Alex Keuroghlian, MD, MPH, an Associate Chief of Public and Community Psychiatry at Massachusetts General Hospital and Associate Professor of Psychiatry at Harvard Medical School, is the senior author of an article in the journal JAMA Internal Medicine, "Health Status and Health Care Access among Lesbian, Gay, and Bisexual Adults in the US, 2013 to 2018" along with Harvard Medical School students Michael Liu and Sahil Sandhu.
What Question Were You Investigating?
One early analysis identified national lesbian, gay, and bisexual (LGB) health disparities using 2013-2014 National Health Interview Survey (NHIS) data.
Since then, there have been substantial policy and sociocultural shifts that may have differentially affected sexual minority subgroups, such as Obergefell v. Hodges recognizing the constitutional right to same-sex marriage, states expanding protections for LGB populations, and increasing public support for LGB-related issues.
Understanding whether the United States has made progress in reducing health inequities among sexual minorities is critical to inform future public health and policy efforts.
Therefore, we sought to evaluate if and how health status and healthcare access have changed among LGB adults in the US, and whether differences relative to their heterosexual counterparts have changed between 2013 and 2018.
What Was Your Approach?
Our serial cross-sectional study used nationally representative 2013-2018 NHIS data. Adult participants were classified as lesbian or gay, bisexual, or heterosexual based on responses to a sexual orientation question.
We focused on three health status outcomes (self-reported health status, functional limitation, and severe psychological distress) and three healthcare access outcomes (usual source of care, healthcare utilization, and healthcare affordability).
The study sample consisted of 183,020 adults, of whom 177,100 (93.8%) were classified as heterosexual, 3,176 (1.6%) as lesbian or gay, and 1,744 (0.93%) as bisexual.
What Were Your Findings?
- Differences in health status and healthcare access between sexual minorities and their heterosexual counterparts have not significantly changed between 2013 and 2018.
- Nearly all subgroups of LGB adults continue to report higher levels of poor or fair health status, functional limitation, severe psychological distress, and difficulties with healthcare affordability than their heterosexual counterparts.
- During the 2016-2018 period, compared to heterosexual males, gay males had higher odds of poor or fair health status, severe psychological distress, and forgoing or delaying medical care due to cost and had lower odds of lacking a usual source of care and not seeing a healthcare professional in the past year. Similar patterns were observed among bisexual males.
- Compared to heterosexual females, lesbian females had higher odds of functional limitation, lacking a usual source of care, not seeing a healthcare professional in the past year, and forgoing or delaying medical care due to cost. Similar patterns were observed among bisexual females.
The persistence of LGB health disparities highlights the need for renewed action at the policy, socio-cultural, and health system levels.
Legal protections for LGB individuals are still heterogenous and largely tenuous across states. In the midst of attacks on the fundamental rights of LGB individuals by state legislators, federal legislation through the Equality Act could ameliorate minority stress by explicitly prohibiting discrimination on the basis of sexual orientation.
The health sector could also play a critical role in promoting the health of sexual minorities by ensuring all clinicians receive adequate training in the unique health needs of LGB populations and increasing access to providers with expertise in sexual minority health.
Liu M, Sandhu S, Reisner SL, Gonzales G, Keuroghlian AS. Health Status and Health Care Access Among Lesbian, Gay, and Bisexual Adults in the US, 2013 to 2018. JAMA Intern Med. Published online February 20, 2023. doi:10.1001/jamainternmed.2022.6523
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