Introduction
Although population studies have documented the poorer health outcomes of sexual minorities, few have taken an intersectionality approach to examine how sexual orientation, gender, and race jointly affect these outcomes. Moreover, little is known about how behavioral risks and healthcare access contribute to health disparities by sexual, gender, and racial identities.
Methods
Using ordered and binary logistic regression models in 2015, data from the 2013 and 2014 National Health Interview Surveys (N=62,302) were analyzed to study disparities in self-rated health and functional limitation. This study examined how gender and race interact with sexual identity to create health disparities, and how these disparities are attributable to differential exposure to behavioral risks and access to care.
Results
Conditional on sociodemographic factors, all sexual–gender–racial minority groups except straight white women, gay white men, and bisexual non-white men reported worse self-rated health than straight white men (p<0.05). Some of these gaps were attributable to differences in behaviors and healthcare access. All female groups, as well as gay non-white men, were more likely to report a functional limitation than straight white men (p<0.05), and these gaps largely remained when behavioral risks and access to care were accounted for. The study also discusses health disparities within sexual–gender–racial minority groups.
Conclusions
Sexual, gender, and racial identities interact with one another in a complex way to affect health experiences. Efforts to improve sexual minority health should consider heterogeneity in health risks and health outcomes among sexual minorities.
Economic development strategies aimed at attracting highly skilled workers through investment in urban amenities are gaining momentum throughout the United States. However, most of the foundational research for the approach was tested in very large cities, both in the United States and abroad. Based on quality of place (QOP) variables suggested from previous research, confirmatory factor analysis was used to generate a set of factors for a selection of small and midsized U.S. cities, and linear regression was used to relate these factors to the presence of college-educated populations, younger college-educated populations, and adult population growth. The results indicated that some of the QOP factors associated with better human capital outcomes in prior literature focusing on larger cities were also significant predictors of better human capital outcomes in midsized cities. The relationship between these factors and development outcomes for small cities was much weaker.
Previous studies suggest that members of sexual minority groups have poorer access to health services than heterosexuals. However, few studies have examined how sexual orientation interacts with gender and race to affect health care experience. Moreover, little is known about the role in health care disparities played by economic strains such as unemployment and poverty, which may result from prejudice and discrimination based on sexual orientation. Using data for 2013-15 from the National Health Interview Survey, we found that most members of sexual minority groups no longer have higher uninsurance rates than heterosexuals, but many continue to experience poorer access to high-quality care. Gay nonwhite men, bisexual white women, and bisexual and lesbian nonwhite women are disadvantaged in multiple aspects of access, compared to straight white men. Only some of these disparities are attributable to economic factors, which implies that noneconomic barriers to care are substantial. Our results suggest that the intersection of multiple social identities can reveal important gaps in health care experience. Making culturally sensitive services available may be key to closing the gaps.
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