Experienced Discrimination and Medical Mistrust Among Patients with Cirrhosis: Survey Results from a Multicenter Cohort.

IF 12 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Clinical Gastroenterology and Hepatology Pub Date : 2025-10-09 DOI:10.1016/j.cgh.2025.09.038

Nicole E Rich, Jennifer Kramer, Yan Liu, Juana Campos, Lisa Quirk, Donna Smith, Jahna Anyanwu, Amanda Gibbons, Aaron Loewy, Dalal Youssef, Akash Pagadala, Riya Malhorta, Hadley McGhee, Donna White, Meena Tadros, Fasiha Kanwal, Amit G Singal

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引用次数: 0

Abstract

Introduction: Medical mistrust and experiences of discrimination contribute to racial and ethnic disparities in clinical outcomes for several health conditions; however, the prevalence of these constructs remain understudied in patients with cirrhosis.

Methods: We prospectively enrolled patients with cirrhosis to complete surveys at four large U.S. health systems. We administered validated surveys including the Experiences of Discrimination measure and the Group-Based Medical Mistrust Scale (GBMMS). Univariable and multivariable regression models were used to examine associations of race and ethnicity with patient-reported discrimination and medical mistrust.

Results: Among 3357 patients, 1037 (30.9%) completed the survey (43.4% White, 22.4% Black, 30.2% Hispanic; median age 61.3 years, 63.0% men). Overall, 27.1% of patients reported experiencing discrimination and 9.8% reported high medical mistrust (GBMMS ≥3). More Black patients reported frequent discrimination (40.5%) compared to Hispanic (22.2%) and White patients (18.7%) (p<0.001). In multivariable analysis, compared to White race, Black race (OR 4.37, 95%CI 2.49 - 7.67) and Hispanic ethnicity (OR 1.85, 95%CI 1.06 - 3.25) were associated with the top quartile of discrimination scores. Similarly, 22.3% of Black patients reported high mistrust compared to 6.8% and 4.2% of White and Hispanic patients, respectively (p<0.001). Black patients continued to be more likely than White patients to report high mistrust in multivariable models (OR 3.59, 95%CI 2.05 - 6.29). There were no statistically significant associations between higher levels of discrimination or mistrust and the composite outcome of hospitalization, decompensation or death.

Conclusion: Experienced discrimination and medical mistrust are common among Black patients with cirrhosis. Addressing these factors may mitigate racial and ethnic inequities in care, reduce barriers to care and improve outcomes for patients with cirrhosis.

查看原文本刊更多论文

肝硬化患者的经验歧视和医疗不信任：来自多中心队列的调查结果。

导言：医疗不信任和歧视的经历导致了几种健康状况的临床结果的种族和民族差异；然而，这些结构在肝硬化患者中的流行程度仍未得到充分研究。方法：我们前瞻性地招募肝硬化患者完成美国四个大型卫生系统的调查。我们进行了有效的调查，包括歧视经验测量和基于群体的医疗不信任量表（GBMMS）。使用单变量和多变量回归模型来检查种族和民族与患者报告的歧视和医疗不信任的关系。结果：3357例患者中，1037例（30.9%）完成调查，其中白人43.4%，黑人22.4%，西班牙裔30.2%，中位年龄61.3岁，男性63.0%。总体而言，27.1%的患者报告遭受歧视，9.8%的患者报告高度医疗不信任（GBMMS≥3）。黑人患者（40.5%）比西班牙裔患者（22.2%）和白人患者（18.7%）更频繁地遭受歧视。(结论：黑人肝硬化患者普遍存在经历过的歧视和医疗不信任。解决这些因素可以减轻护理中的种族和民族不平等，减少护理障碍，改善肝硬化患者的预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Gastroenterology and Hepatology 医学-胃肠肝病学

CiteScore

16.90

自引率

4.80%

发文量

903

审稿时长

22 days

期刊介绍： Clinical Gastroenterology and Hepatology (CGH) is dedicated to offering readers a comprehensive exploration of themes in clinical gastroenterology and hepatology. Encompassing diagnostic, endoscopic, interventional, and therapeutic advances, the journal covers areas such as cancer, inflammatory diseases, functional gastrointestinal disorders, nutrition, absorption, and secretion. As a peer-reviewed publication, CGH features original articles and scholarly reviews, ensuring immediate relevance to the practice of gastroenterology and hepatology. Beyond peer-reviewed content, the journal includes invited key reviews and articles on endoscopy/practice-based technology, health-care policy, and practice management. Multimedia elements, including images, video abstracts, and podcasts, enhance the reader's experience. CGH remains actively engaged with its audience through updates and commentary shared via platforms such as Facebook and Twitter.