Asian American Self-Reported Discrimination in Healthcare and Having a Usual Source of Care

Background: Self-reported racial or ethnic discrimination in a healthcare setting has been linked to worse health outcomes and not having a usual source of care, but has been rarely examined among Asian ethnic subgroups. Objective: We examined the association between Asian ethnic subgroup and self-reported discrimination in a healthcare setting, and whether both factors were associated with not having a usual source of care. Design: Using the California Health Interview Survey (CHIS) 2015–2017, we used logistic regression models to assess associations among Asian ethnic subgroup, self-reported discrimination, and not having a usual source of care. Interactions between race and self-reported discrimination, foreign-born status, poverty level, and limited English proficiency were also analyzed. Participants: Respondents represented adults age 18 + residing in California who identified as White, Black, Hispanic, American Indian/Alaska Native, Asian (including Chinese, Filipino, Japanese, Korean, Vietnamese, and Other Asian), and Other. Main Measures: We examined two main outcomes: self-reported discrimination in a healthcare setting and having a usual source of care. Key Results: There were 62,965 respondents. After survey weighting, Asians (OR 1.78, 95% CI 1.19–2.66) as an aggregate group were more likely to report discrimination than non-Hispanic Whites. When Asians were disaggregated, Japanese (3.12, 1.36–7.13) and Koreans (2.42, 1.11–5.29) were more likely to report discrimination than non-Hispanic Whites. Self-reported discrimination was marginally associated with not having a usual source of care (1.25, 0.99–1.57). Koreans were the only group associated with not having a usual source of care (2.10, 1.23–3.60). Foreign-born Chinese (ROR 7.42, 95% CI 1.7–32.32) and foreign-born Japanese (ROR 4.15, 95% CI 0.82–20.95) were more associated with self-reported discrimination than being independently foreign-born and Chinese or Japanese. Conclusions: Differences in self-reported discrimination in a healthcare setting and not having a usual source of care were observed among Asian ethnic subgroups. Better understanding of these differences in their sociocultural contexts will guide interventions to ensure equitable access to healthcare.