Affordability, negative experiences, perceived racism, and health care system distrust among black American women aged 45 and over

Black Americans (AA) face a confluence of challenges when seeking care including unaffordable costs, negative experiences with providers, racism, and distrust in the healthcare system. This study utilized l inear regressions and mediation analysis to explore the interconnectedness of these challenges within a community-based sample of 313 AA women aged 45 and older. Approximately 23% of participants reported affordability problems, while 44% had a negative experience with a provider. In the initial linear regression model excluding perceived racism, higher levels of distrust were observed among women reporting affordability problems (beta = 2.66; p = 0.003) or negative experiences with a healthcare provider (beta = 3.02; p = <0.001). However, upon including perceived racism in the model, it emerged as a significant predictor of distrust (beta = 0.81; p = < 0.001), attenuating the relationships between affordability and distrust (beta = 1.74; p = 0.030) and negative experience with a provider and distrust (beta = 1.79; p = 0.009). Mediation analysis indicated that perceived racism mediated approximately 35% and 41% of the relationships between affordability and distrust and negative experience with a provider and distrust, respectively. These findings underscore the critical imperative of addressing racism in the efforts to mitigate racial disparities in healthcare. Future research should explore the applicability of these findings to other marginalized populations.