State-Level Sexism and Women's Health Care Access in the United States: Differences by Race/Ethnicity, 2014-2019.

Abstract

<b>Objectives.</b> To quantify racial/ethnic differences in the relationship between state-level sexism and barriers to health care access among non-Hispanic White, non-Hispanic Black, and Hispanic women in the United States. <b>Methods.</b> We merged a multidimensional state-level sexism index compiled from administrative data with the national Consumer Survey of Health Care Access (2014-2019; n = 10 898) to test associations between exposure to state-level sexism and barriers to access, availability, and affordability of health care. <b>Results.</b> Greater exposure to state-level sexism was associated with more barriers to health care access among non-Hispanic Black and Hispanic women, but not non-Hispanic White women. Affordability barriers (cost of medical bills, health insurance, prescriptions, and tests) appeared to drive these associations. More frequent need for care exacerbated the relationship between state-level sexism and barriers to care for Hispanic women. <b>Conclusions.</b> The relationship between state-level sexism and women's barriers to health care access differs by race/ethnicity and frequency of needing care. <b>Public Health Implications.</b> State-level policies may be used strategically to promote health care equity at the intersection of gender and race/ethnicity. (<i>Am J Public Health</i>. 2021;111(10):1796-1805. https://doi.org/10.2105/AJPH.2021.306455).