The Link Between Perceived Racism and Health Services Utilization Among Older Adults: An Analysis of Commonwealth Fund's 2021 International Health Policy Survey

Objectives: To understand the link between perceived racial/ethnic discrimination among older adults and 2 health service utilization processes: (1) visiting health care providers or emergency room (ER), and (2) repeated visits after the first encounter. Methods: Analysis of 2021 Commonwealth Fund International Health Policy Survey of Older Adults - a nationally representative, self-reported, and cross-sectional survey from Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, the United Kingdom, and the United States. We used a 2-part multivariable hurdle model. Results: Perceived discrimination was associated with 18% reduced odds of visiting at least 1 primary care provider (OR: 0.82; 95% CI: 0.68-0.99). Among those who have visited at least 1 provider, those who perceived discrimination were more likely to visit different providers when compared with those who did not (RR: 1.06; 95% CI: 1.01-1.11). Perceived racism was associated with first (OR: 1.13; 95% CI: 1.01-1.27) and frequent (RR: 1.14; 95% CI: 1.01-1.29) ER visits. Conclusions: Perceived racial discrimination is linked with higher health service utilization among older adults in high-income countries. Policy Implications: A multilevel policy response that includes workforce sensitization and diversification, system transparency and accountability, and addressing structural barriers to accessing health care is warranted.