Abstract
There are known health disparities between lesbian, gay, bisexual and transgender (LGBT) people and non-LGBT people, but only in the past couple of decades have population-based health surveys in the United States included questions on sexual and gender identity. We aimed to better understand LGBT disparities in health, health care access and utilization, and quality of care. Data are from the Survey of the Health of Wisconsin (SHOW) from 2014 to 2016 (n = 1957). The analyses focused on comparing health care access and utilization, and quality of care between LGB and non-LGB people and transgender and cisgender people. 3.8% (n = 73) identified as lesbian, gay or bisexual, and 1.3% (n = 25) were transgender. LGB adults were 2.17 (95th CI: 1.07–4.4) times more likely to delay obtaining health care. Transgender adults were 2.76 (95th CI: 1.64–4.65) times more likely to report poor quality of care and 2.78 (95th CI: 1.10–7.10) unfair treatment when receiving medical care. The results show differences in health care access and utilization and quality of care, and they add to the growing body of literature that suggest that improved health care services for LGBT patients are needed to promote health equity for LGBT populations.
Highlights
Health care access and utilization and quality of care are continuing to improve in the United States, but these improvements are not consistent across states or populations (Agency for Healthcare Research and Quality, 2016)
The results of this study are important because they add to the growing literature on LGBT health disparities and barriers to accessing and utilizing health care services
As we approach 2020, it becomes clear that LGBT health disparities still exist in the United States, and great changes in policy and healthcare delivery are still needed to achieve health equity for LGBT populations
Summary
Health care access and utilization and quality of care are continuing to improve in the United States, but these improvements are not consistent across states or populations (Agency for Healthcare Research and Quality, 2016). There are vast inconsistencies in the questions on sexual and gender identity, and few use the validated questions recommended by the William's Institute: (Bradford et al, 2013) three questions to establish sexual orientation (self-identification of sexual orientation, sexual behavior, and sexual attraction) (Braveman et al, 2010), and a validated two-step question approach to measuring gender identity for population-based surveys (sex-assigned at birth and gender identity) (Centers for Disease Control and Prevention, 2017) This incommensurability prevents surveys from identifying LGBT people with high sensitivity and specificity (Cohen, 2017), which limits our ability to estimate the size of these populations, understand the health disparities, and to address these disparities on an individual, health system, and policy level
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