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Unequal Access to Primary Care Providers at the Intersection of Race/Ethnicity, Sexual Orientation, and Gender

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Not all U.S. populations have equal access to a primary care provider (PCP). This study presents one of the first population-based evidence of inequities in access to PCPs at the intersection of race/ethnicity, sexual orientation, and gender. We analyzed pooled data from the Behavioral Risk Factor Surveillance System from 2016 to 2021 across 42 states and 1 territory in the United States. The final sample encompassed 1,142,344 respondents aged 18 and older. Logistic regression models, stratified by gender spectrum, were estimated to compare predicted probabilities of having a PCP across 20 sexual and racial/ethnic identity groups. Among those on the feminine spectrum, most sexual minorities of color exhibited lower rates of having a PCP compared to heterosexual White individuals. Even when sociodemographic and health factors were accounted for, PCP access disadvantages remained significant in some groups of Native and Hispanic sexual minorities. Among sexual minorities of color on the masculine spectrum, inequities were less prominent, and sociodemographic and health factors nearly explained all their disadvantages. Sexual orientation, gender, and race/ethnicity intersect to shape the access to PCPs. Future research, policy designs, and clinical practices should adopt an intersectional approach to achieve a better understanding of healthcare inequities and to reduce inequities.
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RESEARCH BRIEFS
Population Research and Policy Review (2024) 43:55
https://doi.org/10.1007/s11113-024-09898-z
Abstract
Not all U.S. populations have equal access to a primary care provider (PCP). This
study presents one of the rst population-based evidence of inequities in access
to PCPs at the intersection of race/ethnicity, sexual orientation, and gender. We
analyzed pooled data from the Behavioral Risk Factor Surveillance System from
2016 to 2021 across 42 states and 1 territory in the United States. The nal sample
encompassed 1,142,344 respondents aged 18 and older. Logistic regression models,
stratied by gender spectrum, were estimated to compare predicted probabilities
of having a PCP across 20 sexual and racial/ethnic identity groups. Among those
on the feminine spectrum, most sexual minorities of color exhibited lower rates of
having a PCP compared to heterosexual White individuals. Even when sociodemo-
graphic and health factors were accounted for, PCP access disadvantages remained
signicant in some groups of Native and Hispanic sexual minorities. Among sex-
ual minorities of color on the masculine spectrum, inequities were less prominent,
and sociodemographic and health factors nearly explained all their disadvantages.
Sexual orientation, gender, and race/ethnicity intersect to shape the access to PCPs.
Future research, policy designs, and clinical practices should adopt an intersectional
approach to achieve a better understanding of healthcare inequities and to reduce
inequities.
Keywords Inequity · Healthcare · Intersectionality · Primary care
Received: 29 November 2023 / Accepted: 22 June 2024 / Published online: 5 July 2024
© The Author(s), under exclusive licence to Springer Nature B.V. 2024
Unequal Access to Primary Care Providers at the
Intersection of Race/Ethnicity, Sexual Orientation, and
Gender
NingHsieh1· DeirdreShires1· HuiLiu2· SamSaord3· Kryssia J.Campos4
Ning Hsieh
hsiehnin@msu.edu
1 Department of Sociology, Michigan State University, 509 East Circle Drive, 317 Berkey
Hall, East Lansing, MI 48824-1111, USA
2 Purdue University, West Lafayette, IN, USA
3 Cornell University, Ithaca, NY, USA
4 Los Angeles General Medical Center, Los Angeles, CA, USA
1 3
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