical mistrust, 6118 respondents were included in the multivariable model. In adjusted analyses, the prevalence of mistrust was significantly higher among non-White respondents (aPR, 1.10 [95%CI, 1.03–1.18]) relative to White respondents. By individual racial or ethnic group, the prevalence of mistrust was significantly higher among Hispanic (aPR, 1.12 [95%CI, 1.04–1.21]) and Black respondents (aPR, 1.10 [95%CI, 1.01–1.20]), compared to White respondents. Differences in the prevalence of mistrust among Asian (aPR, 0.98 [95%CI, 0.83–1.17]) and Other Race respondents (aPR, 1.18 [95%CI, 0.93–1.50], relative to White respondents, were not statistically significant. Associations between covariates and mistrust are reported in eTable 2. In the sensitivity analysis, while the distribution of mistrust across racial and ethnic groups mirrored that of the main analysis, only the combined non-White and Other Race groups showed a significantly higher prevalence of mistrust relative to the White group (eTable 3).
Association Between Perceived Discrimination and Medical Mistrust
An estimated 6.3% (95%CI, 5.2–7.3%) of US adults report experiencing both perceived discrimination and medical mistrust (eTable 4). Notably, the prevalence of mistrust was significantly higher among those reporting perceived discrimination (aPR, 1.38 [95%CI, 1.30–1.47]) (Table 3), relative to their non-discriminated counterparts.
Table 3.
Association Between Perceived Racial or Ethnic Discrimination in Healthcare and Medical Mistrust
| N = 6118 | Unadjusted PR (95%CI) | Adjusted PRa (95%CI) |
|---|---|---|
| Not discriminated | 1.00 (reference) | 1.00 (reference) |
| Discriminated | 1.43 (1.34–1.51)*** | 1.38 (1.30–1.47)*** |
| Missing | 0.90 (0.56–1.46) | 0.88 (0.55–1.41) |
PR, prevalence ratio
***P < 0.001
aAdjustments were made for race and ethnicity, age, sex, and sexual orientation
DISCUSSION
Racial and ethnic discrimination in healthcare settings and medical mistrust are pervasive barriers to care that adversely impact the health behaviors and outcomes of those who experience them. This cross-sectional analysis of HINTS data suggests that perceived racial or ethnic discrimination is reported by one in seven non-White US adults. Moreover, the study estimated that approximately two-thirds of US adults report medical mistrust, with increased levels among Black and Hispanic respondents relative to White respondents. Further, the prevalence of mistrust was significantly increased among those reporting perceived discrimination.
Perceived Racial or Ethnic Discrimination in the Healthcare Setting
An estimated 21% of US adults report experiencing some form of discrimination in the medical setting, with discrimination based on race or ethnicity being the most common.5 Moreover, racial or ethnic bias in healthcare, compared to other forms of discrimination, inflicts unique physiological and psychological harm on patients, exacerbated by structural, interpersonal, and internalized racism in other societal sectors.10,18 In the present study, although only an estimated 7.1% of the population report having experienced racial or ethnic discrimination in healthcare, these experiences are reported extensively among racial and ethnic minority groups, with the highest prevalence observed among Other Race individuals (21.5%), followed by Black (18.8%), Asian (15.1%), and Hispanic individuals (9.8%).
These findings add depth to previous studies describing high prevalence of perceived racial or ethnic discrimination in healthcare among non-White racial and ethnic groups.19–22 For instance, a national survey by the Kaiser Family Foundation in 2023 reported experiences of racial or ethnic discrimination within the past 3 years among 18% of Black, 10% of Asian, and 11% of Hispanic respondents.19 Similarly, the National Immunization Survey–Adult COVID Module, conducted between April 2021 and November 2022, found that 10.7% of Black, 2.8% of Asian, and 4.5% of Hispanic respondents perceived discrimination in healthcare within the past 2 years.20 Interestingly, the survey questions in both of these studies were specific to recent timeframes, whereas the HINTS survey question did not impose a time limit, potentially capturing a longer period during which instances of discrimination could have occurred. Additionally, while the estimates for Black and Hispanic populations were largely consistent with these studies, the present study found a higher prevalence of discrimination among the Asian population.19–22 This increase possibly reflects the documented rise in anti-Asian racism during the COVID-19 pandemic, which has extended into the healthcare settings.23,24 Overall, these findings contribute to a deeper understanding of the extent of racial or ethnic discrimination in the US healthcare system and emphasize the ongoing need for ameliorative efforts at the national level.
Medical Mistrust
Medical mistrust, like discrimination, exists in many forms, ranging from distrust of individual healthcare providers to a lack of confidence in broader medical institutions, industries, or the healthcare system as a whole.25 Furthermore, medical mistrust is associated with unfavorable health behaviors such as reduced willingness to be vaccinated, greater acceptance of medical misinformation, and avoidance of medical care.25–28 According to the General Social Survey, a biennial nationally representative survey of US adults, public trust in the US healthcare system has nearly halved over the past five decades with the proportion of respondents reporting “a great deal of trust” in medicine declining from 61% in 1974 to just 33% in 2022.29 In the current study, the finding of high trust among only an estimated 37.7% of the population corroborates this recent estimate. This trend suggests a troubling decline in trust in the US healthcare system and highlights the critical need to understand and address the various factors underlying this growing public health crisis.
