JAMA Dermatology

<jats:sec id="ab-doi230045-4"><jats:title>Importance</jats:title><jats:p>Research on the prevalence of barriers to care among sexual and gender minority (SGM) patients with chronic inflammatory skin diseases (CISDs) in the US is limited.</jats:p></jats:sec><jats:sec id="ab-doi230045-5"><jats:title>Objective</jats:title><jats:p>To compare the prevalence of cost and noncost barriers to care among SGM and non-SGM patients with CISDs and to analyze the prevalence of barriers based on SGM status and race and ethnicity.</jats:p></jats:sec><jats:sec id="ab-doi230045-6"><jats:title>Design, Setting, and Participants</jats:title><jats:p>A cross-sectional study of health care access and utilization survey data collected by the National Institutes of Health’s All of Us Research Program between May 31, 2017, and July 1, 2022, was conducted. Participants were adults aged 18 years or older with CISDs who enrolled in All of Us directly online or through partner health care practitioner organizations located across the US.</jats:p></jats:sec><jats:sec id="ab-doi230045-7"><jats:title>Exposures</jats:title><jats:p>Chronic inflammatory skin diseases, sexual orientation and gender identity, and race and ethnicity.</jats:p></jats:sec><jats:sec id="ab-doi230045-8"><jats:title>Main Outcome and Measures</jats:title><jats:p>The main outcome was the experience of cost and noncost barriers to health care among SGM patients with CISDs. Multivariable logistic regression was used to examine the association of SGM status with experiencing barriers to care.</jats:p></jats:sec><jats:sec id="ab-doi230045-9"><jats:title>Results</jats:title><jats:p>This study included 19 743 patients with CISDs; 1877 were SGM patients (median age, 40.5 years [IQR, 28.7-57.9 years]; 1205 [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). 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. In addition, SGM patients with CISDs were 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 health care practitioner who shares the same background with regard to 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 health care practitioners (AOR, 1.47; 95% CI, 1.30-1.65).</jats:p></jats:sec><jats:sec id="ab-doi230045-10"><jats:title>Conclusions and Relevance</jats:title><jats:p>The findings of this cross-sectional study of survey data suggest that SGM patients with CISDs may be disproportionately affected by cost and noncost barriers to health care. Dermatologists and other health care 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.</jats:p></jats:sec>

Barriers to health care among adults identifying as sexual minorities: a US national study.

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Barriers to health care among adults with minoritized identities in the United States, 2013-2017.

The “All of Us” Research Program.

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Racial and ethnic differences in barriers to care among US adults with chronic inflammatory skin diseases: A cross-sectional study of the All of Us Research Program.

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A Consensus-Based Checklist for Reporting of Survey Studies (CROSS).

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Toward a field of intersectionality studies: theory, applications, and praxis.

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Estimation and comparison of current and future racial/ethnic representation in the US health care workforce.

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Lesbian, gay, bisexual, and transgender identity and disclosure among dermatologists in the US.

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Increasing racial and ethnic diversity in dermatology: a call to action.

Diversity and career goals of graduating allopathic medical students pursuing careers in dermatology.

Influence of gender and sexual identity on adolescent skin health.

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Association of racial/ethnic and gender concordance between patients and physicians with patient experience ratings.

Patient-physician racial concordance and the perceived quality and use of health care.

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Patient-provider race and sex concordance and the risk for medication primary nonadherence.

Assessment of Black patients’ perception of their dermatology care.

Sexual and gender minority curricula within US dermatology residency programs.

Hidradenitis suppurativa in sexual and gender minorities: A review and considerations for providers.

Dermatologic care for lesbian, gay, bisexual, and transgender persons: terminology, demographics, health disparities, and approaches to care.

Residency education on sexual and gender minority health: ensuring culturally competent dermatologists and excellent patient care.

Improving dermatologic care for sexual and gender minority patients through routine sexual orientation and gender identity data collection.

Use of primary care services among patients with chronic skin disease seen by dermatologists.

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Discrimination in the United States: Experiences of lesbian, gay, bisexual, transgender, and queer Americans.

Health Serv Res

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Structural racism and health inequities in the USA: evidence and interventions.

Lancet

Medicare Part D payments for topical steroids: rising costs and potential savings.

A retrospective claims analysis confirms the cost of most biologic agents for psoriasis is increasing more rapidly than medical inflation.

Dermatologic care of sexual and gender minority/LGBTQIA youth, part I: an update for the dermatologist on providing inclusive care.

Dermatologic care of sexual and gender minority/LGBTQIA youth, part 2: recognition and management of the unique dermatologic needs of SGM adolescents.

Dermatologic care for lesbian, gay, bisexual, and transgender persons: epidemiology, screening, and disease prevention.

Research on the prevalence of barriers to care among sexual and gender minority (SGM) patients with chronic inflammatory skin diseases (CISDs) in the US is limited.
To compare the prevalence of cost and noncost barriers to care among SGM and non-SGM patients with CISDs and to analyze the prevalence of barriers based on SGM status and race and ethnicity.
A cross-sectional study of health care access and utilization survey data collected by the National Institutes of Health's All of Us Research Program between May 31, 2017, and July 1, 2022, was conducted. Participants were adults aged 18 years or older with CISDs who enrolled in All of Us directly online or through partner health care practitioner organizations located across the US.
Chronic inflammatory skin diseases, sexual orientation and gender identity, and race and ethnicity.
The main outcome was the experience of cost and noncost barriers to health care among SGM patients with CISDs. Multivariable logistic regression was used to examine the association of SGM status with experiencing barriers to care.
This study included 19 743 patients with CISDs; 1877 were SGM patients (median age, 40.5 years [IQR, 28.7-57.9 years]; 1205 [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). 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. In addition, SGM patients with CISDs were 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 health care practitioner who shares the same background with regard to 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 health care practitioners (AOR, 1.47; 95% CI, 1.30-1.65).
The findings of this cross-sectional study of survey data suggest that SGM patients with CISDs may be disproportionately affected by cost and noncost barriers to health care. Dermatologists and other health care 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.

Barriers to Care Among Sexual and Gender Minority Individuals With Chronic Inflammatory Skin Diseases in the US.

Barriers to Care Among Sexual and Gender Minority Individuals With Chronic Inflammatory Skin Diseases in the US

Papers