Kamalpreet S. Hara, MBBS1, Rachel Canning, BS1, Lindsey Philpot, PhD, MPH1, Jordan Richardson, 2, Evdokiya Knyazhanskaya, 2, Jean Fox, MD1, Douglas A. Simonetto, MD3, Victor Chedid, MD, MS1 1Mayo Clinic, Rochester, MN; 2Mayo Clinic, Alix School of Medicine, Rochester, MN; 3Mayo Clinic School of Graduate Medical Education, Rochester, MN
Introduction: Around 16% of LGBTQ+ adults in the US reported having experienced discrimination in healthcare settings, leading some patients to postpone or avoid healthcare services out of fear of stigmatization. We surveyed Rochester (RST) Pride attendees regarding their healthcare experiences.
Methods: At RST Pride 2022, attendees completed an anonymous online/paper survey to compare healthcare experiences among LGBTQ+ vs straight individuals and among gender diverse groups of LGBTQ+ community (Cis vs. Trans or queer or plus (TQ+)). Characteristics of straight and LGBTQ+ individuals were compared using logistic regression for dichotomized outcomes and general linearized models for categorical outcomes after adjusting for age. Outcomes were considered significant when the p-value < 0.05.
Results: Of 132 respondents, LGBTQ+ respondents (N=89) were younger than straight respondents (N=43) and comparatively had more difficult access to healthcare (22.7% vs 7%; p=0.215). LGBTQ+ reported more public insurance (31.8% vs. 18.6%; p=0.16) and reported seeking urgent/emergent care in greater proportion (22.5% vs. 7%; p=0.055) than straight individuals. 62.9% of LGBTQ+ individuals disclosed their sexual orientation/gender identity (SOGI) to their healthcare provider (HCP) and 38.6% of HCP’s asked their patients about SOGI. Most LGBTQ+ individuals feared negative reaction from HCP because of SOGI (p=0.0006). Universal signs of acceptance in healthcare facilities made LGBTQ+ individuals feel safer to disclose (p=0.006) compared to straight individuals. 67.9% of respondents actively looked for gender-neutral language on intake forms and perceived it being inclusive. LGBTQ+ individuals felt misunderstood by HCP compared to straight individuals (31.0% vs. 7.3%; p=0.005). When comparing healthcare experience of cis-gender (n=37) vs. TQ+ (n=52) LGBTQ+ individuals, TQ+ had more difficult access to care (27.5% vs 16.2%; p=0.113). 2 TQ+ reported being refused care, verbally harassed and physical attacked at healthcare setting because of gender identity compared to zero cis individuals. Cost of care is hugely inhibitive for TQ+ individuals while seeking care (14 vs 4, p=0.036).
Discussion: LGBTQ+ individuals have poor healthcare experiences and reduced healthcare access. Fear of discrimination limits them from disclosing their SOGI. Trans and non-binary individuals face worse discrimination and high-cost barrier when seeking health care compared with their cis LGB peers. These findings will be validated in a larger cohort.
Figure: Healthcare Experiences of Trans, queer, plus individuals compared to cis Lesbian, gay, and bisexual individuals.
Heterosexual / Straight (N=43)
LGBT+ (N=89)
Total (N=132)
p value
Age
Missing
18-25
26-35
36-45
46-55
56-55
66-75
76+
0 (0.0%)
4 (9.3%)
12 (27.9%)
8 (18.6%)
8 (18.6%)
6 (14.0%)
4 (9.3%)
1 (2.3%)
1 (1.1%)
37 (41.6%)
28 (31.5%)
10 (11.2%)
6 (6.7%)
5 (5.6%)
1 (1.1%)
1 (1.1%)
1 (0.8%)
41 (31.1%)
40 (30.3%)
18 (13.6%)
14 (10.6%)
11 (8.3%)
5 (3.8%)
2 (1.5%)
Race
Missing
White
Black / African American
Asian
Other
1 (2.3%)
37 (86.0%)
2 (4.7%)
3 (7.0%)
0 (0.0%)
0 (0.0%)
79 (88.8%)
0 (0.0%)
4 (4.5%)
6 (6.7%)
1 (0.8%)
116 (87.9%)
2 (1.5%)
7 (5.3%)
6 (4.5%)
Education Level
Missing
Less than high school
High school graduate
Some college
2-year degree
4-year degree
Professional degree
Doctorate
Prefer not to answer
1 (2.3%)
0 (0.0%)
1 (2.3%)
5 (11.6%)
5 (11.6%)
8 (18.6%)
14 (32.6%)
8 (18.6%)
1 (2.3%)
0 (0.0%)
8 (9.0%)
8 (9.0%)
28 (31.5%)
6 (6.7%)
20 (22.5%)
11 (12.4%)
8 (9.0%)
0 (0.0%)
1 (0.8%)
8 (6.1%)
9 (6.8%)
33 (25.0%)
11 (8.3%)
28 (21.2%)
25 (18.9%)
16 (12.1%)
1 (0.8%)
Relationship Status
Missing
Single, never married
Marriage or partnered in a marriage-like relationship
Separated
Divorced
Other
Prefer not to answer
2 (4.7%)
11 (25.6%)
25 (58.1%)
1 (2.3%)
4 (9.3%)
0 (0.0%)
0 (0.0%)
1 (1.1%)
49 (55.1%)
25 (28.1%)
1 (1.1%)
3 (3.4%)
6 (6.7%)
3 (3.4%)
3 (2.3%)
60 (45.5%)
50 (37.9%)
2 (1.5%)
7 (5.3%)
6 (4.5%)
3 (2.3%)
How would you describe your access to health care?
