Discrimination and Intersecting Inequities to Healthcare Access among Refugee Newcomers in the United States

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 gender, 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 mediated by gender and moderated by race and gender. 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. Multivariate linear regression was used to estimate the association between discrimination and healthcare barriers, adjusting for a wide range of demographic, socioeconomic, and health-related covariates. Blinder-Oaxaca decomposition was employed to distinguish between explained and unexplained portions of gender disparities. Mediation analysis assessed whether perceived discrimination accounted for gender differences in access, while a three-way interaction model (Discrimination × Race × Gender) evaluated intersectional moderation effects. Results Perceived discrimination emerged as the strongest independent predictor of healthcare barriers, even after controlling for other determinants such as English proficiency, financial hardship, and physical health. Refugees reporting discrimination faced significantly higher barriers (mean difference = 0.56, p < .001). Notably, 57.7% of the gender disparity in access remained unexplained by observable characteristics, pointing to structural and institutional inequities. Mediation analysis revealed a significant indirect effect of gender on healthcare barriers through perceived discrimination. Further, discrimination’s impact varied significantly across racial and gender groups (F(18, 3585) = 2.31, p < .01), with Black, MENA, and Asian women reporting the highest access barriers under high discrimination, while White men reported the lowest. Conclusions These findings underscore the structurally embedded nature of healthcare inequities among refugees. Discrimination functions as both a pathway and amplifier of access disparities, particularly for multiply marginalized groups. Addressing these inequities requires intersectional, structurally competent approaches that treat discrimination as a modifiable determinant of health and prioritize institutional accountability in refugee health policy and practice.