Association for Public Policy Analysis & Management

Importance: Prior studies have identified disparities in health and access to care for lesbian, gay and bisexual (LGB) adults, but previous research has been limited in size and scope. Ongoing discourse surrounding same-sex marriage also requires a closer examination on how marriage influences health among LGB adults.

Objective: The objectives of this study were to estimate disparities in health and access to care for LGB adults in the United States and to investigate how marriage shapes health in LGB populations.

Design, Setting, and Participants:Data from the 2013 National Health Interview Survey (NHIS) were used to analyze and compare health outcomes, health behaviors and access to health care among a nationally representative sample of lesbian, gay and bisexual adults (n=775) aged 18 years and older and their heterosexual peers (n=32,529).

Results:Gay men were more likely to report heart disease (OR, 1.64; 95% CI, 1.02-2.64), cigarette smoking (OR, 1.70; 95% CI, 1.02-2.81) and unmet dental care due to cost (OR, 1.59; 95% CI, 1.05-2.42) compared to heterosexual men. Bisexual men exhibited greater odds of severe psychological distress (OR, 5.36; 95% CI, 1.33-21.53) and fair/poor health (OR, 2.41; 95% CI, 1.07-5.45). Lesbian women were more likely to report obesity (OR, 1.83; 95% CI, 1.21-2.76) and no usual source of care (OR, 1.81; 95% CI, 1.13-2.87). Bisexual women exhibited greater odds of chronic obstructive pulmonary disease (OR, 2.46; 95% CI, 1.29-4.71) and unmet mental health care due to cost (OR, 2.89; 95% CI, 1.45-5.77). Differences in health behaviors, mental health and access to care diminished when stratifying adults to those who were married.

Conclusions and Relevance: This study confirms significant disparities in health and access to health care for LGB adults. Health care providers should anticipate health differentials when providing care to sexual minority patients. Findings from this study also provide early evidence supporting policy statements by the American Medical Association endorsing same-sex marriage as a non-medical policy intervention for improving health and access to health care.