Barriers to Care Among Sexual and Gender Minority Patients with Cervical Spondylosis in the US

Introduction: Chronic conditions, like cervical spondylosis (CS), present unique barriers to healthcare access, especially for sexual and gender minority (SGM) patients, who often face both cost-related and non-cost-related obstacles. This study examines disparities in access to care for SGM patients with CS compared to non-SGM patients, focusing on cost-related and non-cost-related barriers and the impact of intersecting identities like race/ethnicity and gender.

Methods: We conducted a retrospective cohort analysis using data from the National Institutes of Health's All of Us Research Program. Patients with CS were identified using ICD-9 and ICD-10 codes, with SGM status defined as identification with a marginalized gender identity or sexual orientation. Descriptive statistics and logistic regression analyses were used to evaluate associations between SGM status and healthcare barriers, adjusting for demographic and socioeconomic factors. Analyses were stratified by race/ethnicity and gender for detailed comparisons.

Results: Out of 6,781 CS patients, 514 (7.6%) identified as SGM. SGM patients were younger, had lower median incomes, and higher Medicaid enrollment compared to non-SGM patients. Adjusted analysis revealed that SGM patients had higher odds of delaying mental health care (AOR, 1.74), filling prescriptions (AOR, 1.61), and attending specialist visits (AOR, 1.43) due to cost. They also faced more non-cost barriers, such as lack of transportation (AOR, 1.69) and perceived lack of respect from healthcare providers (AOR, 1.30). SGM patients of color, particularly Hispanic/Latino and non-Hispanic Black individuals, reported more barriers compared to non-Hispanic White non-SGM counterparts.

Conclusion : SGM patients with CS face significant, multifaceted barriers to care, particularly in cost-related areas and within specific racial/ethnic groups. These findings highlight the need for systemic changes, including policies addressing financial inequities and provider-level interventions to improve cultural competence. Addressing these barriers could enhance care quality and accessibility for marginalized populations managing chronic spinal conditions like CS.