Barrier or stressor? The role of discrimination experiences in health service use.
BACKGROUND
Discrimination is a well-established stressor that is substantially associated with poor health and a known contributor to health inequalities. However, the role of discrimination in health service use is less explored. This study will take an intersectional approach to investigate differences in health service use and examine the role of discrimination experiences.


METHODS
Data on health service use were assessed in a diverse inner London sample of 1052 participants in the South East London Community Health (SELCoH) Study. Latent class analysis (LCA) was used to define classes of intersectional social status using multiple indicators of socioeconomic status (SES), ethnicity and migration status. Adjusted associations between intersectional social status and discrimination experiences with health service use indicators are presented.


RESULTS
Using latent class analysis allowed us to identify an intersectional social status characterized by multiple disadvantage that was associated with decreased secondary physical health service use and a class characterized by both privilege and disadvantage that was associated with increased health service use for mental disorder after controlling for age, gender and health status. Anticipated discrimination was also associated with increased service use for mental disorder in adjusted models. There was no evidence to suggest that discrimination experiences were acting as a barrier to health service use.


CONCLUSIONS
This study highlights the complex ways in which discrimination experiences may increase the need for health services whilst also highlighting differences in health service use at the intersection of ethnicity, migration status and SES. Findings from this study illustrate the importance of measuring multiple levels of discrimination and taking an intersectional approach for health service use research.
['Gazard|Billy|B|http://orcid.org/0000-0002-7562-5393', 'Chui|Zoe|Z|', 'Harber-Aschan|Lisa|L|', 'MacCrimmon|Shirlee|S|', 'Bakolis|Ioannis|I|', 'Rimes|Katharine|K|', 'Hotopf|Matthew|M|', 'Hatch|Stephani L|SL|']
D000293:Adolescent D000328:Adult D004641:Emigration and Immigration D005006:Ethnicity D005260:Female D006297:Health Services Accessibility D006801:Humans D008131:London D008297:Male D008875:Middle Aged D010342:Patient Acceptance of Health Care D012923:Social Class D063508:Social Discrimination D013315:Stress, Psychological D055815:Young Adult
Discrimination Health service use Intersectional approaches Community health Epidemiology Population survey