Sexual Minorities in England Have Poorer Health and Worse Health Care Experiences

A National Survey

Published in: Journal of General Internal Medicine, v. 30, no. 1, Jan 2015, p. 9-16

Posted on RAND.org on January 01, 2014

by Marc N. Elliott, David E. Kanouse, Q. Burkhart, Gary Abel, Georgios Lyratzopoulos, Megan K. Beckett, Mark A. Schuster, Martin Roland

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Research Questions

  1. How does the health of sexual minorities (lesbian, gay, and bisexual individuals) in England compare with that of the heterosexual population?
  2. How do the health care experiences of these individuals compare with those of the heterosexual population?

BACKGROUND: The health and healthcare of sexual minorities have recently been identified as priorities for health research and policy. OBJECTIVE: To compare the health and healthcare experiences of sexual minorities with heterosexual people of the same gender, adjusting for age, race/ethnicity, and socioeconomic status. DESIGN: Multivariate analyses of observational data from the 2009/2010 English General Practice Patient Survey. PARTICIPANTS: The survey was mailed to 5.56 million randomly sampled adults registered with a National Health Service general practice (representing 99 % of England's adult population). In all, 2,169,718 people responded (39 % response rate), including 27,497 people who described themselves as gay, lesbian, or bisexual. MAIN MEASURES: Two measures of health status (fair/poor overall self-rated health and self-reported presence of a longstanding psychological condition) and four measures of poor patient experiences (no trust or confidence in the doctor, poor/very poor doctor communication, poor/very poor nurse communication, fairly/very dissatisfied with care overall). KEY RESULTS ; Sexual minorities were two to three times more likely to report having a longstanding psychological or emotional problem than heterosexual counterparts (age-adjusted for 5.2 % heterosexual, 10.9 % gay, 15.0 % bisexual for men; 6.0 % heterosexual, 12.3 % lesbian and 18.8 % bisexual for women; p < 0.001 for each). Sexual minorities were also more likely to report fair/poor health (adjusted 19.6 % heterosexual, 21.8 % gay, 26.4 % bisexual for men; 20.5 % heterosexual, 24.9 % lesbian and 31.6 % bisexual for women; p < 0.001 for each). Adjusted for sociodemographic characteristics and health status, sexual minorities were about one and one-half times more likely than heterosexual people to report unfavorable experiences with each of four aspects of primary care. Little of the overall disparity reflected concentration of sexual minorities in low-performing practices. CONCLUSIONS: Sexual minorities suffer both poorer health and worse healthcare experiences. Efforts should be made to recognize the needs and improve the experiences of sexual minorities. Examining patient experience disparities by sexual orientation can inform such efforts.

Key Findings

Sexual Minorities in England Are More Likely to Suffer Poor Health

  • Sexual minorities were two to three times more likely than their heterosexual counterparts to report having a longstanding psychological or emotional problem, including depression, anxiety, and substance abuse.
  • Among women, 25 percent of lesbians and 31 percent of bisexual women reported poor health, compared to 21 percent of heterosexual women.
  • Among men, 22 percent of gay men and 26 percent of bisexual men reported poor general health, compared to 20 percent of heterosexual men.

Sexual Minorities Report Worse Experiences with Their Doctors and Nurses

Lesbian, gay, and bisexual men and women were up to 50 percent more likely than heterosexuals to report negative experiences with primary care services, including

  • lower levels of trust and confidence with their primary care physicians
  • worse communication with both primary care physicians and nurses
  • lower overall satisfaction with care.

Research conducted by

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