Patterns of Lesbian, Gay, Bisexual, Transgender, and Queer Patient Experiences and Receipt of Preventive Services.

Objective: To identify patterns of LGBTQ+ patient experiences, to identify sociodemographic characteristics associated with patterns of LGBTQ+ patient experiences, and to assess the relationship between LGBTQ+ patient experience and receipt of preventive services.

Study setting and design: This observational cohort study included adults across the U.S. South. We conducted latent class analysis of seven indicators of clinical and cultural competency to identify patterns of LGBTQ+ patient experiences. Outcomes included the proportion of respondents with lifetime and recent influenza vaccination, HIV testing, and colorectal cancer screening.

Data sources and analytic sample: Data come from Waves 1 and 2 of the LGBTQ+ Social Networks, Aging, and Policy Study collected between April 2020 and October 2022. The sample included 954 LGBTQ+ adults ages 50-76 living in Tennessee, Georgia, Alabama, or North Carolina at baseline.

Principal findings: We identified three patterns of LGBTQ+ patient experiences. 34% of the sample reported LGBTQ+ affirming care, 60% reported neutral care, and 6% reported discriminatory care. Gender identity, sexual orientation, race and ethnicity, state of residence, and HIV status predicted patterns of patient experiences (all p < 0.01). Compared to patients with affirming care, patients with neutral care were 12.4 percentage points less likely to have ever been tested for HIV (p < 0.0001) and 17.1 percentage points less likely to have been recently tested for HIV (p < 0.0001); patients reporting discriminatory care were 12.2 percentage points less likely to have recently received an influenza vaccination (p = 0.024) and 14.8 percentage points less likely to have recently completed a colorectal cancer screening (p = 0.035).

Conclusions: In the absence of explicitly LGBTQ+ affirming patient experiences, LGBTQ+ midlife and older adults are less likely to receive preventive services such as colorectal cancer screenings, influenza vaccinations, and HIV testing. Interventions to increase the capacity of health systems to provide LGBTQ+ affirming care are needed to advance health equity.