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. 2023 Dec 1;159(12):1323-1331.
doi: 10.1001/jamadermatol.2023.3328.

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

Michael R Nock  1 , Kanika Kamal  2 , John G Zampella  3 , Mya L Roberson  4 , Jeffrey M Cohen  1 , John S Barbieri  2
Affiliations

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

Michael R Nock et al. JAMA Dermatol. .

Abstract

Importance: 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.

Objective: 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.

Design, setting, and participants: 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.

Exposures: Chronic inflammatory skin diseases, sexual orientation and gender identity, and race and ethnicity.

Main outcome and measures: 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.

Results: 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).

Conclusions and relevance: 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.

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Conflict of interest statement

Conflict of Interest Disclosures: Ms Kamal reported serving as a medical student liaison for the American Academy of Dermatology’s Lesbian, Gay, Bisexual, Transgender, Queer Expert Resource Group. Dr Zampella reported receiving personal fees from Dermavant, Ferndale Pharma, and Janssen for serving on their advisory boards and from Vaseline Healing for an invited lecture outside the submitted work, as well as serving as vice-chair and chair-elect of the American Academy of Dermatology LGBTQ Expert Resource Group. Dr Roberson reported receiving personal fees from Concert Genetics and a grant from the National Institutes of Health (NIH) outside the submitted work. Dr Cohen reported receiving personal fees from Advarra and a grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, outside the submitted work. Dr Barbieri reported receiving personal fees from Dexcel Pharma for consulting outside the submitted work. No other disclosures were reported.

References

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    1. Hernandez SM, Sparks PJ. Barriers to health care among adults with minoritized identities in the United States, 2013-2017. Am J Public Health. 2020;110(6):857-862. doi: 10.2105/AJPH.2020.305598 - DOI - PMC - PubMed
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    1. Nock MR, Barbieri JS, Krueger LD, Cohen JM. 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. J Am Acad Dermatol. 2023;88(3):568-576. doi: 10.1016/j.jaad.2022.09.054 - DOI - PubMed
    1. All of Us Research Program. Who can join? National Institutes of Health. Accessed January 30, 2023. https://www.joinallofus.org/who-can-join

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