Perceived discrimination and refraining from seeking physician's care in Sweden : an intersectional analysis of individual heterogeneity and discriminatory accuracy (AIHDA)
Hassan, Mariam LU
; Öberg, Johan
LU
; Wemrell, Maria
LU
; Perez Vicente, Raquel
LU
; Lindström, Martin
LU
and Merlo, Juan
LU
(2024)
In International Journal for Equity in Health
23.
- Abstract
BACKGROUND: Discrimination may further impede access to medical care for individuals in socially disadvantaged positions. Sociodemographic information and perceived discrimination intersect and define multiple contexts or strata that condition the risk of refraining from seeking physician's care. By applying analysis of individual heterogeneity and discriminatory accuracy (AIHDA) we aimed to improve the mapping of risk by considering both strata average risk differences and the accuracy of such strata risks for distinguishing between individuals who did or did not refrain from seeking physician's care.
METHODS: We analysed nine annual National Public Health Surveys (2004, 2007-2014) in Sweden including 73,815 participants. We... (More)
BACKGROUND: Discrimination may further impede access to medical care for individuals in socially disadvantaged positions. Sociodemographic information and perceived discrimination intersect and define multiple contexts or strata that condition the risk of refraining from seeking physician's care. By applying analysis of individual heterogeneity and discriminatory accuracy (AIHDA) we aimed to improve the mapping of risk by considering both strata average risk differences and the accuracy of such strata risks for distinguishing between individuals who did or did not refrain from seeking physician's care.
METHODS: We analysed nine annual National Public Health Surveys (2004, 2007-2014) in Sweden including 73,815 participants. We investigated the risk of refraining from seeking physician's care across 64 intersectional strata defined by sex, education, age, country of birth, and perceived discrimination. We calculated strata-specific prevalences and prevalence ratios (PR) with 95% confidence intervals (CI), and the area under the receiver operating characteristic curve (AUC) to evaluate the discriminatory accuracy (DA).
RESULTS: Discriminated foreign-born women aged 35-49 with a low educational level show a six times higher risk (PR = 6.07, 95% CI 5.05-7.30) than non-discriminated native men with a high educational level aged 35-49. However, the DA of the intersectional strata was small (AUC = 0.64). Overall, discrimination increased the absolute risk of refraining from seeking physician's care, over and above age, sex, and educational level.
CONCLUSIONS: AIHDA disclosed complex intersectional inequalities in the average risk of refraining from seeking physician's care. This risk was rather high in some strata, which is relevant from an individual perspective. However, from a population perspective, the low DA of the intersectional strata suggests that potential interventions to reduce such inequalities should be universal but tailored to the specific contextual characteristics of the strata. Discrimination impairs access to healthcare.
(Less)
- author
- Hassan, Mariam
LU
; Öberg, Johan
LU
; Wemrell, Maria
LU
; Perez Vicente, Raquel
LU
; Lindström, Martin
LU
and Merlo, Juan
LU
- organization
- publishing date
- 2024-10-05
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Access to medical care, Health inequities, Intersectionality, Perceived discrimination, Social determinants of health, Sweden
- in
- International Journal for Equity in Health
- volume
- 23
- article number
- 199
- publisher
- BioMed Central (BMC)
- external identifiers
-
- scopus:85205802318
- pmid:39367379
- ISSN
- 1475-9276
- DOI
- 10.1186/s12939-024-02291-4
- language
- English
- LU publication?
- yes
- additional info
- © 2024. The Author(s).
- id
- 3e59b393-4f08-41e1-91cf-bccf8a95de0a
- date added to LUP
- 2024-10-08 09:24:57
- date last changed
- 2025-06-12 07:04:55
@article{3e59b393-4f08-41e1-91cf-bccf8a95de0a,
abstract = {{<p>BACKGROUND: Discrimination may further impede access to medical care for individuals in socially disadvantaged positions. Sociodemographic information and perceived discrimination intersect and define multiple contexts or strata that condition the risk of refraining from seeking physician's care. By applying analysis of individual heterogeneity and discriminatory accuracy (AIHDA) we aimed to improve the mapping of risk by considering both strata average risk differences and the accuracy of such strata risks for distinguishing between individuals who did or did not refrain from seeking physician's care.</p><p>METHODS: We analysed nine annual National Public Health Surveys (2004, 2007-2014) in Sweden including 73,815 participants. We investigated the risk of refraining from seeking physician's care across 64 intersectional strata defined by sex, education, age, country of birth, and perceived discrimination. We calculated strata-specific prevalences and prevalence ratios (PR) with 95% confidence intervals (CI), and the area under the receiver operating characteristic curve (AUC) to evaluate the discriminatory accuracy (DA).</p><p>RESULTS: Discriminated foreign-born women aged 35-49 with a low educational level show a six times higher risk (PR = 6.07, 95% CI 5.05-7.30) than non-discriminated native men with a high educational level aged 35-49. However, the DA of the intersectional strata was small (AUC = 0.64). Overall, discrimination increased the absolute risk of refraining from seeking physician's care, over and above age, sex, and educational level.</p><p>CONCLUSIONS: AIHDA disclosed complex intersectional inequalities in the average risk of refraining from seeking physician's care. This risk was rather high in some strata, which is relevant from an individual perspective. However, from a population perspective, the low DA of the intersectional strata suggests that potential interventions to reduce such inequalities should be universal but tailored to the specific contextual characteristics of the strata. Discrimination impairs access to healthcare.</p>}},
author = {{Hassan, Mariam and Öberg, Johan and Wemrell, Maria and Perez Vicente, Raquel and Lindström, Martin and Merlo, Juan}},
issn = {{1475-9276}},
keywords = {{Access to medical care; Health inequities; Intersectionality; Perceived discrimination; Social determinants of health; Sweden}},
language = {{eng}},
month = {{10}},
publisher = {{BioMed Central (BMC)}},
series = {{International Journal for Equity in Health}},
title = {{Perceived discrimination and refraining from seeking physician's care in Sweden : an intersectional analysis of individual heterogeneity and discriminatory accuracy (AIHDA)}},
url = {{http://dx.doi.org/10.1186/s12939-024-02291-4}},
doi = {{10.1186/s12939-024-02291-4}},
volume = {{23}},
year = {{2024}},
}