21 Feb LGB Adults Report Little Improvement in HealthCare Status and Access
MedicalResearch.com Interview with:
Michael Liu, MPhil
Rhodes Scholar,MPhil in Evidence-Based Social Intervention and Policy Evaluation.
Harvard Medical School
MedicalResearch.com: What is the background for this study?
Response: Over the past few decades, research has shown that lesbian, gay, and bisexual (LGB) individuals have worse health outcomes and face unique challenges related to their experiences and costs of care. These disparities are driven by “minority stress” associated with belonging to a marginalized group. Such stressors erode health through a range of structural and interpersonal forces, including employment discrimination, family rejection, and internalized stigma
One early analysis established national baseline estimates for LGB health outcomes using 2013-2014 National Health Interview Survey (NHIS) data. Since then, there have been substantial shifts in social policy and public opinion that may have differentially affected sexual minority subgroups. The US Supreme Court decision in Obergefell v. Hodges guaranteed the constitutional right to same-sex marriage across all states. Over the last decade, states have expanded rights and protections for LGB populations related to employment and housing discrimination, sexual orientation conversion efforts, HIV criminalization, and religious exemptions. Public support for LGB-related issues has also been increasing with more representation in media, uptake of LGB-affirming policies, and advocacy efforts.
No studies have assessed national trends in health status or healthcare access among specific sexual minority subgroups amid the rapidly shifting sociocultural and policy landscape. Thus, we sought out to evaluate if and how health status and healthcare access have changed between 2013 and 2018 in the US among LGB adults, and whether differences relative to their heterosexual counterparts have changed over time.
MedicalResearch.com: What are the main findings?
Response: Using nationally representative data from the NHIS, we found that that differences in health status and healthcare access between LGB adults and their heterosexual counterparts have not 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
MedicalResearch.com: What should readers take away from your report?
Response: 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.
MedicalResearch.com: What recommendations do you have for future research as a results of this study?
Response: LGB adults are a heterogenous population. Future data collection efforts and research should prioritize understanding these health inequities through an intersectional lens, incorporating aspects such as gender identity, race, ethnicity, and socioeconomic status. Other studies should also seek to unpack how individual experiences of minority stressors, local policy environments, and structural stigma influence health and health care access for sexual minorities. Perhaps most importantly, future research could also help understand the effects of recent LGB-related policies and help develop and evaluate interventions to improve the health and wellbeing of diverse LGB populations.
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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