When examining medical mistrust by race and ethnicity, the highest levels are reported among the Hispanic and Black populations, respectively, consistent with previously published trends.27,28,30,31 Historical injustices such as the Tuskegee Syphilis Study, slavery, and structural racism are commonly cited as root causes of medical mistrust among racial and ethnic minority groups.32 However, modern-day inequities including a persistent lack of physician diversity, unequal healthcare access, and ongoing biases, such as Black patients being less likely to receive adequate pain treatment33 and low healthcare satisfaction among Spanish-speaking patients due to language discordance,34 continue to engender and exacerbate mistrust within non-White groups.9,25,35
Notably, despite a statistically higher prevalence of mistrust among non-White respondents relative to White respondents, the association was numerically modest and potentially weaker than those reported in prior studies.30,36 This suggests that while race and ethnicity are associated with mistrust, other factors such as education, health literacy, or political ideology may also play significant roles. These influences are evident in the high vaccine hesitancy and acceptance of medical misinformation observed across groups, including White populations, during the COVID-19 pandemic.11,12
In the sensitivity analysis including additional adjustments for household income, highest attained education, and health insurance status, the findings of higher medical mistrust among Black and Hispanic individuals were no longer statistically significant. This may reflect the mediating effects of these variables, which could attenuate the direct association between race and ethnicity and mistrust. Future research should further explore these mediating factors and monitor longitudinal trends to better understand their impact on confidence in the healthcare system.
Importantly, medical discrimination and mistrust are interconnected and numerous studies have sought to interpret their complex relationship, largely at the regional or state levels, or among specific patient populations.30,31,37,38 In this study, an estimated 6.3% of the US adult population report experiencing both perceived discrimination and mistrust, with a significantly higher prevalence of mistrust among those reporting perceived discrimination, relative to their non-discriminated counterparts. Perceived discrimination is often examined as a precursor to mistrust; however, it is equally essential to consider the reverse sequence where pre-existing medical skepticism can increase the likelihood of perceiving subtle microaggressions and biases. Therefore, reducing one factor might help to diminish the other. Future studies should seek to elucidate this multifactorial association, as we strive for a more equitable healthcare system.
Addressing the social drivers of health inequity has become a central priority of the US healthcare system, especially in the wake of the COVID-19 pandemic which amplified longstanding health disparities, healthcare racism, and medical mistrust.1,9,11,20,39 This study provides a modern characterization of perceived racism and distrust in healthcare, focusing on their prevalences among racial and ethnic groups of color, and contributing to a limited body of national-level data.22,30,31,37,38 Furthermore, the present study uniquely assesses both perceived discrimination and mistrust within the same sample, shedding light on their association within the US population. These findings provide a comprehensive evaluation of current healthcare racism and mistrust, as well as a baseline for future assessments to be conducted alongside the implementation of interventions.
Limitations
This study should be interpreted in the context of several limitations. First, the survey data were obtained through self-report, subjecting responses to recall and desirability biases. Second, due to small sample sizes, the experiences of individuals identifying as American Indian or Alaska Native, Native Hawaiian or Pacific Islander, or Multiple Races, as well as those within specific ethnic sub-groups (e.g., Afro-Caribbean, Mexican, Chinese), could not be assessed. Third, due to the inability to establish the chronological order in which experiences of discrimination and the development of medical mistrust might have occurred, the causal impact of one on the other could not be delineated. Despite these limitations, given the high levels of both discrimination and mistrust observed within certain groups, future research should investigate their reciprocal influence.
CONCLUSION
Racial and ethnic discrimination in the healthcare setting and medical mistrust are barriers to care that disproportionately impact historically marginalized groups. Among the US population, perceived racial or ethnic discrimination in healthcare is highly prevalent among Other Race, Black, Asian, and Hispanic individuals. Moreover, medical mistrust is reported by approximately two-thirds of the national population, with the highest levels among Hispanic and Black individuals. Additionally, the prevalence of mistrust was significantly increased among individuals reporting perceived discrimination.
These findings underscore the urgent need for sustained attention and system-wide interventions to eliminate the social causes of health inequities at the national scale. Future studies should aim to identify sources of medical discrimination and mistrust while also seeking to understand the unique experiences and needs of diverse patient populations in the present day. Ultimately, this will enable the development of tailored strategies to address and improve longstanding disparities in healthcare.
Supplementary Information
Below is the link to the electronic supplementary material.
Acknowledgements:
The authors would like to thank Shaveta Kanoria (Academic Affairs, Houston Methodist Academic Institute) for scientific editing assistance.
Abbreviations
- HINTS
Health Information National Trends Survey
- PR
Prevalence ratio
- STROBE
Strength and Reporting of Observational Studies in Epidemiology
- US
United States
Author Contribution:
MK, GB, FS, EM, and MF conceptualized and designed the study, and participated in data interpretation. MK, GB, and MF prepared tables and figures and performed statistical analysis. MK drafted the initial manuscript. All authors had access to data and a role in writing the manuscript. All authors read and approved the final manuscript as submitted, and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Declarations:
Conflict of Interest:
The authors declare that they do not have a conflict of interest.
Footnotes
Prior Presentations
2023 Health Information National Trends Survey (HINTS) Data Users Conference, September 21–22, 2023, Bethesda, MD, USA.
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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