1143 — Experiences of Discrimination in a Prospective Cohort of Veterans with Heart Failure

Gordon HS, Jesse Brown (Chicago) VAMC; Pugach O, University of Illinois at Chicago; Ford ME, Medical University of South Carolina, Hollings Cancer Center;

Objectives:
Few studies have examined experiences of discrimination (EOD) in healthcare among diverse patients with severe medical conditions and among patients in VA Medical Centers (VA). Patients with severe conditions who are frequent users of healthcare or are Veterans may have different EOD than others.

Methods:
We conducted a prospective observational cohort study of patients hospitalized for an exacerbation of heart failure (HF) at 2 VAs (in Northern and Southern US). At up to two outpatient follow-up visits in the 6-months after discharge, we used self-report questionnaires to examine associations of reported EOD with patient demographics, visit outcomes, and adherence to physicians' recommendations for 162 patients; 61.7% Black (N = 100) and 38.3% White (N = 62). Bivariate comparisons used chi-square, t-tests, and correlations, as appropriate. Repeated measures analyses were conducted with mixed linear regression.

Results:
There were no statistically significant differences for reported EOD in health care in black compared with white patients (14.0% vs. 11.3%; P = 0.62) or for ethnicity, age, income, education, or geographical site (P > 0.20). However, compared to white patients, black patients were significantly more likely to report EOD in every other area of daily life measured: school, employment, work, housing, store and restaurant services, financial services, public settings, and law enforcement (P < 0.01). In repeated measures analyses examining all patients, those who reported EOD in health care also reported less trust of the VA health care system (P = 0.02) and lower self-efficacy to communicate with their physician (P = 0.04), but no statistically significant differences (P > 0.05) for trust in physician, HF specific health status, and adherence to physicians' recommendations.

Implications:
In this cohort of HF patients, EOD in health care was not significantly different by race. Patients who indicated that they had EOD in health care indicated less trust in the VA system and lower self-efficacy to communicate with their physician.

Impacts:
Unique characteristics of Veterans hospitalized for a severe condition or of Veterans as a special population may have been just as strong as or stronger than identification with a particular racial group when reporting EOD in healthcare.