New Study on Differences in Health by Sexual Orientation

Questions for Kevin Heslin, Health Statistician and Lead Author of “Sexual Orientation Differences in Access to Care and Health Status, Behaviors, and Beliefs: Findings from the National Health and Nutrition Examination Survey, National Survey of Family Growth, and National Health Interview Survey.”

Q: Why did you decide to do this report?

KH: Lesbian, gay, and bisexual (LGB) people have historically been underrepresented in national health surveillance systems, which has limited efforts to identify disparities in population health status and access to care by sexual orientation. However, the National Center for Health Statistics (NCHS) has included measures of sexual orientation in three nationally representative data systems for a number of years: National Health and Nutrition Examination Survey (NHANES), the National Survey of Family Growth (NSFG), and the National Health and Interview Survey (NHIS). These three surveys have complementary strengths that, when brought together in a single analysis, can provide a more KHThis is the first report to bring together national health statistics from three NCHS data systems for the purpose of analyzing these data by sexual identity. We wanted to show the breadth of topics that can be studied by researchers using NCHS data about the health of lesbian, gay, and bisexual (LGB) people.

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Q: What did you find in your analysis?

KH: To a few, the analyses found that the association with sexual identity differed between men and women for several measures of health and access to care.

• Mean body weight was lower in gay men than heterosexual men, but higher in lesbian and bisexual women than heterosexual women.
  • Gay men were more likely than heterosexual men to have received treatment for an STD in the previous 12 months, while lesbian women were less likely than heterosexual women to have received STD treatment in the last year.
  • Gay men reported having a usual place of medical care more often than heterosexual men. In contrast, both lesbian and bisexual women reported having this type of health care access less often than heterosexual women.
• Other health measures showed similar associations according to LGB sexual orientation.
  • NHIS data showed that lesbian, gay, and bisexual adults all reported that they couldn’t afford common health services more often than heterosexual adults.
  • Bisexual men and women, gay men, and lesbian women all reported smoking and heavy drinking (NHIS) and using marijuana and illicit stimulants (NSFG) more often than heterosexual people.
• There was some consistency in related health measures across the different data systems.
  • NHIS data showed that lesbian and bisexual women had higher lifetime prevalence of three conditions associated with overweight or obesity—diabetes, heart disease, and hypertension. These NHIS findings are consistent with findings from the NHANES physical examinations showing higher average body weight, waist circumference, and BMI in lesbian and bisexual women than heterosexual women.

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Q: Is it fair to say that LGB people have more health problems and access to care problems than heterosexual people?

KH: There were some health measures that showed similar associations according to LGB sexual orientation. For instance, NHIS data showed that lesbian, gay, and bisexual adults all reported that they couldn’t afford common health services more often than heterosexual adults.

One of the strengths of this report was the stratification by sex. These findings suggest that the association of sexual identity with some indicators of health and access to care is different for men and women, which may have implications for the development of health programs and policies to reduce sexual orientation disparities and promote health equity. The results of this report also underscore how important it is to keep the bisexual and gay or lesbian categories separate in these kinds of analyses – in contrast to creating an overarching “sexual minority and heterosexual” categorization. Bisexual people were different from their gay or lesbian and heterosexual counterparts on several health indicators.

Additionally, there are other health problems and access to care problems that were beyond the scope of this report.

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Q: What is the take-home message from this report?

KH: NHANES, NHIS, and NSFG enable research on topics relevant to the health of LGB people, which may inform efforts to advance health equity by focusing on disparities by sexual orientation.

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Q: Are there plans for any follow-up research that looks into these issues further?

KH: NCHS data can support further health research relevant to LGB people. We analyzed a wide range of health-related topics in this report, but there’s more data and topics within all of these surveys to further advance health research.  These resources can help to monitor progress toward the goal of improving the health, safety, and well-being of LGB people.