Everyday Discrimination and Health Care Utilization Among US Adults

Importance: Everyday discrimination, defined as repeated exposure to subtle slights and unfair treatment, has been reported to be associated with adverse health outcomes, but its association with health care use remains incompletely understood. Objective: To examine the association between everyday discrimination and health care use among US adults. Design, Setting, and Participants: This cross-sectional study included 27 384 National Health Interview Survey respondents 18 years and older who completed the Everyday Discrimination Scale (EDS) in 2023. Statistical analysis was performed from August to October 2025. Exposure: Everyday discrimination was measured using the validated 5-item EDS, with composite scores ranging from 0 to 20 (higher scores indicate greater discrimination). Main Outcomes and Measures: Four categories of binary, self-reported health care outcomes across multiple timeframes were examined: delayed or forgone care, health care visits, cancer screenings, and vaccinations and other preventive screenings. Adjusted odds ratios (AORs) and 95% CIs were estimated using survey-weighted logistic regression, adjusted for demographic, socioeconomic, geographic, and clinical covariates. Results: The sample included 27 384 adults (mean [SD] age, 48.1 [18.5] years; 51.2% female [weighted percentage]). The mean (SD) EDS score was 2.48 (3.34). Higher EDS scores were associated with increased odds of cost-related barriers to medical care (AOR per 1-point increase, 1.13; 95% CI, 1.11-1.15) and prescription medications (AOR, 1.14; 95% CI, 1.12-1.16). Higher scores were also associated with greater use of emergency department visits (AOR, 1.05; 95% CI, 1.04-1.06), urgent care (AOR, 1.05; 95% CI, 1.04-1.06) but lower odds of physician visits (AOR, 0.97; 95% CI, 0.96-0.99) and dental visits (AOR, 0.98; 95% CI, 0.97-0.99). Everyday discrimination was associated with lower engagement in cholesterol testing (AOR, 0.96; 95% CI, 0.95-0.97) and diabetes screening (AOR, 0.97; 95% CI, 0.96-0.98). Conclusions and Relevance: In this cross-sectional study of 27 384 US adults, higher everyday discrimination scores were associated with higher reliance on emergency services and lower engagement with preventive care. Interventions addressing interpersonal and structural forms of discrimination, including culturally responsive care, implicit bias training, patient navigation programs, and expanded primary care access, are essential to reduce discrimination's impact on health care use and outcomes.