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July 27, 2021

Report Illuminates Health Care–Related Challenges Faced by LGBT+ Adults

Author Affiliations
  • 1Consulting Editor, JAMA Health Forum and JAMA
JAMA Health Forum. 2021;2(7):e212685. doi:10.1001/jamahealthforum.2021.2685

LGBT+ people are more likely than non-LGBT+ people to report being in fair or poor health and having higher rates of ongoing health conditions and disability, according to a new report from the Kaiser Family Foundation. LGBT+ individuals also are more likely to have negative experiences in encounters with clinicians, such as having their concerns dismissed, the report notes.

The report’s authors analyzed data from a Kaiser Family Foundation survey to compare the experiences of self-identified LGBT+ adults with those of their non-LGBT+ counterparts. “Understanding the health care needs and experiences of the more than 11 million LGBT people in the United States is important for addressing barriers and facilitating access to care and coverage,” they wrote.

Despite improvement in the collection of data on LGBT+ people, the practice is still not standard, and lack of research regarding these individuals’ health status and needs and access to health care “limits the ability of those in both policy and health care sectors to address health needs and disparities within the population,” the report says.

To address this knowledge gap, the researchers analyzed newly available data from the 2020 Kaiser Women’s Health Survey to compare the experiences of self-identified LGBT+ adults with those of non-LGBT+ adults. This survey of a nationally representative sample of 4800 people aged 18 to 64 years, including 492 LGBT+ individuals, featured measures of sexual orientation, gender identity, other demographic factors and asked about multiple health-related issues, including experiences engaging with the health system and the effects of the COVID-19 pandemic.

Compared with their non-LGBT+ counterparts, LGBT+ adults have demographic differences that might have implications for their health needs and access to care, the researchers found. The LGBT+ respondents were younger (59% were aged 18 to 35 years vs 38% of non-LGBT+ adults), had lower incomes (34% reported incomes below 200% of the federal poverty level vs 25% of non-LGBT+ adults), and were less likely to be married (23% vs 48%).

Despite being a younger population, a higher proportion of LGBT+ individuals reported having only fair or poor health (23%) compared with non-LGBT+ individuals (14%), and the latter more commonly reported good or excellent health (86% vs 77%). In addition, a higher proportion of LGBT+ individuals said they have chronic health conditions requiring regular monitoring, care, or medication (47% vs 40%).

In terms of access to health care, LGBT+ and non-LGBT+ respondents were equally likely (81% vs 82%) to have a regular place to receive health care, such as a physician’s office, a health center clinic, or an urgent care center. Most LGBT+ individuals (72%) and non-LGBT+ people (78%) reported having a regular physician or other clinician, such as a physician assistant or nurse practitioner, to go to when they need care.

However, despite having regular sources and sites of care similar to those of non-LGBT+ people, LGBT+ individuals report experiences in accessing care that are sometimes more challenging. More than 1 in 3 (36%) reported having a negative experience with a clinician compared with about 1 in 5 (22%) of non-LGBT+ individuals.

Specifically, compared with non-LGBT+ individuals, LGBT+ patients were more likely to report encounters with clinicians who dismissed their concerns (29% vs 16%), assumed something about them without asking (21% vs 11%), did not believe they were telling the truth (16% vs 8%), or suggested they were personally to blame for a health problem (13% vs 8%).

When asked about their experiences with the COVID-19 pandemic and health care, both groups reported missing or delaying care, but a greater share of LGBT+ individuals (22%) than non-LGBT+ (13%) individuals reported that their health worsened as a result. LGBT+ patients were twice as likely to say they sought mental health care because of the pandemic (24% vs 12%).

Health care costs were more likely to pose a problem for LGBT+ patients compared with their non-LGBT+ counterparts. “LGBT+ people report having problems with health care costs at higher rates than non-LGBT+ people, including those related to medical bills and other insurance costs, potentially reflecting both lower incomes and higher health needs,” the authors note.

About 30% of LGBT+ individuals reported that they or a household family member had difficulty paying medical bills in the past year (vs 19% of non-LGBT+ individuals), a trend that was especially pronounced among LGBT+ adults aged 18 to 44 years or those who said they are in poorer health and that may be correlated with income, the report said. Among the 3 in 10 LGBT+ individuals who had trouble paying their medical bills in the past 12 months, the majority (58%) said that it was at least partly the result of the COVID-19 pandemic.

The authors note that understanding the health care needs and experiences of LGBT+ people in the US is important for addressing barriers and improving access to care and coverage.

“Given LGBT+ people’s common experiences with stigma, discrimination, and violence in a range of environments (eg, home, work, school, health care, etc) and the evolving legal protections based on sexual orientation and gender identity, collecting this data is especially important in furthering goals of equity and access,” they wrote.

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Article Information

Published: July 27, 2021. doi:10.1001/jamahealthforum.2021.2685

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Stephenson J. JAMA Health Forum.

Corresponding Author: Joan Stephenson, PhD, Consulting Editor, JAMA Health Forum (Joan.Stephenson@jamanetwork.org).

Conflict of Interest Disclosures: None reported.

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