Intersectional inequalities in interpersonal discrimination in outpatient care according to sex, history of migration, and income in Germany

Experiences of interpersonal discrimination in outpatient care (e.g. being treated disrespectfully) are a frequent phenomenon in Germany and in other countries. It can be expected that such experiences contribute to the production and perpetuation of health inequalities.

We explored intersectional inequalities in interpersonal discrimination in outpatient care according to sex, history of migration, and income. Analyses were based on an online survey in a random sample of the adult population in Germany (n = 3.246). A modified version of the Everyday Discrimination Scale was used to assess frequencies of interpersonal discrimination experiences in outpatient care. Sex, history of migration, and net income were considered as indicators of social inequalities. Intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) was conducted.

Analyses showed significantly higher frequencies of interpersonal discrimination experiences for females and respondents with a low income while associations with migration history were not significant. Social inequalities in discrimination experiences were attributable to additive (and not multiplicative) effects of sex, migration history, and income, with sex contributing most and migration history least to these inequalities. Analyses across the 18 intersectional strata (combining subgroups of sex, income, and migration history) revealed significant differences in frequencies of discrimination experiences between the most (female second-generation migrants with low income) and least affected strata (men with high income and no migration history).

As such discrimination experiences can result in reduced health care engagement and adverse health outcomes, these findings point to an important public health issue.