Association between racial discrimination and delayed or forgone care amid the COVID-19 pandemic

Elsevier, Preventive Medicine, Volume 162, September 2022
Zhang D., Li G., Shi L., Martin E., Chen Z., Li J. et al.

Racial discrimination has intensified in the U.S. during the COVID-19 pandemic, but how it disrupted healthcare is largely unknown. This study investigates the association of racial discrimination with delaying or forgoing care during the pandemic based on data from a nationally representative survey, the Health, Ethnicity and Pandemic (HEAP) study (n = 2552) conducted in October 2020 with Asians, Hispanics and non-Hispanic Blacks oversampled. Racial discrimination during the pandemic was assessed in three domains: experienced racial discrimination, race-related cyberbullying, and Coronavirus racial bias beliefs. Respondents answered whether they had delayed or forgone any type of healthcare due to the pandemic. Overall, 63.7% of respondents reported delaying or forgoing any healthcare during the pandemic. About 20.3% East/Southeast Asians, 18.6% non-Hispanic Blacks and 15.9% Hispanics reported experiences of racial discrimination, compared with 2.8% of non-Hispanic Whites. Experienced racial discrimination was associated with delaying/forgoing care among non-Hispanic Blacks (Adjusted odds ratios[AOR] = 4.58, 95% confidence interval[CI]: 2.22–9.45), Hispanics (AOR = 3.88, 95%CI: 1.51–9.98), and East/Southeast Asians (AOR = 2.14, 95%CI: 1.22–3.77). Experiencing race-related cyberbullying was significantly associated with delaying/forgoing care among non-Hispanic Blacks (AOR = 1.34, 95%CI: 1.02–1.77) and East/Southeast Asians (AOR = 1.51, 95%CI: 1.19–1.90). Coronavirus racial bias was significantly associated with delaying/forgoing care among East/Southeast Asians (AOR = 1.55, 95%CI: 1.16–2.07). The three domains of racial discrimination were consistently associated with delayed or forgone health care among East/Southeast Asians during the COVID-19 pandemic; some of the associations were also seen among non-Hispanic Blacks and Hispanics. These results demonstrate that addressing racism is important for reducing disparities in healthcare delivery during the pandemic and beyond.