• Sara N Bleich, Mary G Findling, Logan S Casey, Robert J Blendon, John M Benson, Gillian K SteelFisher, Justin M Sayde, and Carolyn Miller.
• Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
• Health Serv Res. 2019 Dec 1; 54 Suppl 2: 1399-1408.

ObjectiveTo examine experiences of racial discrimination among black adults in the United States, which broadly contribute to their poor health outcomes.Data Source And Study DesignData come from a nationally representative, probability-based telephone survey including 802 non-Hispanic black and a comparison group of 902 non-Hispanic white US adults, conducted January-April 2017.MethodsWe calculated the percent of blacks reporting discrimination in several domains, including health care. We used logistic regression to compare the black-white difference in odds of discrimination, and among blacks only to examine variation by socioeconomic status, gender, and neighborhood racial composition.Principal FindingsAbout one-third of blacks (32 percent) reported experiencing discrimination in clinical encounters, while 22 percent avoided seeking health care for themselves or family members due to anticipated discrimination. A majority of black adults reported experiencing discrimination in employment (57 percent in obtaining equal pay/promotions; 56 percent in applying for jobs), police interactions (60 percent reported being stopped/unfairly treated by police), and hearing microaggressions (52 percent) and racial slurs (51 percent). In adjusted models, blacks had significantly higher odds than whites of reporting discrimination in every domain. Among blacks, having a college degree was associated with higher odds of experiencing overall institutional discrimination.ConclusionsThe extent of reported discrimination across several areas of life suggests a broad pattern of discrimination against blacks in America, beyond isolated experiences. Black-white disparities exist on nearly all dimensions of experiences with public and private institutions, including health care and the police. Evidence of systemic discrimination suggests a need for more active institutional interventions to address racism in policy and practice.© 2019 The Authors. Health Services Research published by Wiley Periodicals, Inc. on behalf of Health Research and Educational Trust.

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