Abstract
A large body of research has documented disparities in health and access to care for lesbian, gay, and bisexual (LGB) people in the United States. Less research has examined how the level of legal protection afforded to LGB people (the state policy environment) affects health disparities for sexual minorities. This study used data on 14,687 sexual minority adults and 490,071 heterosexual adults from the 2014–2016 Behavioral Risk Factor Surveillance System to document differences in health. Unadjusted state-specific prevalence estimates and multivariable logistic regression models were used to compare poor/fair self-rated health by gender, sexual minority status, and state policy environments (comprehensive versus limited protections for LGB people). We found disparities in self-rated health between sexual minority adults and heterosexual adults in most states. On average, sexual minority men in states with limited protections and sexual minority women in states with either comprehensive or limited protections were more likely to report poor/fair self-rated health compared to their heterosexual counterparts. This study adds new findings on the association between state policy environments and self-rated health for sexual minorities and suggests differences in this relationship by gender. The associations and impacts of state-specific policies affecting LGB populations may vary by gender, as well as other intersectional identities.
Highlights
Numerous studies have documented wide disparities in health status for sexual minorities, or gay, lesbian, bisexual (LGB), and other nonheterosexual populations [1,2,3,4,5,6,7]
Sexual minorities are more likely to report worse health status compared to their heterosexual counterparts due to, in part, “minority stress”, which is the additional stress sexual minorities experience associated with being a member of a marginalized community [10,11,12,13]
Consistent with prior studies [31], sexual minority men were more likely to be younger, racially and ethnically diverse, and college graduates
Summary
Numerous studies have documented wide disparities in health status for sexual minorities, or gay, lesbian, bisexual (LGB), and other nonheterosexual populations [1,2,3,4,5,6,7]. Sexual minorities experience barriers to routine medical care. Numerous studies have noted higher levels of uninsurance and reports of financial barriers to care for LGB people compared with their heterosexual peers [8,9]. Many employers historically did not cover same-sex spouses of sexual minority workers—leaving some LGB individuals without health care benefits. Previous research has noted that sexual minorities living in states without legal protections (e.g., same-sex marriage) were more likely to report symptoms of depression, anxiety, and alcohol use disorder [14,15]
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