LGBTQ and health disparities: What you should know
Members of the LGBTQ+ (lesbian, gay, bisexual, transgender and queer) community face unique healthcare challenges and health disparities. To promote health equity in this population, the general public and healthcare professionals must know more about health disparities among LGBTQ people and work to be allies in improving these concerns.
Reasons behind health disparities in the LGBTQ community
Members of the LGBTQ community experience health disparities for several reasons related to limitations to healthcare access and ongoing discrimination.
LGBTQ individuals have historically had lower rates of access to healthcare insurance than heterosexual individuals, related to an inability to access spousal employer-sponsored insurance and general disparities in employment due to discrimination.
While the number of uninsured LGBTQ people has decreased in response to the Affordable Care Act and the passage of same-sex marriage, the usage of healthcare services is lower in the LGBTQ community. Surveys show that some LGBTQ individuals may not access healthcare due to experiencing discrimination upon disclosing their identity or healthcare providers not having adequate training to deal with LGBTQ-specific concerns.
As a result, access to preventative care and regular screenings for health issues is lower and can increase the risk of certain chronic conditions.
Health disparities faced by LGBTQ+
Sexually transmitted infections (STIs)
One of the most significant LGBTQ+ health disparities is in the rates of STIs. Research finds that men who have sex with men (including gay, bisexual or another sexuality that includes same-gender sex) have an increased risk for STIs, including HIV, syphilis and gonorrhea. Transgender women are also at higher risk for HIV than the general U.S. population.
Substance abuse
LGBTQ individuals are more likely to report the use of marijuana, opioid misuse, alcohol use disorder, vaping and tobacco products, often as a coping mechanism to deal with stress.
Notably, research finds that the intersectionality of identities has a role in substance use disparities. Data from the 2015-2018 National Survey on Drug Use and Health found that disparities in cigarette smoking, heavy drinking and marijuana use were higher in LGBTQ women compared to heterosexual women. Within this group, Black and Hispanic LGBTQ women had higher disparities than white LGBTQ women.
Mental health conditions
LGBTQ individuals may experience more mental health issues starting in childhood related to emotional distress, identity concealment, internalized homophobia, ongoing discrimination and victimization. Studies find that LGBTQ individuals report higher rates of depression, anxiety, suicidal ideation and suicide attempts compared to heterosexual individuals.
These mental health disparities are also compounded by limited access to insurance or mental health providers trained to address LGBTQ concerns.
Higher cancer risk
The data about cancer risk in the LGBTQ community is limited, but recent studies have found that this community might be at elevated risk of a cancer diagnosis. According to the 2013-2016 National Health Interview Survey, gay men had a 50% increase in reporting a diagnosis of cancer when compared to other groups of similar age. The same survey found that bisexual women had a 70% increase.
There are many barriers to care that may account for this disparity in cancer risk, including lack of insurance, competence among clinicians in handling LGBTQ concerns, and discrimination which leads to avoiding or delaying care. All of these barriers can lead to inadequate cancer screening or appropriate treatment.
Eating disorders
LGBTQ adults and adolescents face higher rates of eating disorders and disordered eating patterns than their heterosexual counterparts. A portion of this LGBTQ health disparity is related to stigma, discrimination, mental health and general media.
Specific to the LGBTQ community, physical appearance stereotypes associated with certain sexual or gender identities can lead to disordered eating practices to meet an “ideal body type” for acceptance within the community.
Among transgender individuals, some may engage in disordered eating habits as an unhealthy mechanism to deal with body dysmorphia or socially align with their gender. Research finds that individuals may strive to lose or gain weight to feminize or masculinize their bodies to fit their gender identity.
Heart disease
When it comes to LGBTQ health disparities, heart disease may not be the first to come to mind, but LGBTQ adults are at higher risk for experiencing cardiovascular disease (CVD) compared to heterosexual adults.
