BOSTON, February 20, 2023—A research letter published today in JAMA Internal Medicine finds that differences in health status and health care access between sexual minorities and their heterosexual counterparts did not change from 2013 through 2018. Disparities persisted despite substantial policy, legislative, and sociocultural shifts recognizing the constitutional right to marriage equality and increasing public support for lesbian, gay, and bisexual (LGB) issues.
The study found that nearly all subgroups of LGB adults in the United States reported higher levels of poor or fair health status, functional limitation, severe psychological distress, and difficulties with health care affordability than their heterosexual counterparts.
“Health inequities are driven by minority group stress and multifaceted societal marginalization. Our findings demonstrate the pernicious effect of stigma and discrimination on health and wellness,” said study senior author Dr. Alex S. Keuroghlian, who directs the National LGBTQIA+ Health Education Center at The Fenway Institute and the Massachusetts General Hospital Division of Public and Community Psychiatry.
“Our research calls for renewed action at the policy, legislative, sociocultural, and health-system levels,” said study lead author Michael Liu, M.Phil. “As we continue to see legislative attacks on lesbian, gay, and bisexual individuals at the state level, federal legislation through the Equality Act could lesson some of the minority stressors experienced by LGB individuals by explicitly prohibiting discrimination on the basis of sexual orientation.”
“The health sector could also promote health among sexual minority groups by ensuring that all clinicians receive adequate training to provide informed, inclusive, and affirming care for these populations,” said study co-author Sahil Sandhu, M.Sc.
The research letter examined nationally representative data from 183,020 adults collected by the National Health Interview Survey (NHIS). Nearly all (93.8% or 177,100) were heterosexual, 1.6% (3,176) were lesbian or gay, and 0.93% (1,744) were bisexual. Other findings include the following:
- Between 2013 and 2018 heterosexual male participants experienced significant annual reductions in poor or fair health status but gay male participants experienced no changes.
- Between 2016 and 2018 gay male participants had higher odds of poor or fair health status, severe psychological distress, and forgoing or delaying medical care due to costs compared with heterosexual males.
- Between 2016 and 2018 lesbian female participants had higher odds of any functional limitation, lacking a usual source of care, not seeing a health care professional during the past year, and forgoing or delaying medical care due to cost compared with heterosexual female participants.
- Between 2016 and 2018 bisexual female participants had higher odds of any functional limitation, lacking a usual source of care, not seeing a health care professional during the past year, and forgoing or delaying medical care due to cost and higher odds of poor or fair health and severe psychological distress compared with heterosexual female participants.
“Health Status and Health Care Access Among Lesbian, Gay, and Bisexual Adults in the US, 2013-2018” was authored by researchers at The Fenway Institute, Fenway Health, Harvard Medical School, Massachusetts General Hospital, Harvard T.H. Chan School of Public Health, and Vanderbilt University and contributes to the growing body of evidence demonstrating that societal marginalization is a persistent driver of health inequities.
It is available online here.