Health Care Discrimination and Delays in Patients With Diabetes and Hypertension (All of Us AoU Study)

Flashcards covering definitions, key results, and implications from the JAMA Network Open study on perceived discrimination, PCC, and delays in care among adults with diabetes and/or hypertension.

What does PDHS stand for and how is it defined in this study?

Perceived discrimination in health care settings; experiences of being treated unfairly based on characteristics such as race, ethnicity, and age in health care interactions.

What is the primary outcome measured in this study?

Delaying health care due to nervousness about seeing a health care professional.

How is PCC defined and measured in this study?

Patient-clinician communication (PCC); assessed with two questions on shared decision-making and clarity of information, using a mean score where higher values indicate poorer communication.

Who were the participants and how large was the sample?

Adults 18+ with type 2 diabetes and/or hypertension from the All of Us Research Program; N = 25,851.

What statistical approach was used to test mediation and moderation?

Structural equation modeling with moderated mediation; PCC as a mediator and age and race/ethnicity as moderators.

What are the key SEM path coefficients for the PDHS → PCC → delays pathway?

a1 (PDHS → PCC) = 0.33; b (PCC → delays) = 0.25; c (direct PDHS → delays) = 0.35.

What is the direct effect of PDHS on health care delays reported in the study?

β = 0.35 (95% CI, 0.27–0.43); P < .001.

What does the indirect (mediated) pathway via PCC consist of in terms of coefficients?

PCC mediates the effect with a1 = 0.33 and b = 0.25, so the indirect effect is a1 × b (0.33 × 0.25).

Which age group showed the largest mediation proportion overall?

Adults aged 18 to 44 years, with mediation proportions highest across racial/ethnic groups.

Which race/ethnicity group consistently shows the largest mediation proportions across age groups?

Hispanic participants; for example 18–44: 20.3%, 45–64: 17.9%, ≥65: 14.7%.

What are the study’s main racial/ethnic categories and the sample’s composition?

Categories: Black (9.5%), Hispanic (6.3%), White (81.3%), Other (2.9%); most participants self-identified as White.

How are the PDHS and PCC scales scored, and what do higher scores indicate?

PDHS: 7-item scale (Likert 1–5 per item); higher scores indicate more discrimination. PCC: 2-item scale (0–4); higher scores indicate poorer communication.

What limitations did the authors acknowledge?

Cross-sectional design; potential response bias; convenience sampling; generalizability limited to people with diabetes/hypertension; possible unmeasured confounding.

What practical implication do the authors highlight?

Improving patient-clinician communication may reduce health care delays due to nervousness related to perceived discrimination, especially for younger and racial/ethnic minority patients.

What is the data source and study period?

All of Us Research Program data; online surveys from 2017 to 2022; analysis completed in 2024; STROBE-guided cross-sectional study.

What percentage of the sample reported delaying care due to nervousness about seeing a health care professional?

8.9% (n = 2300 of 25,851 participants).

What were the mean age and gender distribution of the sample?

Mean age 62.4 years; 58.1% identified as women; 41.3% as men; 0.5% nonbinary/other.