Missing
Very/Somewhat difficult
Not difficult
Very/Somewhat easy
0
3 (7.0%)
7 (16.3%)
33 (76.7%)
0
3 (7.0%)
7 (16.3%)
33 (76.7%)
1
23 (17.6%)
18 (13.7%)
90 (68.7%)
0.2152
What is your insurance type?
Public
Private
None
Prefer not to say
8 (18.6%)
36 (83.7%)
1 (2.3%)
0 (0.0%)
28 (31.8%)
56 (63.6%)
2 (2.3%)
5 (5.7%)
36 (27.5%)
92 (70.2%)
3 (2.3%)
5 (3.8%)
0.1667
0.1850
0.9203
0.9446
Have you had an annual check up with your primary care / family doctor in the past 12 months?
0.2913
Yes
No
Do not know / not sure
32 (74.4%)
11 (25.6%)
0 (0.0%)
60 (67.4%)
24 (27.0%)
5 (5.6%)
92 (69.7%)
35 (26.5%)
5 (3.8%)
Where do you usually seek care?
Outpatient clinic
Hospital
Urgent care / Emergency
Subspecialty clinic
41 (97.6%)
4 (9.5%)
3 (7.0%)
1 (2.4%)
79 (88.8%)
5 (5.6%)
20 (22.5%)
7 (7.9%)
120 (91.6%)
9 (6.9%)
23 (17.4%)
8 (6.1%)
0.0842
0.6802
0.0555
0.1949
Did your HCP ask about your sexual orientation / gender identity?
0.5511
Yes
No
Not sure/do not remember
13 (30.2%)
24 (55.8%)
6 (14.0%)
38 (42.7%)
42 (47.2%)
9 (10.1%)
51 (38.6%)
66 (50.0%)
15 (11.4%)
Did you disclose your sexual orientation / gender identity to your HCP?
0.1593
Yes
No / Prefer not to
25 (58.1%)
18 (41.9%)
56 (62.9%)
33 (37.1%)
81 (61.4%)
48 (38.7%)
Did you notice any effects of disclosing your sexual orientation / gender identity to your provider on subsequent healthcare?
0.8120
Missing
Positive
Neutral
Negative
3
5 (12.5%)
34 (85.0%)
1 (2.5%)
3
21 (24.4%)
59 (68.6%)
6 (7.0%)
6
26 (20.6%)
93 (73.8%)
7 (5.6%)
How often do you fear negative reaction from you HCPs because your sexual orientation / gender identity?
0.0006
Missing
Always / Often
Sometimes
Rarely / Never
1
1 (2.4%)
4 (9.5%)
37 (88.1%)
1
18 (20.5%)
31 (35.2%)
39 (44.3%)
2
19 (14.6%)
35 (26.9%)
76 (58.5%)
Responses to universal signs of acceptance.
Feel more trust toward the setting
Feel it safer to disclose
Does not make a difference
I am suspicious of the setting
Did not notice
Have never seen these signs
36 (83.7%)
14 (32.6%)
7 (16.3%)
0 (0.0%)
0 (0.0%)
0 (0.0%)
68 (76.4%)
55 (61.8%)
10 (11.2%)
1 (1.1%)
4 (4.5%)
6 (6.7%)
104 (78.8%)
69 (52.3%)
17 (12.9%)
1 (0.8%)
4 (3.0%)
6 (4.5%)
0.2346
0.0066
0.8818
0.9026
0.9390
0.9415
Do you look for gender neutral language on health intake forms, like option of “significant other” or “domestic partner”?
