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Barriers to care for U.S. sexual and gender minority patients with inflammatory skin disease

Findings from a cross-sectional study of survey data suggest that U.S. sexual and gender minority (SGM) patients with chronic inflammatory skin diseases (CISDs) may be disproportionately affected by cost and non-cost barriers to healthcare.

These findings come from a paper published online in JAMA Dermatology (Sept. 27, 2023).

The study was conducted to compare the barriers to care between SGM and non-SGM patients and to analyze the prevalence of these barriers based on SGM status, race, and ethnicity.

Researchers reviewed healthcare access and utilization survey data that had been collected by the U.S. National Institutes of Health’s All of Us Research Program between May 31, 2017 and July 1, 2022. The participants were adults aged 18 years or older with CISDs who enrolled in All of Us directly online or through partner healthcare practitioner organizations located across the U.S.

From a total of 19,743 patients with CISDs, 1,877 were SGM patients (median age, 40.5 years [IQR, 28.7-57.9 years]; 1,205 [64.2%] assigned female sex at birth) and 17,866 were non-SGM patients (median age, 57.1 years [IQR, 40.8-68.1 years]; 13,205 [73.9%] assigned female sex at birth).

Investigators found that compared with non-SGM patients, SGM patients with CISDs were significantly more likely to delay specialist care (adjusted odds ratio [AOR], 1.23; 95% CI, 1.03-1.47), mental health care (AOR, 1.62; 95% CI, 1.37-1.91), and filling a prescription (AOR, 1.30; 95% CI, 1.11-1.52) because of cost.

SGM patients with CISDs were also significantly more likely than non-SGM patients to delay care because of transportation issues (AOR, 1.49; 95% CI, 1.22-1.80) and not having a healthcare practitioner who shares the same background regarding race and ethnicity, religion, native language, sexual orientation, and gender identity (AOR, 1.39; 95% CI, 1.19-1.62). Sexual and gender minority patients with CISDs were also significantly more likely than non-SGM patients to report not always being treated with respect by their healthcare practitioners (AOR, 1.47; 95% CI, 1.30-1.65).

The authors conclude that dermatologists and other healthcare practitioners caring for SGM patients with CISDs have an important role in helping to address these barriers and larger systemic issues for SGM patients at both the patient and system levels.


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