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Delays in Accessing Healthcare Across the Gender Spectrum in the All of Us Research Program

  • Original Research
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Abstract

Background

Gender minorities and cisgender women face barriers to healthcare access. Prior work suggests cost may represent a particular barrier to accessing care for transgender and gender diverse (TGD) individuals.

Objective

To examine odds of delaying care for any reason and, secondarily, for 7 specific reasons among TGD individuals and cisgender women compared with cisgender men in the All of Us Research Program.

Design

We calculated the odds of delayed care by gender identity relative to cisgender men using multivariable-adjusted logistic regression, with adjustment for age, race, income, education, and Charlson comorbidity index.

Participants

We examined 117,806 All of Us participants who completed the healthcare access and utilization survey.

Main Measures

The primary outcome was self-reported delayed care in the past 12 months for any of 7 potential reasons: cost (out-of-pocket cost, co-payment costs, and/or high deductible), lack of childcare, lack of eldercare, nervousness associated with visiting the healthcare provider, rurality, inability to take time off work, and lack of transportation.

Key Results

Compared with cisgender men, the multivariable-adjusted odds ratio (OR) for delaying care for any reason was 1.48 (95% CI, 1.44–1.53; P < 0.001) among cisgender women, 1.65 (95% CI, 1.24–2.21; P < 0.001) among TGD individuals assigned male at birth, and 2.76 (95% CI, 2.26–3.39; P < 0.001) among TGD individuals assigned female at birth. Results were consistent across multiple sensitivity analyses. TGD individuals were substantially more likely to cite nervousness with visiting a healthcare provider as a barrier, whereas cisgender women were more likely to delay care due to lack of childcare coverage.

Conclusions

Cisgender women and TGD individuals were more likely to delay seeking heath care compared with cisgender men, and for partially different reasons. These findings highlight the need to address common and distinct barriers to care access among marginalized groups.

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Data Availability

Researchers may request data access at https://www.researchallofus.org/.

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Acknowledgements:

The All of Us Research Program is supported by the National Institutes of Health, Office of the Director: Regional Medical Centers: 1 OT2 OD026549; 1 OT2 OD026554; 1 OT2 OD026557; 1 OT2 OD026556; 1 OT2 OD026550; 1 OT2 OD 026552; 1 OT2 OD026553; 1 OT2 OD026548; 1 OT2 OD026551; 1 OT2 OD026555; IAA #: AOD 16037; Federally Qualified Health Centers: HHSN 263201600085U; Data and Research Center: 5 U2C OD023196; Biobank: 1 U24 OD023121; The Participant Center: U24 OD023176; Participant Technology Systems Center: 1 U24 OD023163; Communications and Engagement: 3 OT2 OD023205; 3 OT2 OD023206; and Community Partners: 1 OT2 OD025277; 3 OT2 OD025315; 1 OT2 OD025337; 1 OT2 OD025276. In addition, the All of Us Research Program would not be possible without the partnership of its participants.

Funding

Dr. Toribio is supported by the National Heart, Lung, and Blood Institute (K23HL147799); the American Heart Association-Harold Amos Medical Research Faculty Development Program by the Robert Wood Johnson Foundation; and Physician Scientist Development Award from the Massachusetts General Hospital Executive Committee on Research and Center for Diversity and Inclusion. Dr. Natarajan is supported by a Hassenfeld Scholar Award from the Massachusetts General Hospital; grants from the National Heart, Lung, and Blood Institute (R01HL1427, R01HL148565, and R01HL148050); and from Fondation Leducq (TNE-18CVD04). Dr. Honigberg is supported by the National Heart, Lung, and Blood Institute (K08HL166687) and American Heart Association (940166, 979465).

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Authors and Affiliations

  1. Cardiovascular Research Center, Massachusetts General Hospital, 185 Cambridge St. CPZN 3.187, Boston, MA, 02114, USA

    Phoebe Finneran BS, Pradeep Natarajan MD, MMSc & Michael C. Honigberg MD, MPP

  2. Metabolism Unit, Division of Endocrinology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA

    Mabel P. Toribio MD

  3. Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA

    Pradeep Natarajan MD, MMSc & Michael C. Honigberg MD, MPP

  4. Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA

    Pradeep Natarajan MD, MMSc & Michael C. Honigberg MD, MPP

Authors
  1. Phoebe Finneran BS
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  2. Mabel P. Toribio MD
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  3. Pradeep Natarajan MD, MMSc
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Corresponding author

Correspondence to Michael C. Honigberg MD, MPP.

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Conflict of Interest:

Dr. Natarajan reports grant support from Amgen, Apple, AstraZeneca, Boston Scientific, and Novartis, spousal employment and equity at Vertex, consulting income from Apple, AstraZeneca, Novartis, Genentech / Roche, Blackstone Life Sciences, Foresite Labs, and TenSixteen Bio, and is a scientific advisor board member and shareholder of TenSixteen Bio and geneXwell, all unrelated to this work. Dr. Honigberg reports consulting fees from CRISPR Therapeutics, advisory board service for Miga Health, and grant support from Genentech, all unrelated to this work.

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Finneran, P., Toribio, M.P., Natarajan, P. et al. Delays in Accessing Healthcare Across the Gender Spectrum in the All of Us Research Program. J GEN INTERN MED 39, 1156–1163 (2024). https://doi.org/10.1007/s11606-023-08548-y

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