Stigmatizing language found in over half of primary care patient records

More than half of patients visiting outpatient primary care clinics have stigmatizing language recorded in their medical notes, according to a cross-sectional study of electronic health records from a large urban health system. The research, published in BMC Primary Care, examined free-text clinical notes written about adults aged 50 to 80 years between January 2018 and December 2023, and found that stigmatizing language appeared in 45.3 percent of all notes analyzed and in the records of 56.0 percent of the patients included.

The study was a retrospective analysis, meaning the researchers reviewed documentation that had already been produced during routine care rather than observing consultations directly. To measure stigmatizing language at scale, the team built a natural language processing pipeline incorporating validated lexicons, which are curated word lists used to identify terms associated with biased or judgmental descriptions of patients. The analysis covered 27,652 patients and 45,262 notes drawn from outpatient primary care visits. Associations between patient characteristics and the presence of stigmatizing language were tested using generalized estimating equations, a statistical approach suited to clustered data in which multiple notes belong to the same individual.

The results pointed to systematic differences in which patients were more likely to have stigmatizing language in their records. After multivariate adjustment, the odds of stigmatizing language rose slightly but significantly with each additional year of age, with an odds ratio of 1.01 per year (95 percent confidence interval 1.01 to 1.02). Male patients showed higher odds than female patients (odds ratio 1.18; 95 percent CI 1.13 to 1.23). Compared with White patients, Asian patients had modestly higher odds (odds ratio 1.10; 95 percent CI 1.00 to 1.19) and Black patients substantially higher odds (odds ratio 1.29; 95 percent CI 1.05 to 1.58). Patients living in the most socioeconomically disadvantaged neighborhoods, defined by the highest quartile of the area deprivation index, had higher odds than those in the lowest quartile (odds ratio 1.21; 95 percent CI 1.10 to 1.33). Insurance type was also associated with documentation patterns: patients covered by Medicare had an odds ratio of 1.47 (95 percent CI 1.35 to 1.61) and those covered by Medicaid an odds ratio of 1.18 (95 percent CI 1.07 to 1.30), compared with the reference categories.

The authors conclude that stigmatizing language was present in the notes of over half of the patients studied, with a disproportionate prevalence among historically marginalized groups. They suggest that electronic health records may reflect or perpetuate broader societal prejudices, and they call for targeted interventions to mitigate biased language in clinical documentation, noting that such language may negatively affect healthcare delivery and outcomes. Because the design is cross-sectional and observational, the reported odds ratios describe associations within a single health system rather than causal effects, and the findings may not generalize to other settings or to younger patient populations. The article was published as open access on 17 October 2026, and the version shared at publication is an accepted manuscript that will be replaced by the final Version of Record after further edits.

Subject of Research: Prevalence and sociodemographic correlates of stigmatizing language in outpatient primary care electronic health records

Article Title: Prevalence of stigmatizing language in outpatient primary care medical records of middle and older aged adults: a cross-sectional study

Article References: Akande, O., Sharifian, M., Zhou, Y., Chapa, A., Beck, A. L., Dhillon, J., Zanazanian, I., Chen, W.-P., Ziogas, A., Zheng, K., McEligot, A. J., & Sadigh, G. (2026). Prevalence of stigmatizing language in outpatient primary care medical records of middle and older aged adults: a cross-sectional study. BMC Primary Care. https://doi.org/10.1186/s12875-026-03607-9

Image Credits: AI Generated

DOI: 10.1186/s12875-026-03607-9

Keywords: stigmatizing language, electronic health records, primary care, natural language processing, health equity, clinical documentation, cross-sectional study, healthcare bias, patient demographics, BMC Primary Care, Prevalence, stigmatizing