By Nathaniel M. Tran, Tara McKay, Gilbert Gonzales, Carrie Fry & Stacie B. Dusetzina

Introduction: Understanding how LGBTQ+ patient experiences vary and are associated with receipt of preventive services may help reduce disparities between LGBTQ+ and non-LGBTQ+ populations.

Objective: (1) To identify latent classes of LGBTQ+ patient experiences using seven indicators of clinical and cultural competence, (2) to identify sociodemographic characteristics associated with class membership, and (3) to evaluate the relationship between class membership and receipt of preventive care.

Methods: 954 LGBTQ+ adults ages 50-76 from the Vanderbilt University Social Networks, Aging, and Policy Study. Respondents reported on seven indicators of their clinician’s LGBTQ+ clinical and cultural competency. Latent class analysis was conducted to identify subgroups of LGBTQ+ patient experiences. We estimated marginal effects of class membership on preventive care using logistic regression.

Results: We identified 3 latent classes with 34% of the sample assigned to the Affirming, 60% to the Neutral, and 6% to the Discriminatory class. Gender identity, sexual orientation, race and ethnicity, state of residence, and HIV status were significant predictors of class membership (all p<0.01), but not educational attainment, household income, health insurance status, or chronic conditions. Compared to individuals in the Affirming class, those in the Neutral class were 12.4 percentage points less likely to have ever been tested for HIV and 17.1 percentage points less likely to have been recently tested for HIV, both p<0.001; those in the Discriminatory class were 12.2 percentage points less likely to have recently received an influenza vaccination and 14.8 percentage points less likely to have recently completed a colorectal cancer screening, both p<0.05.

Discussion: In the absence of explicitly affirming healthcare experiences, LGBTQ+ patients are significantly less likely to receive timely preventive services such as colorectal cancer screenings, influenza vaccinations, and HIV testing. Increasing the capacity of health systems to provide affirming healthcare experiences for LGBTQ+ patients may help advance health equity.

Source SSRN