Research ArticleHealth Inequalities Among Sexual Minority Adults: Evidence from Ten U.S. States, 2010
Introduction
More than 9 million U.S. adults self-identify as lesbian, gay, bisexual, or transgender (LGBT).1 Although health surveillance for transgender people remains scarce,2 accumulating evidence shows that LGB individuals experience several health disparities relative to their heterosexual peers, including a higher prevalence of smoking,3 asthma,4 poor mental health,5, 6 and self-directed violence.6 However, population-based information about LGB individuals is limited for several reasons, including the omission of sexual orientation in most state/federal U.S. health surveillance programs. Although a few state surveillance reports include LGB populations, these have limited generalizability beyond the individual state, and small sample sizes often require data aggregation across multiple years.
Conron and colleagues4 pooled Massachusetts Behavioral Risk Factor Surveillance System (BRFSS) data from 2001 to 2008. Their findings corroborated several LGB health disparities (e.g., smoking, asthma, and weight) and highlighted underexplored areas of potential inequalities (e.g., cardiovascular disease [CVD] risk). By comparing lesbian/gay and bisexual groups separately with their heterosexual peers, several divergent patterns of disparities were noted.
For instance, some indicators (e.g., smoking) were consistently elevated across both lesbian/gay and bisexual individuals while other indicators were not, such as reduced health care access among bisexual persons but not among lesbian/gay persons. In 4 years of pooled BRFSS data from Washington State, Dilley and colleagues7 noted a higher prevalence of smoking among LGB respondents and found that lesbian women and bisexual individuals had less health care coverage.
There are compelling needs for larger and more diverse probability-based studies of LGB populations. For example, both previous BRFSS studies used data aggregated over several years from single states, Massachusetts and Washington, which may be more accepting toward LGB individuals.8 Thus, it is unclear whether these results would generalize to the U.S. adult population. A multi-state approach for examining LGB disparities would greatly improve estimates of LGB disparities and indicate progress toward the Healthy People 2020 goal to improve health among LGBT populations.9
The CDC’s BRFSS is currently the largest federally funded population-based survey.10 Although the national BRFSS has never assessed sexual orientation, 12 U.S. states elected to include sexual identity in their 2010 individual BRFSS surveys. This report compares key health indicators for LGB and heterosexual respondents using 2010 BRFSS data pooled from states that assessed sexual identity.
Section snippets
Survey Data
Individual health departments in all U.S. states, territories, and the District of Columbia administer the BRFSS through computer-assisted telephone interviews with probability-based samples of non-institutionalized adults aged ≥18 years. The CDC creates an annual core survey for all BRFSS samples, and aggregates individual BRFSS data sets to create a national data set with survey weights to adjust for the complex sampling design. Further information about the 2010 BRFSS (N=451,075) is
Results
The weighted prevalence of LGB identity across the ten-state sample was 2.4% (95% CI=2.2, 2.7). Compared with respondents who indicated either LGB or heterosexual identities, those who indicated other, don’t know, or refusal were older. The don’t know and other groups had lower educational attainment. Higher proportions of Hispanic respondents indicated don’t know and refusal.14 No gender differences were observed among the groups. (data not shown).
Discussion
Overall, these findings show a pattern of disparities in general health, mental health, activity limitations owing to health, and substance abuse (i.e., tobacco and alcohol) that corroborate those reported by Conron et al.4 and Dilley et al.7 For instance, higher smoking prevalence is among the most consistently identified health risk disparities for sexual minority individuals,3 and we replicated this finding after disaggregating gender and sexuality. The results also confirmed findings about
Acknowledgments
The authors thank the BRFSS coordinators and support staff from Alaska, Arizona, California, Maine, Massachusetts, Montana, New Mexico, North Dakota, Washington, and Wisconsin for their cooperation in providing individual state data sets.
This work was supported partially by a postdoctoral fellowship to John R. Blosnich in an Institutional National Research Service Award from the National Institute of Mental Health (5T32MH020061) and a predoctoral National Research Service Award to Grant W.
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