Limits...
Discrimination based on criminal record and healthcare utilization among men recently released from prison: a descriptive study.

Frank JW, Wang EA, Nunez-Smith M, Lee H, Comfort M - Health Justice (2014)

Bottom Line: Healthcare discrimination based on race/ethnicity is associated with decreased healthcare access and utilization among racial/ethnic minority patients.Participants who reported discrimination were older (mean, 42 vs. 39 years; p = .01), more likely to be college educated (26% vs. 11%; p = .03), and had more extensive incarceration histories (median years incarcerated, 16 vs. 9; p = .002) compared to those who did not report discrimination.Self-reported criminal record discrimination by healthcare workers was significantly associated with frequent ED utilization [odds ratio (OR) = 2.7, 95% confidence interval 24 (CI) 1.2-6.2] but not infrequent primary care utilization [OR = 1.6, 95% CI 0.7-3.8].

View Article: PubMed Central - PubMed

Affiliation: Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, US ; Denver Veterans Affairs Medical Center, Denver, CO, USA.

ABSTRACT

Background: Healthcare discrimination based on race/ethnicity is associated with decreased healthcare access and utilization among racial/ethnic minority patients. Discrimination based on criminal record may also negatively impact healthcare access and utilization among ex-prisoners.

Methods: We conducted a secondary analysis of data from a cross-sectional survey of 172 men recently released from state prison. We examined the association between self-reported criminal record discrimination by healthcare workers and utilization of 1) emergency department (ED) and 2) primary care services. We created staged logistic regression models, adjusting for sociodemographic characteristics and self-reported racial/ethnic discrimination.

Results: Among 172 male participants, 42% reported a history of criminal record discrimination by healthcare workers. Participants who reported discrimination were older (mean, 42 vs. 39 years; p = .01), more likely to be college educated (26% vs. 11%; p = .03), and had more extensive incarceration histories (median years incarcerated, 16 vs. 9; p = .002) compared to those who did not report discrimination. Self-reported criminal record discrimination by healthcare workers was significantly associated with frequent ED utilization [odds ratio (OR) = 2.7, 95% confidence interval 24 (CI) 1.2-6.2] but not infrequent primary care utilization [OR = 1.6, 95% CI 0.7-3.8].

Conclusions: Recently released prisoners report criminal record discrimination by healthcare workers, and this experience may impact healthcare utilization. Future studies should seek to further characterize criminal record discrimination by healthcare workers and prospectively examine its impact on health outcomes.

No MeSH data available.


Related in: MedlinePlus

Healthcare utilization stratified by self-reported criminal record and racial/ethnic discrimination by healthcare workersED = Emergency Department. P values represent pairwise comparisons using chi-square test. Groups are mutually exclusive.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4308970&req=5

Figure 1: Healthcare utilization stratified by self-reported criminal record and racial/ethnic discrimination by healthcare workersED = Emergency Department. P values represent pairwise comparisons using chi-square test. Groups are mutually exclusive.

Mentions: In unadjusted analyses, self-reported criminal record discrimination by healthcare workers was significantly associated with frequent ED utilization (37% vs. 16%%; p = .002) but not with infrequent primary care utilization (30% vs. 24%%; p = .39). Reported utilization did not differ among participants who also reported racial/ethnic discrimination by healthcare workers compared to those who reported criminal record discrimination only (Figure 1). Model 1 presents these unadjusted associations as crude odds ratios for criminal record discrimination (Table 2). In multivariable analyses adjusting for sociodemographic and correctional characteristics (Model 2), self-reported criminal record discrimination by healthcare workers remained significantly associated with frequent ED utilization (odds ratio [OR] 2.7, 95% confidence interval [CI] 1.2–5.8) but not infrequent primary care utilization (OR 2.1, 95% CI 0.9–4.5). In Model 3, the association between criminal record discrimination by healthcare workers and frequent ED utilization (OR 2.7, 95% CI 1.1–6.3) was not attenuated by adjustment for self-reported racial/ethnic discrimination and the interaction between the two forms of self-reported discrimination. Of note, racial/ethnic discrimination by healthcare workers was significantly associated with infrequent primary care utilization (OR 2.5, 95% CI 1.1–5.8) but not frequent ED utilization.


