Are LGB teenagers missing out on needed care?

Research has shown that transgender individuals tend to underutilize health care when compared to their cisgender peers. However, little research has been done to examine how health care utilization may differ among lesbian, gay, or bisexual (LGB) children and teenagers. As LGB teenagers are at risk of a number of disparities because of their sexual orientation, an understanding of health care use could be key to making care more equitable.¹

The investigators looked at wave 3 data from the Health Passages study. The study was a longitudinal observational study that included a diverse sample of students from Birmingham, Alabama; Houston, Texas; and Los Angeles County, California. Collection of data started in 2010 when the sample students were in the 5th grade; wave 2 data were collected in the 7th grade; and the third wave data were collected in the 10th grade. Audio computer-assisted self-administered interviews in English and Spanish were used to collect information from both participants and parents. Participants were asked about the last time they were seen by a clinician, whether a condition had gone untreated in the last 12 months, and questions to determine demographic characteristics, including sexual orientation.

There were 4256 participants included in the study at the start of wave 1, of which 640 identified as LGB at the time of wave 1. No major difference was found when parents were asked about delaying necessary health care. However, a significantly greater proportion of LGB teenagers stated that they had a serious concern that had gone untreated in the past 12 months (8.3% [95% CI, 8.2%-8.4%] vs 3.7% [95% CI, 3.7%-3.7%]; adjusted odds ratio [aOR], 2.36 [95% CI, 1.65-3.37]). Furthermore, a greater proportion of LGB teenagers reported not getting needed care, such as a routine check-up or visit for illness, than their non-LGB peers(42.4% [95% CI, 42.2%-42.6%] vs 30.2% [95% CI, 30.1%-30.4%]; aOR, 1.68 [95% CI, 1.38-2.05]).

Reasons for seeking medical care for LGB adolescents vs non-LGB teenagers were more likely to be for sexually transmitted infections (10.2% [95% CI, 10.1%-10.3%] vs 5.5% [95% CI, 5.5%-5.6%]), contraception (3.9% [95% CI, 3.8%-4.0%] vs 1.2% [95% CI, 1.2%-1.3%]), and substance use (5.1% [95% CI, 4.8%-5.3%] vs 1.1% [95% CI, 1.1%-1.2%]). LGB teenagers were more likely to say they weren’t communicating with their clinician about a topic needing discussion (15.3% [95% CI, 15.2%-15.4%] vs 9.4% [95% CI, 9.3%-9.4%]; aOR, 1.71 [95% CI, 1.27-2.30]) and the reasons including being embarrassed, not wanting parents to find out, and the topic not being brought up by the clinician.

The investigators concluded that LGB teenagers had more unmet health needs, less chances to seek needed care, and greater difficulty discussing any concerns with their clinicians than peers who were non-LGB. Providing care that is sensitive to sexual orientation could help tackle these disparities. During visits, taking the time to ask about sexual identity, attractions, and behaviors, particularly in sexual and reproductive health, could help foster that respectful environment.

Reference

1. Reisner S, Mateo C, Elliott M, et al. Analysis of reported health care use by sexual orientation among youth. JAMA Netw Open. 2021;4(10):e2124647. doi:10.1001/jamanetworkopen.2021.24647