# Social determinants of health as risk and protective factors for health care access among sexual and gender minority parents

## TL;DR

This study explores how social factors affect healthcare access for sexual and gender minority parents compared to non-parents.

## Contribution

The study identifies specific social determinants of health that influence healthcare access among sexual and gender minority parents.

## Key findings

- SGM parents were less likely to disclose their identity to healthcare providers compared to SGM non-parents.
- Greater identity concealment and social isolation predicted increased healthcare avoidance among SGM parents.
- Social isolation also predicted delayed healthcare access among SGM parents.

## Abstract

Sexual and gender minority (SGM) people are increasingly becoming parents. To examine the relationship between social determinants of health (SDOH) and health care access among SGM parents, we used 2018–2019 prospective cohort data from The PRIDE Study. We compared health care access between 555 SGM parents and 555 age-matched SGM non-parents. We then used modified Poisson regression to assess the association between SDOH at baseline and health care access at one-year follow-up among SGM parents. We found that SGM parents and SGM non-parents reported differences in SGM identity disclosure to health care providers and health care utilization. SGM parents were less likely than SGM non-parents to disclose SGM identity to health care providers (p < 0.001) and reported more health care avoidance (p = 0.021). Among SGM parents, greater SGM identity concealment (aRR 1.13, 95% CI 1.05–1.22) and increased social isolation (aRR 1.06, 95% CI 1.01–1.10) predicted increased health care avoidance attributed to fear of disrespect or mistreatment. Increased social isolation (aRR 1.05, 95% CI 1.01–1.09) also predicted increased all-cause delayed health care access. Among SGM parents, these proxy measures of interpersonal-level and community-level SDOH suggested risk and protective factors influencing health care access.