Journal of Community Health

, Volume 42, Issue 6, pp 1163–1172 | Cite as

Health Disparities by Sexual Orientation: Results and Implications from the Behavioral Risk Factor Surveillance System

Original Paper

Abstract

Until recently, population-based data for monitoring sexual minority health have been limited, making it difficult to document and address disparities by sexual orientation. The primary objective of this study was to examine differences by sexual orientation in an array of health outcomes and health risk factors using one of the nation’s largest health surveys. Data for this study came from 8290 adults who identified as lesbian, gay, or bisexual (LGB) and 300,256 adults who identified as heterosexual in the 2014–2015 Behavioral Risk Factor Surveillance System (BRFSS). Logistic regression models were used to compare physical and mental health outcomes, health condition diagnoses, and health risk factors by sexual orientation, controlling for demographic and socioeconomic status. Controlling for sociodemographic characteristics, gay and bisexual men reported higher odds of frequent mental distress [odds ratio (OR) 1.71, P = 0.001; OR 2.33, P < 0.001] and depression (OR 2.91, P < 0.001; OR 2.41, P < 0.001), compared with heterosexual men. Lesbian and bisexual women had higher odds of frequent mental distress (OR 1.53, P < 0.001; OR 2.08, P < 0.001) and depression (OR 1.93, P < 0.01; OR 3.15, P < 0.001), compared to heterosexual women. Sexual minorities also faced higher odds of poor physical health, activity limitations, chronic conditions, obesity, smoking, and binge drinking, although these risks differed by sexual orientation and gender. This study adds to the mounting evidence of health disparities by sexual orientation. Community health practitioners and policymakers should continue to collect data on sexual orientation in order to identify and address root causes of sexual orientation-based disparities, particularly at the community-level.

Keywords

Health disparities Sexual orientation LGBT health 

Notes

Compliance with Ethical Standards

Conflict of interest

The authors have no funding sources or conflicts of interest to disclose.

