Sexual and gender minority adults avoid necessary care due to identity discordance with clinicians and experiences of discrimination

Background and Goal: Identity discordance between patients and clinicians is associated with worse self-rated patient experience and less receipt of necessary care. Most prior studies have focused on racial discordance. However, whether these phenomena also apply to sexual and gender minority adults is currently unknown. This study evaluated how prevalent avoidance due to patient-clinician identity discordance is and its potential association with health care discrimination among sexual and gender minority adults.

Study Approach: A cross-sectional analysis was conducted of the National Institutes of Health’s All of Us Research Program. Data were collected from adults aged 18 years or older enrolled between May 2018 and July 2022. Sexual minority, heterosexual, gender minority, and cisgender adults were identified based on responses to interview questions.

Results: After adjusting for sociodemographic characteristics, sexual minority adults were significantly more likely than heterosexual adults to report care avoidance on the basis of patient-clinician identity discordance. Gender minority adults were also more likely to report care avoidance in comparison to cisgender adults. Additionally, median health care discrimination scores were higher among sexual minority and gender minority adults relative to heterosexual and cisgender adults. Among sexual and gender minority adults, higher levels of health care discrimination were significantly associated with a higher prevalence of care avoidance.

Why It Matters: These findings are consistent with emerging qualitative research showing that sexual and gender minority patients prefer clinicians who share similar sexual orientations and/or gender identities. Patient preferences are likely due to a desire for more affirming care and expertise specific to sexual and gender minorities, in addition to perceptions of safety, comfort, and solidarity.

Health Care Discrimination and Care Avoidance Due to Patient-Clinician Identity Discordance Among Sexual and Gender Minority Adults

Michael Liu, MPhil, et al

Harvard Medical School, Boston, Massachusetts

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