Perceived medical discrimination in American Indian women: Effect on health care decisions, cancer screening, diabetes services and diabetes management

Kelly L. Gonzales
College of Public Health and Human Sciences, Oregon State University
June, 2010


American Indians and Alaska Natives have disproportionately high rates of diabetes, and it is not known if perceived medical discrimination is associated with diabetes health measures and poorer health for this population. This study examined the effect of perceived medical discrimination (PMD) in American Indian women on health care decisions, cancer screening, diabetes services, and diabetes control. The study investigated the performance of well-known PMD measures, reported prevalence and correlates of PMD, association of PMD with the receipt of cancer screening, standard Indian Health Service (IHS) diabetes care services and diabetes control measures. Survey and medical records data were collected from 270 AI women whose primary medical care is from Northwest Indian health care facilities. Medical data on receipt of 13 IHS minimum standards of care and 3 clinical values were collected from the Resource Patient Management System and used to assess diabetes control. Race-PMD was assessed using a validated multi-item scale. Logistic regression was performed using Generalized Estimating Equations. Three PMD scales tested in our study had high internal reliability (?=0.85, 0.90, and 0.94). Prevalence of PMD was 4 to 6.5 times greater than that previously reported. Race-based PMD was significantly associated with negative health care decisions, including postponing needed medical care, delaying or foregoing follow-up care, avoiding getting care at the facility, and not following medical advice. Race-based PMD was significantly associated with AI women not being up-to-date on clinical breast exams (OR 2.56), pap tests (OR 2.67) and mammography (OR 1.61). Respondents reporting race-PMD were significantly more likely to not be current on IHS standards of diabetes care for annual dental exams and testing for creatinine, total cholesterol, and HDL, and had a 49% increased likelihood of receiving fewer standard diabetes care services (?6). The study found no significant association between race-PMD and diabetes control measures. Race-PMD may be a barrier to medical care utilization by influencing AI womens' health care decisions to postpone and delay needed medical care. These findings have implications for health-care centered efforts and policies to address and eliminate the health disparities of diabetes, as well as cancer, within this population.