Sexual minorities more likely to report impaired health

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New national data suggest that lesbian, gay and bisexual adults are more likely to report impaired physical and mental health and heavy drinking and smoking, which may be the result of stressors they experience because of discrimination, according to one of the leading health surveys in the US.

For the first time, the 2013 and 2014 National Health Interview Survey (NHIS) included a question on sexual orientation.

Dr Gilbert Gonzales, of Vanderbilt University in Nashville, and co-authors used the data to examine health and health risks in the lesbian, gay and bisexual (LGB) adult population and to establish baselines of the physical, functional and mental health status of these sexual minorities.

The study compared health outcomes among lesbian (n=525), gay (n=624) and bisexual (n=515) adults and their heterosexual peers (n=67,150). The total group (n=68,814) was 51% female and had an average age of nearly 47 years old.

The authors report: gay, bisexual and heterosexual men reported similar levels of self-rated health, functional status and physical health; while 16.9% of heterosexual men had moderate or severe psychological distress, 25.9% of gay men and 40.1% of bisexual men reported those levels of distress; bisexual men reported the highest prevalence of heavy drinking at 10.9% compared with heterosexual (5.7%) or gay (5.1%) men; gay and bisexual men were more likely to be current smokers compared with heterosexual men but bisexual men were most like to be heavy smokers (9.3%) compared with heterosexual (6.0%) and gay (6.2%) men; 21.9% of heterosexual women showed symptoms of moderate and severe psychological distress compared with lesbian (28.4%) and bisexual (46.4%) women; bisexual women had the heaviest alcohol consumption (11.7%) compared with lesbian (8.9%) and heterosexual (4.8%) women; both lesbian and bisexual women (greater than 25%) were more likely to be current smokers compared with heterosexual women (14.7%), although lesbian women (5.2%) were more likely to be heavy smokers than heterosexual (3.4%) and bisexual (4.2%) women; and lesbian women were more likely to report poor or fair health and multiple chronic conditions compared with heterosexual women; bisexual women were more likely to report multiple chronic conditions than heterosexual women.

The authors suggest the highest prevalence and risk of psychological distress among bisexual adults may be associated with them being “marginalised” by the heterosexual population and experiencing “stigma” from gay and lesbian adults, leaving them with fewer connections in the sexual minority community.

The authors note study limitations, including that survey responses were self-reported. Also, data on transgender identity was not ascertained because transgender individuals are often not identified in federally sponsored health surveys. Also, the survey cannot establish causation for the health outcomes.
“Findings from our study indicate that LGB adults experience significant health disparities – particularly in mental health and substance use – likely due to the minority stress that LGB adults experience as a result of their exposure to both interpersonal and structural discrimination.

As a first step toward eliminating sexual orientation-based health disparities, it is important for health care professionals to be aware and mindful of the increased risk of impaired health, alcohol consumption and tobacco use among their LGB adult patients,” the article concludes.

In a related editor’s note, JAMA Internal Medicine deputy editor Dr Mitchell H Katz, writes: “Health care professionals can help by creating environments that are inclusive and supportive of sexual minority patients. As with discussion of other personal issues, such as religious beliefs or sexual function, the important thing is to ask open-ended questions that do not prejudge responses. For example, asking a new patient whether he or she has sex with men, women or both indicates openness and acceptance. Whatever the answer, following up by asking of the patient has a special partner shows interest and willingness to discuss intimate issues. In caring for people who have experienced bias and discrimination, support is a very potent medicine.”




Previous studies identified disparities in health and health risk factors among lesbian, gay, and bisexual (LGB) adults, but prior investigations have been confined to samples not representative of the US adult population or have been limited in size or geographic scope. For the first time in its long history, the 2013 and 2014 National Health Interview Survey included a question on sexual orientation, providing health information on sexual minorities from one of the nation’s leading health surveys.
Objective: To compare health and health risk factors between LGB adults and heterosexual adults in the United States.

Design, Setting and Participants

Data from the nationally representative 2013 and 2014 National Health Interview Survey were used to compare health outcomes among lesbian (n = 525), gay (n = 624), and bisexual (n = 515) adults who were 18 years or older and their heterosexual peers (n = 67 150) using logistic regression.
Main Outcomes and Measures: Self-rated health, functional status, chronic conditions, psychological distress, alcohol consumption, and cigarette use.


The study cohort comprised 68 814 participants. Their mean (SD) age was 46.8 (11.8) years, and 51.8% (38 063 of 68 814) were female. After controlling for sociodemographic characteristics, gay men were more likely to report severe psychological distress (odds ratio [OR], 2.82; 95% CI, 1.55-5.14), heavy drinking (OR, 1.97; 95% CI, 1.08-3.58), and moderate smoking (OR, 1.98; 95% CI, 1.39-2.81) than heterosexual men; bisexual men were more likely to report severe psychological distress (OR, 4.70; 95% CI, 1.77-12.52), heavy drinking (OR, 3.15; 95% CI, 1.22-8.16), and heavy smoking (OR, 2.10; 95% CI, 1.08-4.10) than heterosexual men; lesbian women were more likely to report moderate psychological distress (OR, 1.34; 95% CI, 1.02-1.76), poor or fair health (OR, 1.91; 95% CI, 1.24-2.95), multiple chronic conditions (OR, 1.58; 95% CI, 1.12-2.22), heavy drinking (OR, 2.63; 95% CI, 1.54-4.50), and heavy smoking (OR, 2.29; 95% CI, 1.36-3.88) than heterosexual women; and bisexual women were more likely to report multiple chronic conditions (OR, 2.07; 95% CI, 1.34-3.20), severe psychological distress (OR, 3.69; 95% CI, 2.19-6.22), heavy drinking (OR, 2.07; 95% CI, 1.20-3.59), and moderate smoking (OR, 1.60; 95% CI, 1.05-2.44) than heterosexual women.

Conclusions and Relevance

This study supports prior research finding substantial health disparities for LGB adults in the United States, potentially due to the stressors that LGB people experience as a result of interpersonal and structural discrimination. In screening for health issues, clinicians should be sensitive to the needs of sexual minority patients.

Gilbert Gonzales; Julia Przedworski; Carrie Henning-Smith

JAMA material
JAMA Internal Medicine abstract
JAMA Internal Medicine editorial

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