Understanding primary care utilization and barriers to care among sexual and racial/ethnic minority populations

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Project Summary This project addresses AHRQ’s two Special Emphasis Notices on advancing primary care research and health equity (NOT-HS-22-011 and NOT-HS-21-014). Both sexual and racial/ethnic minority populations make up a significant and growing share of the U.S. population. Both populations experience higher rates of delayed health care, unmet care needs, and poorer quality of care than their respective majority counterparts. However, while prior studies have attempted to identify key factors leading to health care disadvantages in either population, they often overlook how the intersection of minoritized sexual orientation and race/ethnicity may complicate utilization of and barriers to care. Despite increasing research on sexual health care among Black and Hispanic sexual minority men, primary care experiences across Asian, Black, and Hispanic sexual minority women and men have not been systematically examined due primarily to data limitations. Guided by the framework of intersectionality and Behavioral Model of Health Services Use, this project aims to: (1) comprehensively document inequities in primary care utilization among sexual minority people of color in comparison to their heterosexual and White counterparts, and (2) identify unique mechanisms underlying the inequities facing each disadvantaged group. We will break new ground in understanding primary care inequities at the intersection of sexual orientation and race/ethnicity by analyzing two large population-based datasets from the National Health Interview Survey (2013-20) and the Behavioral Risk Factor Surveillance System (2014-20). These datasets have adequate sample sizes for studying sexual minority groups of color, rich information on health care experiences, and comparable measures for factors of health care utilization and sociodemographic characteristics. They also complement each other in their survey designs and health care measurements. Power analysis indicates that the samples of sexual minority people of color are sufficiently large to detect small effects at power>0.8. We will use multiple regression analyses and the Kitagawa-Oaxaca-Blinder decomposition approach to assess primary care inequities and multifaceted pathways linked to the inequities. Overall impact. This project will provide the first systematic and population-based analysis of primary care inequities and their underlying mechanisms at the intersection of race/ethnicity and sexual orientation. It will elucidate unique primary care challenges faced by sexual minority people of color, an underserved and understudied population that experiences significant and persistent health disadvantages. Findings will inform clinical practices, medical education, and policy designs of effective interventions to reduce health care inequities, a major goal of AHRQ. More broadly, the project will advance the understanding and application of intersectionality in health care research.