References

  1. 1.
    Institute of Medicine (2011). The health of lesbian, gay, bisexual, and transgender people: Building a foundation for better understanding. Washington, DC: The National Academies Press.Google Scholar
  2. 2.
    Healthy People 2020 (2016). Lesbian, gay, bisexual, and transgender health. http://www.healthypeople.gov/2020/topics-objectives/topic/lesbian-gay-bisexual-and-transgender-health. Accessed Feb 17, 2016.
  3. 3.
    Gonzales, G., Przedworski, J., Henning-Smith, C. (2016). Comparison of health and health risk factors between lesbian, gay, and bisexual adults and heterosexual adults in the United States. JAMA Internal Medicine. doi: 10.1001/jamainternmed.2016.3432.PubMedGoogle Scholar
  4. 4.
    Elliott, M. N., Kanouse, D. E., Burkhart, Q., et al. (2015). Sexual minorities in England have poorer health and worse health care experiences: A national survey. Journal of General Internal Medicine: Official Journal of the Society for Research and Education in Primary Care Internal Medicine, 30(1), 9–16. doi: 10.1007/s11606-014-2905-y.CrossRefGoogle Scholar
  5. 5.
    Hatzenbuehler, M. L., O’Cleirigh, C., Grasso, C., Mayer, K., Safren, S., & Bradford, J. (2012). Effect of same-sex marriage laws on health care use and expenditures in sexual minority men: A quasi-natural experiment. American Journal of Public Health, 102(2), 285–291. doi: 10.2105/AJPH.2011.300382.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Fredriksen-Goldsen, K. I., Cook-Daniels, L., Kim, H. J., et al. (2014). Physical and mental health of transgender older adults: An at-risk and underserved population. The Gerontologist, 54(3), 488–500. doi: 10.1093/geront/gnt021.CrossRefPubMedGoogle Scholar
  7. 7.
    Meyer, I. H., & Wilson, P. A. (2009). Sampling lesbian, gay, and bisexual populations. Journal of Counseling Psychology, 56(1), 23–31. doi: 10.1037/a0014587.CrossRefGoogle Scholar
  8. 8.
    Sanchez, J. P., Meacher, P., & Beil, R. (2005). Cigarette smoking and lesbian and bisexual women in the Bronx. Journal of Community Health, 30(1), 23–37. doi: 10.1007/s10900-004-6093-2.CrossRefPubMedGoogle Scholar
  9. 9.
    Sánchez, J. P., Hailpern, S., Lowe, C., & Calderon, Y. (2007). Factors associated with emergency department utilization by urban lesbian, gay, and bisexual individuals. Journal of Community Health, 32(2), 149–156. doi: 10.1007/s10900-006-9037-1.CrossRefPubMedGoogle Scholar
  10. 10.
    Dale, S. K., Bogart, L. M., Galvan, F. H., Wagner, G. J., Pantalone, D. W., & Klein, D. J. (2016). Discrimination and hate crimes in the context of neighborhood poverty and stressors among HIV-positive African–American men who have sex with men. Journal of Community Health, 41(3), 574–583. doi: 10.1007/s10900-015-0132-z.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Liu, H., Reczek, C., & Brown, D. (2013). Same-sex cohabitors and health: The role of race-ethnicity, gender, and socioeconomic status. Journal of Health and Social Behavior, 54(1), 25–45. doi: 10.1177/0022146512468280.CrossRefPubMedGoogle Scholar
  12. 12.
    Reczek, C., Kiu, H., & Brown, D. (2014). Cigarette smoking in same-sex and different-sex unions: The role of socioeconomic and psychological factors. Population Research Policy Review, 33(4), 527–551. doi: 10.1007/s11113-013-9297-2.CrossRefPubMedGoogle Scholar
  13. 13.
    Gonzales, G., & Henning-Smith, C. (2015). Disparities in health and disability among older adults in same-sex cohabiting relationships. Journal of Aging and Health, 27(3), 432–453. doi: 10.1177/0898264314551332.CrossRefPubMedGoogle Scholar
  14. 14.
    Gonzales, G., & Blewett, L. A. (2014). National and state-specific health insurance disparities for adults in same-sex relationships. American Journal of Public Health 104(2):e95–e104.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Cochran, S. D., & Mays, V. M. (2011). Sexual orientation and mortality among US men aged 17 to 59 years: Results from the National Health and Nutrition Examination Survey III. American Journal of Public Health, 101(6), 1133–1138. doi: 10.2105/AJPH.2010.300013.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Matthews, D. D., & Lee JGL (2014). A profile of North Carolina lesbian, gay, and bisexual health disparities, 2011. American Journal of Public Health, 104(6), 98–105. doi: 10.2105/AJPH.2013.301751.CrossRefGoogle Scholar
  17. 17.
    Conron, K. J., Mimiaga, M. J., & Landers, S. J. (2010). A population-based study of sexual orientation identity and gender differences in adult health. American Journal of Public Health, 100(10), 1953–1960. doi: 10.2105/AJPH.2009.174169.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Blosnich, J. R., Farmer, G. W., Lee JGL, Silenzio VMB, & Bowen, D. J. (2014). Health inequalities among sexual minority adults. American Journal of Preventive Medicine, 46(4), 337–349. doi: 10.1016/j.amepre.2013.11.010.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Ward, B. W., Dahlhamer, J. M., Galinsky, A.M., Joestl, S.S. (2014). Sexual orientation and health among U.S. adults: National Health Interview Survey, 2013. National Health Statistical Report. 2(77):1–12. http://www.ncbi.nlm.nih.gov/pubmed/25025690.
  20. 20.
    Jackson, C. L., Agénor, M., Johnson, D. A., Austin, S. B., & Kawachi, I. (2016). Sexual orientation identity disparities in health behaviors, outcomes, and services use among men and women in the United States: A cross-sectional study. BMC Public Health, 16(807), 1–11. doi: 10.1186/s12889-016-3467-1.Google Scholar
  21. 21.
