Health equity is a fundamental right, yet for many LGBTQ+ individuals, it remains an elusive goal. A growing body of research reveals persistent and troubling disparities in the health outcomes of the LGBTQ+ community compared to the rest of the population. These disparities encompass mental health, physical health, and access to quality care, and have profound implications for the wellbeing of LGBTQ+ children, youth, adults, and seniors.
Below are 4 of the most pressing health disparities facing this at-risk population:
1. Mental Health Disorders
Mental health is an area of particular concern for LGBTQ+ populations. Numerous studies have found that these individuals experience depression, anxiety disorders, and suicidality at significantly higher rates than their peers. For example, one meta-analysis published in BMC Psychiatry found that people who identify as LGBTQ+ were 1.5 times more likely to experience depression and anxiety disorders over their lifetimes.
Mental health disparities are even more pronounced for those who identify as transgender. One study from the Williams Institute at UCLA School of Law found that 81% of transgender adults in the U.S. have thought about suicide, 42% of transgender adults have attempted it, and 56% have engaged in self-harm over their lifetimes.
Researchers believe these struggles are largely rooted in the unique stressors LGBTQ+ people often face, including stigma, discrimination, and social exclusion. For LGBTQ+ youth, bullying and family rejection are further risk factors.
2. Substance Abuse
Closely intertwined with mental health are disparities in substance abuse. Research consistently shows that LGBTQ+ individuals have higher rates of tobacco, alcohol, and drug use compared to the heterosexual population. According to research, 39.1% of sexual minority adults used illicit drugs, compared to 17.1% of heterosexual adults. Furthermore, a recent study by the American Lung Association found that lesbian, gay, bisexual, and transgender adults and youth smoke at substantially higher rates than the general population. When research shows that smoking claims more than 480,000 American lives each year, these facts cannot be overlooked.
Substance use in the LGBTQ+ population is likely driven by a complex interplay of factors. Studies and polls show that minority stress, mental health challenges, and a lack of LGBTQ-specific substance abuse treatment all contribute to this pervasive issue. Historically, bars and clubs have also been important social spaces for LGBTQ+ individuals, which may have normalized a culture of alcohol, tobacco, and drug use. The long-term health consequences of substance abuse, including increased risk for cancer, heart disease, and liver disease require both awareness and targeted intervention.
3. Physical Health Challenges
While research on LGBTQ+ physical health is seemingly less robust than that on mental health, researchers have identified some important disparities. For instance, gay and bisexual men are at a significantly greater risk for sexually transmitted infections (STIs), including HIV. In 2021, the Centers for Disease Control and Prevention (CDC) found that men who have sex with men (MSM) accounted for 71% of new HIV diagnoses in the United States.
Lesbian and bisexual women, on the other hand, are more likely to be overweight or obese, which can increase the risk for chronic conditions like heart disease and diabetes. Some studies also suggest that lesbian and bisexual women may have higher rates of breast, ovarian, and endometrial cancers.
Finally, transgender individuals face unique physical health concerns. Symptoms of gender dysphoria are strongly correlated with suicidality, particularly among youth. Transgender women, particularly those who are black or Latina, are also at very high risk for HIV, accounting for 89% of new diagnoses in 2021. Finally, both transgender men and women may avoid preventive services like cancer screenings due to fear of discrimination or past negative experiences with healthcare providers.
4. Healthcare Access and Quality
Perhaps the most serious disparities LGBTQ+ people face are those related to healthcare access and quality. Due to fear of discrimination, LGBTQ+ individuals are less likely to have health insurance and more likely to delay or avoid seeking care. Unfortunately, research conducted by John Hopkins Medicine indicates that an estimated 7 out of 10 LGBTQ+ individuals have had at least one negative healthcare experience.
In a familiar pattern, individuals who identify as transgender are at a greater risk for poor access to healthcare. The 2015 U.S. Transgender Survey found that a third of respondents had negative experiences with healthcare providers in the past year, including refusal of treatment, verbal harassment, and even physical assault. Furthermore, another third avoided visiting a healthcare provider simply because they could not afford care.
These barriers to equitable healthcare can have serious health consequences. LGBTQ+ individuals who delay or avoid care may present with more advanced diseases. Similarly, those who encounter discrimination in healthcare settings may be less likely to adhere to treatment or to return for follow-up care, worsening their overall health.
Conclusion
Equitable, non-judgmental care is a top priority when treating any vulnerable population. Healthcare providers must ensure that all patients, regardless of sexual orientation, receive the high-quality, evidence-based care they need to maintain their wellbeing and longevity. As research on LGBTQ+ health continues to evolve, treating these individuals will require ongoing dialogue, education, and a commitment to the principles of health equity and value-based care.
Resources:
Williams Institute UCLA School of Law: https://williamsinstitute.law.ucla.edu/press/transpop-suicide-press-release/
National Library of Medicine: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7876969/; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2533652/; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5127283/; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7276492/; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5758934/
National Institute on Drug Abuse: https://nida.nih.gov/research-topics/substance-use-suds-in-lgbtq-populations; https://nida.nih.gov/publications/drugs-brains-behavior-science-addiction/addiction-health
The American Lung Association: https://www.lung.org/getmedia/d843353c-2609-4554-9daf-f4b629c99503/lgbt-issue-brief-update.pdf.pdf
The Centers for Disease Control and Prevention: https://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/effects_cig_smoking/index.htm; https://www.cdc.gov/sti/about/about-stis-and-gay-men.html
UCI School of Humanities: https://www.humanities.uci.edu/news/legacy-lgbtq-nightlife
WebMD: https://www.webmd.com/women/lesbian-health
Take Action Against Cancer: https://takeactionagainstcancer.com/cancer-facts-for-lesbian-and-bisexual-women/
The Lancet: Child and Adolescent Health: https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(22)00280-2/abstract
AidsVu: https://aidsvu.org/resources/data-on-transgender-people-living-with-hiv/
SCA Health: https://insights.sca.health/insight/article/marching-against-colorectal-cancer; https://insights.sca.health/insight/article/what-is-value-based-care
John Hopkins Medicine: https://www.hopkinsmedicine.org/health/wellness-and-prevention/lgbt-health-care-answers-from-expert-paula-neira
2015 U.S. Transgender Survey: https://transequality.org/sites/default/files/docs/usts/USTS-Full-Report-Dec17.pdf
