Predictors of Healthcare Avoidance for Black Men and Women

Background and Purpose: Racial disparities in overall health outcomes for Black females and males has been linked to health care utilization stemming from barriers to care—such as social determinants of health, racism, and bias. However, scant research exists exploring the extent to which intersecting factors shape healthcare utilization for Black individuals. Our study examined the self-reported impact of race, sex, SES, and body size on perceived treatment by healthcare providers, and whether these factors, individually and intersectionally, predict healthcare avoidance among Black individuals in large body sizes in the US.

Methods: Data for the study were collected using the Prolific platform between October 27, 2025, and November 19, 2025, using a cross-sectional survey. The sample included US citizens who were English speakers, identified as Black, aged 35 or older, and who self-reported a body mass index (BMI) of 25 or higher. Our sample (N = 473) was primarily female (n = 371, 79.8%) and had a mean age of 48.67 (SD = 9.85, range = 35-81). Descriptive statistics were computed to examine perceptions of the influence of social and structural factors on treatment by healthcare providers. Additionally, logistic regression analyses were completed to examine independent and intersectional relationships between social and structural factors on healthcare avoidance. Independent variables included sex (male/female), SES (Financial Strain Index; Hamby et al, 2011), and BMI (continuous); the dependent variable was ever avoiding healthcare (yes/no).

Results: Nearly half of participants (49.3%) reported a belief that race influenced how they were treated by healthcare providers. Approximately one‑fourth indicated that their weight (28.1%), age (25.4%), or gender (25.2%) shaped their treatment, while one‑third (34.2%) reported no differential treatment. Notably, almost one‑third (31.7%) reported experiencing differential treatment “often” or “always” based on their race, followed by weight (20.3%) and gender (15.9%). Intersectional analyses revealed no significant interaction effects (p = .876). However, each factor independently predicted healthcare avoidance. Females were more likely than males (OR = 0.51, CI = 0.29,0.87, p = .014) to avoid care, individuals experiencing greater financial strain were more likely to avoid care (OR = 0.61, CI = 0.42,0.89, p = .009), and participants with higher BMI had an increased likelihood of avoiding care (OR = 1.03, CI = 1.00,1.05, p = .033).

Conclusion and Implications: Findings indicate that Black females and males experience multiple barriers to care, as evidenced by perceptions of differential treatment by providers, and avoidance of healthcare. Most notably, both weight and gender were found to be salient factors in terms of both perceptions and avoidance of healthcare. These findings have important implications for healthcare, as racial-, gender-, and body size-biased interactions with healthcare may pose specific healthcare utilization risks and drive disparities in health outcomes. Further research is needed to continue examining the role of body size and weight stigma in healthcare avoidance to identify important intervention opportunities, and future research should consider applying an intersectional approach that includes other racial categories to examine the impacts of race and body size on healthcare avoidance.