Identity discordance between patients and clinicians is associated with worse self-rated patient experience and less receipt of necessary care. And this is also true among sexual and gender minorities (SGM) who avoid seeking necessary care due to patient-clinician identity discordance.
This is according to a study – “Health Care Discrimination and Care Avoidance Due to Patient-Clinician Identity Discordance Among Sexual and Gender Minority Adults” by Michael Liu, Vishal R. Patel, Sahil Sandhu, Sari Reisner and Alex S. Keuroghlian – appeared in the Annals of Family Medicine.
In this study, the researchers conducted a cross-sectional analysis of the National Institutes of Health’s All of Us Research Program, a national and community-engaged cohort that explicitly aims to recruit participants from communities historically underrepresented in biomedical research. Data were collected from adults aged 18 years or older enrolled from May 2018 to July 2022 through a health care provider organization or enrollment website.
Of 97,130 participants with sexual orientation data, 9,699 (10.0%) were identified as sexual minorities and 87,431 (90.0%) as heterosexual. Of 98,309 participants with gender identity data, 1,277 (1.3%) were identified as gender minorities and 97,032 (98.7%) as cisgender.
It was found that SGM adults “were more likely to have lower income, be younger, uninsured, and not married or living with a partner compared with heterosexual and cisgender adults.”
After adjusting for sociodemographic characteristics, sexual minority adults were found to be “significantly more likely than heterosexual adults to report patient-clinician identity discordance (PCID) based care avoidance (20.0% vs 9.4%).
Gender minority adults were also more likely to report PCID-based care avoidance than cisgender adults (34.3% vs 10.3%).
Similar patterns were observed among gay (aRR = 1.79; 95% CI, 1.60-2.01; P <0.001), lesbian (aRR = 1.47; 95% CI, 1.28-1.68; P <0.001), bisexual (aRR = 1.43; 95% CI, 1.32-1.55; P <0.001), transgender (aRR = 2.03; 95% CI, 1.67-2.43; P <0.001), and non-binary adults (aRR = 1.79; 95% CI, 1.54-2.07; P <0.001).
SGM adults disproportionately reported avoiding care because of perceived patient-clinician identity differences, stressed the researchers, with one in five sexual minority adults and more than one-third of gender minority adults sharing this experience. These rates were 58% and 100% higher relative to those of their non-SGM counterparts, respectively. Notably, exposure to discrimination in health care settings was more prevalent among SGM adults and was dose-dependently associated with significantly higher rates of PCID-based care avoidance.
For the researchers: “The findings of this study suggest that reducing SGM health inequities will require concerted efforts from health systems and policymakers. For example, health care and educational institutions should prioritize recruitment and retainment of workforces with diverse sexual orientations and gender identities. The provision of affirming and inclusive care for SGM patients, however, is not solely the responsibility of SGM clinicians. National policy strategies to universally mandate adequate SGM-related clinical training and explicitly prohibit anti-SGM health care discrimination are needed to improve the care experience and health of SGM patients.”