Discrimination based on criminal record and healthcare utilization among men recently released from prison: a descriptive study.

Frank JW, Wang EA, Nunez-Smith M, Lee H, Comfort M - Health Justice (2014)

Healthcare utilization stratified by self-reported criminal record and racial/ethnic discrimination by healthcare workersED = Emergency Department. P values represent pairwise comparisons using chi-square test. Groups are mutually exclusive.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4308970&req=5

Figure 1: Healthcare utilization stratified by self-reported criminal record and racial/ethnic discrimination by healthcare workersED = Emergency Department. P values represent pairwise comparisons using chi-square test. Groups are mutually exclusive.
Mentions: In unadjusted analyses, self-reported criminal record discrimination by healthcare workers was significantly associated with frequent ED utilization (37% vs. 16%%; p = .002) but not with infrequent primary care utilization (30% vs. 24%%; p = .39). Reported utilization did not differ among participants who also reported racial/ethnic discrimination by healthcare workers compared to those who reported criminal record discrimination only (Figure 1). Model 1 presents these unadjusted associations as crude odds ratios for criminal record discrimination (Table 2). In multivariable analyses adjusting for sociodemographic and correctional characteristics (Model 2), self-reported criminal record discrimination by healthcare workers remained significantly associated with frequent ED utilization (odds ratio [OR] 2.7, 95% confidence interval [CI] 1.2–5.8) but not infrequent primary care utilization (OR 2.1, 95% CI 0.9–4.5). In Model 3, the association between criminal record discrimination by healthcare workers and frequent ED utilization (OR 2.7, 95% CI 1.1–6.3) was not attenuated by adjustment for self-reported racial/ethnic discrimination and the interaction between the two forms of self-reported discrimination. Of note, racial/ethnic discrimination by healthcare workers was significantly associated with infrequent primary care utilization (OR 2.5, 95% CI 1.1–5.8) but not frequent ED utilization.

Bottom Line: Healthcare discrimination based on race/ethnicity is associated with decreased healthcare access and utilization among racial/ethnic minority patients.Participants who reported discrimination were older (mean, 42 vs. 39 years; p = .01), more likely to be college educated (26% vs. 11%; p = .03), and had more extensive incarceration histories (median years incarcerated, 16 vs. 9; p = .002) compared to those who did not report discrimination.Self-reported criminal record discrimination by healthcare workers was significantly associated with frequent ED utilization [odds ratio (OR) = 2.7, 95% confidence interval 24 (CI) 1.2-6.2] but not infrequent primary care utilization [OR = 1.6, 95% CI 0.7-3.8].

View Article: PubMed Central - PubMed

Affiliation: Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, US ; Denver Veterans Affairs Medical Center, Denver, CO, USA.

ABSTRACT

Background: Healthcare discrimination based on race/ethnicity is associated with decreased healthcare access and utilization among racial/ethnic minority patients. Discrimination based on criminal record may also negatively impact healthcare access and utilization among ex-prisoners.

Methods: We conducted a secondary analysis of data from a cross-sectional survey of 172 men recently released from state prison. We examined the association between self-reported criminal record discrimination by healthcare workers and utilization of 1) emergency department (ED) and 2) primary care services. We created staged logistic regression models, adjusting for sociodemographic characteristics and self-reported racial/ethnic discrimination.

Results: Among 172 male participants, 42% reported a history of criminal record discrimination by healthcare workers. Participants who reported discrimination were older (mean, 42 vs. 39 years; p = .01), more likely to be college educated (26% vs. 11%; p = .03), and had more extensive incarceration histories (median years incarcerated, 16 vs. 9; p = .002) compared to those who did not report discrimination. Self-reported criminal record discrimination by healthcare workers was significantly associated with frequent ED utilization [odds ratio (OR) = 2.7, 95% confidence interval 24 (CI) 1.2-6.2] but not infrequent primary care utilization [OR = 1.6, 95% CI 0.7-3.8].

Conclusions: Recently released prisoners report criminal record discrimination by healthcare workers, and this experience may impact healthcare utilization. Future studies should seek to further characterize criminal record discrimination by healthcare workers and prospectively examine its impact on health outcomes.

No MeSH data available.


Related in: MedlinePlus