Racial and Gender Disparities in Diagnosis of Malingering in Clinical Settings

Purpose A malingering diagnosis can have consequences for patient care in the emergency room, hospital, and outpatient settings. Use of this diagnosis along racial and gender demographics has not been explored in clinical settings. Objective To determine any differences in socio-demographic characteristics among patients diagnosed with malingering in non-psychiatric inpatient hospitals and emergency departments in the USA. Methods The National Inpatient Sample (NIS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) databases were utilized to identify a malingering diagnosis from 2003 to 2015. Racial, ethnic, and gender disparities were examined. Results The malingering diagnosis is prevalent in 0.1% of both settings. The diagnosis is more prevalent in men than women. Among inpatients, malingering diagnosis was twice as prevalent among blacks compared with whites. The adjusted OR showed similar likelihood among blacks and whites with Hispanic men having the lowest likelihood for the diagnosis. Black women were slightly more likely, while Hispanic women were less likely to be diagnosed than white women. In ED settings, whites had the highest prevalence and a higher adjusted OR for malingering diagnosis compared with other races. There was no gender difference. Conclusion The racial demographics of malingering diagnosis differ between clinical settings. Blacks may have a higher risk to receive the diagnosis as inpatients, whereas whites may have a higher risk in EDs. Hispanics have the lowest likelihood of the diagnosis in both settings. This data suggests a complex, multi-layered phenomenon highlighting how patients are diagnosed with malingering.