Exploring sociodemographic disparities in diagnostic problems and mistakes in the quest for diagnostic equity: insights from a national survey of patient experiences.

Abstract

Introduction: As part of building a platform for epidemiological research on diagnostic errors and problems that centers on patients and equity, this paper summarizes the development and analysis of data collected from fielding a survey in a nationally representative U.S. population to explore the prevalence and harm consequences of diagnostic problems or mistakes (referred to here as "diagnostic P&Ms") by respondent-reported sociodemographic characteristics.

Methods: We applied narrative elicitation methods to enhance the rigor of implementing a novel survey about diagnostic experiences. We conducted a U.S. population-based survey of a nationally representative sample in 2022-2023, drawn from the NORC AmeriSpeak® panel. We conducted multivariate regression analysis at the household level and in a patient subsample to explore sociodemographic predictors of diagnostic P&Ms and related outcomes in the aftermath.

Results: The comparative analysis by sociodemographic characteristics estimates prevalence of diagnostic P&Ms, prevalence of persisting harms, rate of respondent-reported perceptions of personal attribute adversely affecting diagnosis, and concern about future diagnostic P&Ms. Outcome estimates ranged from about 4% (concern about future diagnostic P&M) to 38% (at least one P&M in households during the past 4 years). Several sociodemographic groups experienced statistically significant higher levels of risk for these outcomes, with some at greater than twice the odds compared to reference groups-transgender and gender independent individuals (e.g., 5 + -fold odds of expectation of future P&M compared to cis-males), cis-females (e.g., greater than 1.5 odds of persistent physical and emotional harms compared to cis-males), low household income (e.g., twice the likelihood of multiple P&Ms for incomes under $60 K compared to $100 K+ households), younger age (3-fold odds of at least one diagnostic P&M for those under 25 years old compared to those aged 45-54), multiracial individuals (about twice the odds of diagnostic P&Ms compared to non-Hispanic White), and disabled and unable to work full-time (more than twice the likelihood of perceiving that a personal attribute impaired diagnosis compared to those with other work status designations).

Discussion: This new survey and accompanying data source facilitate an enriched exploration of the patterns of diagnostic disparities and points of leverage through which diagnostic experiences can be made more equitable.