Discrimination and intersecting inequities to healthcare access among refugee newcomers in the United States

Abstract

Background: Refugee newcomers in the United States experience pronounced disparities in healthcare access, shaped not only by individual-level or material constraints but also by systemic and structural inequities. Perceived discrimination, particularly when compounded by intersecting identities such as race and sex, may significantly influence these access barriers. This study investigates the relationship between perceived discrimination and healthcare access barriers among resettled refugees, examining whether this relationship is statistically associated with biological sex and moderated by race and sex. Methods: Data were drawn from the nationally representative Annual Survey of Refugees (2020–2022), comprising 4,246 respondents. Healthcare access barriers were operationalized as a continuous index of self-reported obstacles to care. Negative binomial regression was used to estimate the association between perceived discrimination and healthcare barriers, adjusting for demographic, socioeconomic, and health-related covariates. Blinder-Oaxaca decomposition quantified the explained and unexplained components of disparity in barriers by discrimination status. A mediation model assessed whether perceived discrimination functioned as an intermediate variable linking sex to healthcare barriers, and a three-way interaction model (Discrimination × Race × Sex) evaluated intersectional moderation effects. Results: Perceived discrimination emerged as the strongest independent predictor of healthcare barriers, even after adjusting for English proficiency, financial hardship, and physical health. Refugees reporting discrimination faced significantly higher barriers (mean difference = 0.56, p