Abstract
This study examined whether frailty mediates the relationship between sexual and gender minority (SGM) status and three types of outpatient healthcare utilization among adults aged 50 and older in the All of Us Research Program (2017-2022). We estimated controlled direct effects of SGM status across generalist, specialist, and mental health visits. Healthcare utilization and SGM status were self-reported, and frailty was measured using a survey-based deficit accumulation index. Both SGM status and frailty were independently associated with increased rates of all outpatient visit types. Regarding mediation, our results suggest that if all participants were robust, SGM adults would still have higher healthcare utilization compared to cisgender heterosexual older adults. This indicates that factors beyond frailty influence patterns of healthcare use in this population and highlights the importance of identifying additional determinants to ensure that older SGM adults receive appropriate and responsive care.