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      Inequalities in lesbian, gay, bisexual, and transgender (LGBT) health and health care access and utilization in Wisconsin

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          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

          • LGBT individuals were more likely to report having fair/poor health than non-LGBT.
          • LGB individuals were more likely to delay health care than non-LGB individuals.
          • Trans respondents were more likely to report poor quality of care than non-LGBT.

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          Most cited references 19

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          Socioeconomic disparities in health in the United States: what the patterns tell us.

          We aimed to describe socioeconomic disparities in the United States across multiple health indicators and socioeconomic groups. Using recent national data on 5 child (infant mortality, health status, activity limitation, healthy eating, sedentary adolescents) and 6 adult (life expectancy, health status, activity limitation, heart disease, diabetes, obesity) health indicators, we examined indicator rates across multiple income or education categories, overall and within racial/ethnic groups. Those with the lowest income and who were least educated were consistently least healthy, but for most indicators, even groups with intermediate income and education levels were less healthy than the wealthiest and most educated. Gradient patterns were seen often among non-Hispanic Blacks and Whites but less consistently among Hispanics. Health in the United States is often, though not invariably, patterned strongly along both socioeconomic and racial/ethnic lines, suggesting links between hierarchies of social advantage and health. Worse health among the most socially disadvantaged argues for policies prioritizing those groups, but pervasive gradient patterns also indicate a need to address a wider socioeconomic spectrum-which may help garner political support. Routine health reporting should examine socioeconomic and racial/ethnic disparity patterns, jointly and separately.
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            A population-based study of sexual orientation identity and gender differences in adult health.

            We provide estimates of several leading US adult health indicators by sexual orientation identity and gender to fill gaps in the current literature. We aggregated data from the 2001-2008 Massachusetts Behavioral Risk Factor Surveillance surveys (N = 67,359) to examine patterns in self-reported health by sexual orientation identity and gender, using multivariable logistic regression. Compared with heterosexuals, sexual minorities (i.e., gays/lesbians, 2% of sample; bisexuals, 1%) were more likely to report activity limitation, tension or worry, smoking, drug use, asthma, lifetime sexual victimization, and HIV testing, but did not differ on 3-year Papanicolaou tests, lifetime mammography, diabetes, or heart disease. Compared with heterosexuals, bisexuals reported more barriers to health care, current sadness, past-year suicidal ideation, and cardiovascular disease risk. Gay men were less likely to be overweight or obese and to obtain prostate-specific antigen tests, and lesbians were more likely to be obese and to report multiple risks for cardiovascular disease. Binge drinking and lifetime physical intimate partner victimization were more common among bisexual women. Sexual orientation disparities in chronic disease risk, victimization, health care access, mental health, and smoking merit increased attention. More research on heterogeneity in health and health determinants among sexual minorities is needed.
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              Experiences of transgender-related discrimination and implications for health: results from the Virginia Transgender Health Initiative Study.

              We examined relationships between social determinants of health and experiences of transgender-related discrimination reported by transgender people in Virginia. In 2005 through 2006, 387 self-identified transgender people completed a statewide health needs assessment; 350 who completed eligibility questions were included in this examination of factors associated with experiences of discrimination in health care, employment, or housing. We fit multivariate logistic regression models using generalized estimating equations to adjust for survey modality (online vs paper). Of participants, 41% (n = 143) reported experiences of transgender-related discrimination. Factors associated with transgender-related discrimination were geographic context, gender (female-to male spectrum vs male-to-female spectrum), low socioeconomic status, being a racial/ethnic minority, not having health insurance, gender transition indicators (younger age at first transgender awareness), health care needed but unable to be obtained (hormone therapy and mental health services), history of violence (sexual and physical), substance use health behaviors (tobacco and alcohol), and interpersonal factors (family support and community connectedness). Findings suggest that transgender Virginians experience widespread discrimination in health care, employment, and housing. Multilevel interventions are needed for transgender populations, including legal protections and training for health care providers.
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                Author and article information

                Contributors
                Journal
                Prev Med Rep
                Prev Med Rep
                Preventive Medicine Reports
                Elsevier
                2211-3355
                01 April 2019
                June 2019
                01 April 2019
                : 14
                Affiliations
                [a ]Department of Population Health Sciences, University of Wisconsin-Madison, Wisconsin Alumni Research Foundation, Madison, WI, USA
                [b ]Department of Gender and Women's Studies, University of Wisconsin-Madison, Madison, WI, USA
                Author notes
                [* ]Corresponding author at: Department of Population Health Sciences, University of Wisconsin-Madison, Wisconsin Alumni Research Foundation, 610 Walnut St., Madison, WI 53726, USA. Jjennings2@ 123456show.wisc.edu Jjennings2@ 123456wisc.edu
                Article
                S2211-3355(19)30049-X 100864
                10.1016/j.pmedr.2019.100864
                6465572
                31011518
                © 2019 The Authors

                This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

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