Health Disparities and Specialist Healthcare Utilization Among Autistic Sexual and Gender Minority Adults

Background and Purpose: Research has demonstrated that a substantial group of autistic adults identify as sexual or gender minority (SGM). Holding both autistic and SGM identities may compound health disparities and complicate health system navigation. However, there is a dearth of information about autistic SGM health outcomes and healthcare utilization, which is necessary to inform interventions. We partnered with autistic SGM adults and analyzed cross-sectional electronic medical record (EMR) data (2015-2019) to explore the health outcomes and healthcare utilization patterns of autistic SGM adults compared to cisgender heterosexual (CH) autistic adults.

Methods: EMR data came from Kaiser Permanente North California, an integrated healthcare system serving 4.3 million members. Participants were members with an autism diagnosis (N=4160) recorded by January 1, 2015. Sexual minority individuals (n=122) were identified via a self-report questionnaire and gender minority individuals (n=90) via a stepwise method involving computerized searches of EMR and free-text validation. Multivariate logistic regression adjusting for age, race/ethnicity, and health diagnoses were fit to investigate differences in health outcomes and healthcare utilization for autistic SGM individuals separately compared to autistic cisgender heterosexual (CH) adults. Chi-square analyses were used to examine differences in specialist visits.

Results: For psychiatric conditions, autistic SGM adults had a greater odds of having an anxiety disorder (aOR= 2.7-5.1, p’s<.001), depression (aOR=2.9-4.5, p’s<.001), PTSD (aOR=3.9-5.5, p’s<.001), and schizophrenia (aOR=2.1-3.4, p’s<.03) compared to autistic CH. Sexual minorities had a greater odds of having alcohol or drug dependence (aOR=3.6-3.8, p’s<.006) compared to autistic CH. Gender minorities had greater odds of an eating disorder compared to autistic CH (aOR=6, p<.001). For physical health conditions, autistic SGM adults had an increased odds of pain (aOR= 2.9-4.5, p’s<.001), migraines (aOR=2.0-2.4, p’s<.02), fibromyalgia (aOR=2.8-3.7, p’s<.002), and gastrointestinal disorders (aOR=2.2-2.4, p’s<.001) compared to autistic CH. Sexual minority individuals had an increased odds of autoimmune condition (aOR=1.5, p<.04) compared to autistic CH. Gender minority individuals had increased odds of infection (aOR=2, p<.03), vitamin deficiency (aOR=2.4, p<.03), and anemia (aOR=2.7, p<.01) compared to autistic CH.

For healthcare utilization, autistic sexual minority individuals had an increased odds of OB/GYN visits (aOR=3.0, p<.001), laboratory tests (aOR=2.5, p<.01), urgent care (aOR=1.7, p<.04), radiology (aOR=1.7, p<.02), and emergency department visits (aOR=1.5, p<.04) compared to autistic CH. Autistic gender minority individuals had increased odds of mental health visits (aOR=1.8, p<.03). SGM individuals had higher odds of other specialist visits, including dermatology (p’s<.003), endocrine (p’s<.001), rheumatology (p’s<.05), and sleep medicine (p’s<.03). Only autistic sexual minority individuals had a greater probably of seeing pain care specialists (p=.02) compared to autistic CH.

Conclusions and Implications: Compared to autistic CH, autistic SGM individuals experience higher rates of mental and physical health conditions and greater rates of utilizing certain health services, including specialist care. Providers across many specialties must anticipate and be trained to provide care and healthcare system navigation services for autistic SGM people in order to promote health equity for this marginalized population. Care navigation services may be needed.