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
{"title":"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。","authors":"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","doi":"10.1016/j.cgh.2025.09.038","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":12.0000,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Experienced Discrimination and Medical Mistrust Among Patients with Cirrhosis: Survey Results from a Multicenter Cohort.\",\"authors\":\"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\",\"doi\":\"10.1016/j.cgh.2025.09.038\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>\",\"PeriodicalId\":10347,\"journal\":{\"name\":\"Clinical Gastroenterology and Hepatology\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":12.0000,\"publicationDate\":\"2025-10-09\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical Gastroenterology and Hepatology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.cgh.2025.09.038\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"GASTROENTEROLOGY & HEPATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Gastroenterology and Hepatology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.cgh.2025.09.038","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
Experienced Discrimination and Medical Mistrust Among Patients with Cirrhosis: Survey Results from a Multicenter Cohort.
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.
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.
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