Sexually diverse patients with inflammatory skin diseases experience barriers to care
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Key takeaways:
- Sexual and gender minorities are more likely to delay care due to both financial and non-cost barriers.
- These barriers were also significantly higher in Black and Hispanic/Latino patients in the sexual and gender minority.
Patients in sexual and gender minorities who have chronic inflammatory skin diseases often experience financial and non-financial barriers to care, according to a study.
“Prior work has found increased barriers to care among sexual and gender minority adults in the general population. Our study expands upon prior research by evaluating whether these findings are also present among sexual and gender minority adults with chronic skin disease,” John Barbieri, MD, MBA, assistant professor at Harvard Medical School, director of the advanced acne therapeutics clinic at Brigham and Women’s Hospital and one of the study’s authors, told Healio. “We additionally explore how race and ethnicity are associated with the prevalence of these barriers to care.”
Researchers conducted a cross-sectional study using the NIH All of Us Research Program survey to analyze health care access and utilization.
Patients with chronic inflammatory skin diseases (CISDs) including atopic dermatitis, hidradenitis suppurativa, acne, alopecia areata, lichen planus, prurigo nodularis, psoriasis, rosacea and vitiligo were identified using Systematized Nomenclature of Medicine codes and were categorized as SGM if they identified with one or more minority identities related to sex assigned at birth, gender identity or sexual orientation.
The study included 19,743 patients with CISDs, of which 1,877 (mean age, 40.5 years; 64.2% assigned female sex at birth) were identified as fitting the SGM parameters and 17,866 (mean age, 57.1 years; 73.9% assigned female sex at birth) were considered non-SGM patients.
Patients who identified as SGM were significantly more likely to delay care by a specialist (adjusted OR = 1.23; 95% CI, 1.03-1.47), mental health care (aOR = 1.62; 95% CI, 1.37-1.91) and to fill a prescription (aOR = 1.3; 95% CI, 1.11-1.52) because of cost. Additionally, these patients were more likely to delay care due to non-cost barriers such as transportation issues (aOR = 1.49; 95% CI, 1.22-1.8) or because they could not find a practitioner who shared the same race, religious background, native language, sexual orientation or gender identity (aOR = 1.39; 95% CI, 1.19-1.62).
When asked if they have been treated respectfully by practitioners, those in the SGM were more likely to report they have not (aOR = 1.47; 95% CI, 1.3-1.65).
When stratified by race and ethnicity, the unadjusted prevalence of barriers was significantly higher in the non-Hispanic Black and Hispanic/Latino SMG patients.
“Sexual and gender minority individuals with chronic skin disease experience a variety of cost and non-cost barriers to care, including delaying care, not filling a prescription and reporting not always being treated with respect by their providers,” Barbieri said. “In addition, we found that those who identify as Black or Hispanic are more likely to experience barriers to care.
“Dermatologists and other providers have opportunities to improve care for these patients by ensuring their practices are welcoming to sexual and gender minority individuals and by advocating for changes to address systemic barriers,” Barbieri said.
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