A recent scientific statement from the American Heart Association examined the recent data on the risk of heart disease in the LGBTQ community. They identified that stress and discrimination due to sexual or gender identity increased the risk of developing CVD. Some behavioral risk factors were higher in LGBTQ adults, too. These risk factors include a higher prevalence of tobacco use, diabetes, elevated BMI, poor sleep, substance use and poor mental health.
Certain medications used for hormone therapy may also increase the risk of cardiovascular disease.
Health concerns among LGBTQ youths
While health disparities are a concern for adults, LGBTQ youths are especially vulnerable to many of these issues.
LGBTQ youths are at increased risk of being impacted by mental health and physical conditions. Mental health concerns may arise due to bullying, rejection, isolation, substance abuse, or unidentified undertreated mental health concerns. The youths in this community are also at risk of physical health concerns, such as cardiovascular disease, cancer and STDs.
Youths might be hesitant to seek help due to stigma and discrimination.
Visiting an Urgent Care
Urgent care centers, through our health system partners, have health professionals who are trained to support members of the LGBTQ community in addressing their unique health concerns. We are available seven days a week in our well-equipped medical facilities to provide the right healthcare options for you. Find a center here.
References
https://aspe.hhs.gov/reports/health-insurance-coverage-lgbtq
Macapagal K, Bhatia R, Greene GJ. Differences in Healthcare Access, Use, and Experiences Within a Community Sample of Racially Diverse Lesbian, Gay, Bisexual, Transgender, and Questioning Emerging Adults. LGBT Health. 2016;3(6):434-442. doi:10.1089/lgbt.2015.0124
https://www.cdc.gov/std/statistics/2021/
Pitasi MA, Clark HA, Chavez PR, DiNenno EA, Delaney KP. HIV Testing and Linkage to Care Among Transgender Women Who Have Sex with Men: 23 U.S. Cities. AIDS Behav. 2020;24(8):2442-2450. doi:10.1007/s10461-020-02804-6
https://nida.nih.gov/research-topics/substance-use-suds-in-lgbtq-populations
Felner JK, Wisdom JP, Williams T, et al. Stress, Coping, and Context: Examining Substance Use Among LGBTQ Young Adults With Probable Substance Use Disorders. Psychiatr Serv. 2020;71(2):112-120. doi:10.1176/appi.ps.201900029
Schuler MS, Prince DM, Breslau J, Collins RL. Substance Use Disparities at the Intersection of Sexual Identity and Race/Ethnicity: Results from the 2015-2018 National Survey on Drug Use and Health. LGBT Health. 2020;7(6):283-291. doi:10.1089/lgbt.2019.0352
Moagi MM, van Der Wath AE, Jiyane PM, Rikhotso RS. Mental health challenges of lesbian, gay, bisexual and transgender people: An integrated literature review. Health SA. 2021;26:1487. Published 2021 Jan 20. doi:10.4102/hsag.v26i0.1487
Parker LL, Harriger JA. Eating disorders and disordered eating behaviors in the LGBT population: a review of the literature. J Eat Disord. 2020;8:51. Published 2020 Oct 16. doi:10.1186/s40337-020-00327-y
Nagata JM, Ganson KT, Austin SB. Emerging trends in eating disorders among sexual and gender minorities. Curr Opin Psychiatry. 2020;33(6):562-567. doi:10.1097/YCO.0000000000000645
Caceres BA, Streed CG Jr, Corliss HL, et al. Assessing and Addressing Cardiovascular Health in LGBTQ Adults: A Scientific Statement From the American Heart Association. Circulation. 2020;142(19):e321-e332. doi:10.1161/CIR.0000000000000914
https://www.cdc.gov/healthyyouth/disparities/health-disparities-among-lgbtq-youth.htm
Gonzales, G., & Zinone, R. (2018). Cancer diagnoses among lesbian, gay, and bisexual adults: results from the 2013-2016 National Health Interview Survey. Cancer Causes & Control: CCC, 29(9), 845–854.
https://www.aacr.org/blog/2021/01/26/aacr-conference-examines-cancer-disparities-in-the-lgbtq-population/