    The Health of Lesbian (2014). Behavioral Risk Factor Surveillance System summary data quality report. https://www.cdc.gov/brfss/annual_data/annual_2014.html. Published 2015.
  22. 22.
    Centers for Disease Control and Prevention (2015). Behavioral Risk Factor Surveillance System summary data quality report. https://www.cdc.gov/brfss/annual_data/annual_2015.html. Published 2015. Accessed April 12, 2017.
  23. 23.
    Sell R, Holliday M.(2014) Sexual orientation data collection policy in the United States: Public health malpractice. American Journal of Public Health. doi: 10.2105/AJPH.2013.301814 Google Scholar
  24. 24.
    Dilley, J. A., Simmons, K. W., Boysun, M. J., Pizacani, B. A., & Stark, M. J. (2010). Demonstrating the importance and feasibility of including sexual orientation in public health surveys: Health disparities in the Pacific Northwest. American Journal of Public Health, 100(3), 460–467. doi: 10.2105/AJPH.2007.130336.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Kim, H. J., & Fredriksen-Goldsen, K. I. (2013). Nonresponse to a question on self-identified sexual orientation in a public health survey and its relationship to race and ethnicity. American Journal of Public Health, 103(1), 67–69. doi: 10.2105/AJPH.2012.300835.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    VanKim, N. A., Padilla, J. L., Lee JGL, & Goldstein, A. O. (2010). Adding sexual orientation questions to statewide public health surveillance: New Mexico’s experience. American Journal of Public Health, 100(12), 2392–2396. doi: 10.2105/AJPH.2009.186270.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Meyer, I. H. (1995). Minority stress and mental health in gay men. Journal of Health and Social Behavior, 36(1), 38–56.CrossRefPubMedGoogle Scholar
  28. 28.
    Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5), 674–697. doi: 10.1037/0033-2909.129.5.674.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Hatzenbuehler, M. L., Nolen-Hoeksema, S., & Erickson, S. J. (2008). Minority stress predictors of HIV risk behavior, substance use, and depressive symptoms: Results from a prospective study of bereaved gay men. Heal Psychol, 27(4), 455–462. doi: 10.1037/0278-6133.27.4.455.CrossRefGoogle Scholar
  30. 30.
    Hatzenbuehler, M. L. (2009). How does sexual minority stigma “get under the skin”? A psychological mediation framework. Psychological Bulletin, 135(5), 707–730. doi: 10.1037/a0016441.How.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Grant, J. M., Mottett, L. A., Tanis, J., Harrison, J., Herman, J. L., & Keisling, M. (2011). Injustice at every turn: A report of the national transgender discrimination survey. Washington, DC: National Center for Transgender Equality and National Gay and Lesbian Task Force. doi: 10.1016/S0016-7878(90)80026-2.Google Scholar
  32. 32.
    Rizer, A. M., Mauery, D. R., Haynes, S. G., Couser, B., & Gruman, C. (2015). Challenges in intervention research for lesbian and bisexual women. LGBT Health, 2(2), 105–112. doi: 10.1089/lgbt.2014.0122.CrossRefPubMedGoogle Scholar
  33. 33.
    Seelman, K. L., Adams, M. A., & Poteat, T. (2016). Interventions for healthy aging among mature Black lesbians: recommendations gathered through community-based research. Journal of Women & Aging, 0(0), 1–13. doi: 10.1080/08952841.2016.1256733.Google Scholar
  34. 34.
    McElroy, J. A., Washington, K. T., Wintemberg, J. J., Williams, A., & Redman, S. D. (2016). “I have to age in this body”: Lesbian and bisexual older women’s perspectives on a health behavior intervention. Women’s Health Issues (National Council of State Boards of Nursing (U. S.)), 26(1), S63–S70. doi: 10.1016/j.whi.2016.03.011.CrossRefGoogle Scholar
  35. 35.
    Fogel, S. C., McElroy, J. A., Garbers, S., et al. (2016). Program design for healthy weight in lesbian and bisexual women: A ten-city prevention Initiative. Women’s Health Issues (National Council of State Boards of Nursing (U. S.)), 26, S7–S17. doi: 10.1016/j.whi.2015.10.005.CrossRefGoogle Scholar
  36. 36.
    Mayberry, R. M., Daniels, P., Akintobi, T. H., Yancey, E. M., Berry, J., & Clark, N. (2008). Community-based organizations’ capacity to plan, implement, and evaluate success. Journal of Community Health, 33(5), 285–292. doi: 10.1007/s10900-008-9102-z.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Centers for Disease Control and Prevention (2017). SMART: BRFSS City and County Data and Documentation. https://www.cdc.gov/brfss/smart/smart_data.htm. Accessed April 12, 2017.
  38. 38.
    Daniel, H., & Butkus, R. (2015). Lesbian, gay, bisexual, and transgender health disparities: Executive summary of a policy position paper from the American College of Physicians. Annals of Internal Medicine, 163(2), 135–137. doi: 10.7326/M14-2482.CrossRefPubMedGoogle Scholar
  39. 39.
    Jenkins, I. H. (2016). Reflections on marriage equality. Annals of Internal Medicine, 164(2), 129. doi: 10.7326/M15-1687.CrossRefPubMedGoogle Scholar
  40. 40.
    Gonzales, G., & Henning-Smith, C. (2017). The Affordable Care Act and health insurance coverage for lesbian, gay, and bisexual adults: Analysis of the Behavioral Risk Factor Surveillance System. LGBT Health, 4(1), 62–67. doi: 10.1089/lgbt.2016.0023.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  1. 1.Department of Health PolicyVanderbilt University School of MedicineNashvilleUSA
  2. 2.Division of Health Policy and ManagementUniversity of Minnesota School of Public HealthMinneapolisUSA

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