SGM Patients With Chronic Inflammatory Skin Diseases Affected by Obstacles to Care

Sexual and gender minority (SGM) patients with chronic inflammatory skin diseases (CSIDs) might be affected disproportionately by cost and noncost obstacles to health care, according to a study in JAMA Dermatology.

An understanding of the prevalence of obstacles to care among SGM patients with CISDs in the United States is lacking. "Understanding the prevalence of barriers specifically among SGM patients with CISDs is particularly important because CISDs often require long-term management by a dermatologist and frequent follow-up with other health care practitioners for comorbidities," the authors wrote.

Comparison of the prevalence of cost and noncost obstacles to care among SGM and non-SGM patients with CISDs and to evaluate the prevalence of barriers based on SGM status and race and ethnicity was undertaken by the researchers.

Previous research has shown a heightened prevalence of barriers to care among SGM adults compared with non-SGM adults in the general US population.

This was a cross-sectional study of health care access and utilization survey data obtained by the National Institutes of Health’s All of Us Research Program that was conducted between May 31, 2017, and July 1, 2022. The participants consisted of adults of the age of 18 or older with CISDs who enrolled in All of Us online directly or through partner health care practitioner organizations positioned across the country.

The exposures of this study consisted of chronic inflammatory skin diseases, sexual orientation and gender identity, and race and ethnicity. The main outcome consisted of the experience of cost and noncost barriers to health care among SGM patients with CISDs. Multivariable logistic regression was used.

Diverse Sets of Hands Reaching Up On Black Background Stock Illustration | © iStockPhoto.com

The study cohort included 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). 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) due to cost, compared with non-SGM patients. Sexual and gender minority patients with CISDs were also significantly more likely than non-SGM patients to account not always being treated respectfully by their health care practitioners (AOR, 1.47; 95% CI, 1.30-1.65).

The analysis suggested that SGM patients with CISDs who also identify as Black or Hispanic/Latino are especially likely to experience care barriers, and that experiencing barriers might be partially explained by socioeconomic inequities, consistent with former studies.

“Our finding that many SGM patients with CISDs, particularly non-Hispanic Black SGM women, delay care because their health care practitioner does nots hare the same background with regard to race, religion, native language, sexual orientation, and gender identity is consistent with the lack of diversity of practitioners in medicine,” continued the researchers.

It was also found that SGM patients with CISDs were significantly more likely than non-SGM patients to report not always be treated with respect and emphasizes the necessity of making sure all dermatologists and other practitioners are trained to deliver culturally competent care.

“…there is also a critical need for dermatologists and other health care practitioners to further engage in broader advocacy efforts to address systemic issues that underpin the disparities in barriers to care and health among SGM and racial and ethnic minority adults in the US,” said the researchers.

Dermatologists and other health care practitioners caring for SGM patients with CISDs possess a vital role in assisting to address barriers and larger systemic issues for SGM patients at patient and system levels.

There were some limitations of this study. First, survey responses were not necessarily specific to care in dermatology, and the findings of this study might not be specific to patients with CISDs. And though the All of Us Research Program cohort is diverse and large, the study sample might not be representative of the US adult population with CISDs.

“The findings of this cross-sectional study of survey data suggest that SGM patients with CISDs in the US disproportionately experience a broad range of cost and noncost barriers to care,” concluded the researchers.

Reference

Nock MR, Kamal K, Zampella JG, Roberson ML, Cohen JM, Barbieri JS. Barriers to care among sexual and gender minority individuals with chronic inflammatory skin diseases in the US. JAMA Dermatol. Published online September 27, 2023. doi:10.1001/jamadermatol.2023.3328