0.6098
Missing
Yes
No
Don’t know / Not sure
1
27 (64.3%)
9 (21.4%)
6 (14.3%)
0
62 (69.7%)
16 (18.0%)
11 (12.4%)
1
89 (67.9%)
25 (19.1%)
17 (13.0%)
When you see gender neutral language, how does it impact your perception of the institution?
0.0008
Missing
Viewed as inclusive
Has not impact
Other
1
35 (83.3%)
6 (14.3%)
1 (2.4%)
1
66 (75.0%)
17 (19.3%)
5 (5.7%)
2
101 (77.7%)
23 (17.7%)
6 (4.6%)
Types of experiences with HCP regarding health.
I feel as though they take my symptoms seriously.
0.1523
Missing
Strongly / Somewhat agree
Neutral
Strongly / Somewhat disagree
0
38 (88.4%)
4 (9.3%)
1 (2.3%)
1
71 (80.7%)
10 (11.4%)
7 (8.0%)
1
109 (83.2%)
14 (10.7%)
8 (6.1%)
I have had positive interactions with them.
0.1996
Missing
Strongly / Somewhat agree
Neutral
Strongly / Somewhat disagree
3
37 (92.5%)
3 (7.5%)
0 (0.0%)
1
72 (81.8%)
12 (13.6%)
4 (4.5%)
4
109 (85.2%)
15 (11.7%)
4 (3.1%)
They told me that I don’t need treatment when I feel like I do.
0.6205
Missing
Strongly / Somewhat agree
Neutral
Strongly / Somewhat disagree
3
8 (20.0%)
11 (27.5%)
21 (52.5%)
1
27 (30.7%)
26 (29.5%)
35 (39.8%)
4
35 (27.3%)
37 (28.9%)
56 (43.8%)
I have felt like they don’t understand me.
0.0049
Missing
Strongly / Somewhat agree
Neutral
Strongly / Somewhat disagree
2
3 (7.3%)
9 (22.0%)
29 (70.7%)
2
27 (31.0%)
21 (24.1%)
39 (44.8%)
4
30 (23.4%)
30 (23.4%)
68 (53.1%)
They have seemed annoyed with me.
0.4089
Missing
Strongly / Somewhat agree
Neutral
Strongly / Somewhat disagree
3
5 (12.5%)
9 (22.5%)
26 (65.0%)
1
17 (19.3%)
19 (21.6%)
52 (59.1%)
4
22 (17.2%)
28 (21.9%)
78 (60.9%)
They have said to me that my symptoms “are all in my head”.
0.0954
Missing
Strongly / Somewhat agree
Neutral
Strongly / Somewhat disagree
2
3 (7.3%)
5 (12.2%)
33 (80.5%)
2
17 (19.5%)
16 (18.4%)
54 (62.1%)
4
20 (15.6%)
21 (16.4%)
87 (68.0%)
They have told me that my symptoms were from stress.
0.8547
Missing
Strongly / Somewhat agree
Neutral
Strongly / Somewhat disagree
3
13 (32.5%)
10 (25.0%)
17 (42.5%)
2
31 (35.6%)
23 (26.4%)
33 (37.9%)
5
44 (34.6%)
33 (26.0%)
50 (39.4%)
My interactions with them made me question my intuition about my health.
0.0568
Missing
Strongly / Somewhat agree
Neutral
Strongly / Somewhat disagree
3
6 (15.0%)
9 (22.5%)
25 (62.5%)
1
31 (35.2%)
21 (23.9%)
36 (40.9%)
4
37 (28.9%)
30 (23.4%)
61 (47.7%)
Table: Table 1. Demographics and Healthcare Experiences of Rochester Pride 2022 Attendees.
Disclosures:
Kamalpreet Hara indicated no relevant financial relationships.
Rachel Canning indicated no relevant financial relationships.
Lindsey Philpot indicated no relevant financial relationships.
Jordan Richardson indicated no relevant financial relationships.
Evdokiya Knyazhanskaya indicated no relevant financial relationships.
Jean Fox indicated no relevant financial relationships.
Douglas Simonetto indicated no relevant financial relationships.
Victor Chedid indicated no relevant financial relationships.
Kamalpreet S. Hara, MBBS1, Rachel Canning, BS1, Lindsey Philpot, PhD, MPH1, Jordan Richardson, 2, Evdokiya Knyazhanskaya, 2, Jean Fox, MD1, Douglas A. Simonetto, MD3, Victor Chedid, MD, MS1. E0627 - Health Care Experiences of LGBTQ+ Individuals: A Rochester Pride 2022 Survey, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.
