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Health Services Research & Development

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2008 HSR&D National Meeting Abstract

National Meeting 2008

3036 — Experiences of Discrimination and Self-Reported Health in a Diverse Population of Diabetic Veterans

Frank D (COE Seattle), Rees C (University of Washington), Young BA (COE Seattle)

Perceptions of racial/ethnic discrimination can adversely affect health and may partially explain health disparities. We sought to examine whether life experiences of racial/ethnic discrimination (EOD) were associated with self-reported physical health in a diverse VA population. In addition, we aim to investigate the association of EOD and satisfaction of diabetes care.

The VA Pathways study is an ongoing prospective cohort study of diabetic patients designed to evaluate racial/ethnic differences in diabetes and development of diabetes complications. Participants were mailed questionnaires which included a previously validated measure with 6 questions assessing experiences of racial/ethnic discrimination ever in their lives (EOD) including: at school, getting a job, getting housing, at work, getting medical care, from police or the courts. In addition, questionnaires assessed self-reported demographics (race/ethnicity, income and education). Self-reported health and satisfaction with health care received for their diabetes were rated on an ordinal scale. We used ordinal logistic regression models to determine the association of EOD with general health status, microvascular and macrovascular complications, and satisfaction with diabetes care, adjusting for income and level of education.

1,706 patients participated: 1,290 Whites, 162 African Americans, 74 Hispanics, 35 Asian Americans, and 27 American Indians. EOD was reported by 24% of respondents. Respondents who self-reported EOD had a 30% reduction in the odds of reporting good health compared to those who did not report EOD (OR 0.71 CI .57, .88) p=0.002). EOD was not associated with risk of self-reported macrovascular or microvascular complications of diabetes. Among patients reporting EOD, the odds of being satisfied with the care of their diabetes were 45% lower compared with patients who did not report EOD (OR 0.56 CI 0.44, 0.70 p < .001). Among those who reported EOD in a medical setting, the odds of being satisfied with their diabetes care were significantly lower than for patients who did not report EOD (OR 0.40 CI 0.26, .61 p < .001).

Patients who reported experiences of racial/ethnic discrimination ever in their lives (EOD) did not have a higher rate of self-reported complications from diabetes compared those not reporting EOD. However, report of EOD was associated with self-reported poorer health and lower satisfaction with diabetes care.

Additional research is needed to understand the nature of the association between life experiences of racial/ethnic discrimination and self-reported health and satisfaction with diabetes care.

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