Wong Chelsea N, Smith Louisa H, Cavanaugh Robert, Kim Dae H, Streed Carl G, Kapadia Farzana, Olivieri-Mui Brianne
Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02445, United States.
Department of Medicine, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA 02131, United States.
J Am Med Inform Assoc. 2024 Dec 1;31(12):2916-2923. doi: 10.1093/jamia/ocae205.
To understand how frailty and healthcare delays differentially mediate the association between sexual and gender minority older adults (OSGM) status and healthcare utilization.
Data from the All of Us Research Program participants ≥50 years old were analyzed using marginal structural modelling to assess if frailty or healthcare delays mediated OSGM status and healthcare utilization. OSGM status, healthcare delays, and frailty were assessed using survey data. Electronic health record (EHR) data was used to measure the number of medical visits or mental health (MH) visit days, following 12 months from the calculated All of Us Frailty Index. Analyses adjusted for age, race and ethnicity, income, HIV, marital status ± general MH (only MH analyses).
Compared to non-OSGM, OSGM adults have higher rates of medical visits (adjusted rate ratio [aRR]: 1.14; 95% CI: 1.03, 1.24) and MH visits (aRR: 1.85; 95% CI: 1.07, 2.91). Frailty mediated the association between OSGM status medical visits (Controlled direct effect [Rcde] aRR: 1.03, 95% CI [0.87, 1.22]), but not MH visits (Rcde aRR: 0.37 [95% CI: 0.06, 1.47]). Delays mediated the association between OSGM status and MH visit days (Rcde aRR: 2.27, 95% CI [1.15, 3.76]), but not medical visits (Rcde aRR: 1.06 [95% CI: 0.97, 1.17]).
Frailty represents a need for medical care among OSGM adults, highlighting the importance of addressing it to improve health and healthcare utilization disparities. In contrast, healthcare delays are a barrier to MH care, underscoring the necessity of targeted strategies to ensure timely MH care for OSGM adults.
了解衰弱和医疗保健延迟如何不同程度地介导性少数和性别少数老年成年人（OSGM）状况与医疗保健利用之间的关联。
对“我们所有人”研究项目中年龄≥50岁参与者的数据进行分析，使用边际结构模型来评估衰弱或医疗保健延迟是否介导了OSGM状况与医疗保健利用之间的关系。使用调查数据评估OSGM状况、医疗保健延迟和衰弱情况。电子健康记录（EHR）数据用于在计算出“我们所有人”衰弱指数后的12个月内测量医疗就诊次数或心理健康（MH）就诊天数。分析对年龄、种族和族裔、收入、艾滋病毒、婚姻状况±一般心理健康状况（仅MH分析）进行了调整。
与非OSGM相比，OSGM成年人的医疗就诊率（调整率比[aRR]：1.14；95%置信区间[CI]：1.03，1.24）和MH就诊率（aRR：1.85；95%CI：1.07，2.91）更高。衰弱介导了OSGM状况与医疗就诊之间的关联（受控直接效应[Rcde]aRR：1.03，95%CI[0.87，1.22]），但未介导与MH就诊之间的关联（Rcde aRR：0.37[95%CI：0.06，1.47]）。延迟介导了OSGM状况与MH就诊天数之间的关联（Rcde aRR：2.27，95%CI[1.15，3.76]），但未介导与医疗就诊之间的关联（Rcde aRR：1.06[95%CI：0.97，1.17]）。
衰弱表明OSGM成年人需要医疗护理，凸显了解决这一问题以改善健康和医疗保健利用差异的重要性。相比之下，医疗保健延迟是MH护理的障碍，强调了采取针对性策略以确保OSGM成年人及时获得MH护理的必要性。
