Reducing health disparities for SGM people is a public health priority in the U.S.2-4 When we compare the experiences of people who are SGM to those who are heterosexual (individuals who are sexually attracted to members of the opposite sex) and cisgender (individuals whose gender identities conform to the sex they were assigned at birth), we find that SGM people are more likely to suffer from poorer mental health, substance misuse, sexually transmitted infections, and other health conditions that are often first identified in primary care.5-12 They are also less likely to access preventive services, cancer screening, and treatment for cardiovascular disease, diabetes, hypertension, and other serious conditions.2; 6; 7; 15; 16 Table 1.1 includes an overview of the major health disparities affecting SGM people.
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Health Disparities Among SGM People | |||
Percent of Transgender and Gender-diverse Adults | Percent of Cisgender Adults | ||
Alcohol Use (heavy, episodic drinking) | 36.6% | 30.3% | |
Smoking (current) | 51.5% | 39.5% | |
Mental distress | 22.8% | 11% | |
Depression | 31.2% | 16.8% | |
Coronary Heart Disease/Heart Attack | 10.8% | 6.9% | |
Diabetes | 12.9% | 10.9% | |
Non-Suicidal Self-Injury | 46.7% | 14.6% | |
Lesbian, Gay, and Bisexual (LGB) Adults (age 18 and over)9, 10, 11 | Percent of LGB Adults | Percent of Heterosexual Adults | |
Alcohol Use (heavy drinking in the past year) | 40.4% | 23.3% | |
Smoking (current) | 21.7% | 14.9% | |
Psychological distress | 9.4% | 3.4% | |
Lifetime Suicide Attempt | 11% | 4% | |
Non-Suicidal Self-Injury | 29.7% | 14.6% | |
LGB Elders (age 50 and over)17 | Percent of LGB Elders | Percent of Heterosexual Adults | |
Alcohol (excessive drinker) | 21.9% | 14.5% | |
Smoking (current) | 17.9% | 14.7% | |
Mental Distress | 20.4% | 15% | |
Lesbian, Gay, and Bisexual Youth (grades 9-12)12 | Percent of LGB youth | Percent of heterosexual youth | |
Alcohol (ever drank) | 75.3% | 62.5% | |
Smoking (ever smoked) | 50.4% | 30.5% | |
Felt sad or hopeless | 60.4% | 26.4% | |
Victim of bullying (on school property) | 34.2% | 18.8% | |
Victim of bullying (electronically) | 28% | 14.2% | |
Attempted suicide | 29.4% | 6.4% | |
Transgender and Gender-diverse Youth (grades 9-12)13 | Percent of Transgender and Gender-diverse Youth | Percent of Cisgender Youth* | |
Alcohol (ever drank) | 70.0% | 58.1% | |
Smoking (ever smoked) | 32.9% | 22.6% | |
Felt sad or hopeless | 53.1% | 30% | |
Victim of bullying (on school property) | 34.6% | 17.7% | |
Victim of bullying (electronically) | 29.6% | 14.8% | |
Attempted suicide | 34.6% | 7.3% | |
* Calculated as the average value of cisgender female and cisgender male students.
Compared to heterosexual and cisgender people, SGM individuals have greater challenges getting quality health care.2; 7; 11; 18-22 They are less likely to be insured than heterosexual and cisgender people, which intensifies the access challenges they already face. Often, young SGM people whose families have rejected them, and adult SGM people who are unemployed or homeless, do not have health insurance and have problems paying for care. Even if they have insurance, SGM people may require services not covered under their plans, such as gender-affirming surgeries.23
Another factor underlying health disparities is minority stress, which happens when people experience stigma and discrimination (e.g., verbal harassment, employment termination) in their daily lives because of their minority identities, including at school or work, in public places, and even in healthcare settings.23-25 Minority stress can bring about unhealthy coping behaviors, such as alcohol and drug misuse and other health problems. Being a member of another socially marginalized minority group in addition to being SGM may worsen the effects of this stress, disproportionately impacting racial and ethnic minorities,26 individuals of low income or educational attainment,27; 28 and rural residents.29; 30
Anti-SGM stigma is still commonplace throughout the nation, including in healthcare settings where SGM people have been subjected to negative caregiving experiences and delays in getting services, including providers stating “we don’t do that here” when they seek treatment.31 Anti-SGM stigma can also be expressed subtly through discriminatory attitudes and behaviors among providers and staff.32 Minority stress can result in perceptions of provider bias or incompetence among SGM patients, making them less likely to talk openly about their sexual orientations, gender identities, and health risk behaviors when seeking care.33 In addition, persons suffering from minority stress may internalize stigma, making them less likely to speak out against experiences of prejudice when they occur. As a result, their expectations that they will receive quality care may be lessened, and they may avoid getting care altogether.24; 25; 34