Sexual-orientation disparities in whole person health: age- and gender-stratified analysis of patients in a safety-net system

TL;DR

LGB+ individuals face significant health disparities, including higher rates of depression and anxiety, compared to heterosexual individuals in a safety-net health system.

Contribution

This study uses EHR-based SOGI data to quantify health disparities across age and gender groups within a safety-net system.

Findings

LGB+ adults showed higher emotional burdens like depression and anxiety across age groups.

LGB+ individuals reported greater social adversity, including financial and food insecurity.

Despite higher education levels, LGB+ individuals had mixed physical health outcomes.

Abstract

Despite advancements in LGB+ rights, LGB+ individuals continue to face significant healthcare disparities, particularly in areas such as homelessness, mental health, substance use, health service access, and victimization. Addressing these disparities is essential to improving the quality of life and health outcomes for this population. This study examines the comprehensive health needs of LGB+ individuals using a Whole Person Health (WPH) approach, which includes Social Determinants of Health (SDOH) as well as other critical aspects of well-being, through EHR-based Sexual Orientation and Gender Identity (SOGI) data within a safety-net health system.

This cross-sectional study utilizes the EHR-embedded Whole Person Health Score (WPHS) and SOGI tools to assess the SDOH needs of 34,423 heterosexual, 1,213 LGB+, and 384 Other patients. Transgender and gender-fluid patients were excluded for a separate study. The WPHS incorporates self-reported factors across six domains, providing letter grades converted to numerical values and color-coded intervention levels. Data from August 2020 to July 2023 were analyzed.

Relative to heterosexual peers, LGB+ adults showed consistently higher emotional-health burdens - depression (18–25: +24.1 pp, 95% CI 18.7–29.6; 26–45: +17.0 pp, 13.2–20.9; 46+: +7.2 pp, 1.0–13.3) and anxiety (18–25: +22.9 pp, 18.0–27.8; 26–45: +16.6 pp, 13.0–20.3; 46+: +10.1 pp, 4.1–16.2), with similar elevations by gender (e.g. cis female LGB+ depression +18.0 pp, 14.3–21.6). Social adversity was higher across ages, inadequate finances (18–25: +21.5 pp, 16.0–27.1; 26–45: +13.3 pp, 9.6–17.0), food access (+16.0, +10.8, +6.8 pp for 18–25, 26–45, 46+, respectively), and transportation (+11.6 and +10.5 pp for 18–25 and 26–45). Utilization rose for office visits (26–45: +7.4 pp, 3.5–11.4) and prescription use (18–25: +13.5 pp, 7.8–19.2; 26–45: +12.5 pp, 8.7–16.3; 46+: +5.7 pp, 1.9–9.6). Notably, LGB+ adults were more educated (lower “lack of higher education”: 26–45 −11.5 pp, −15.4 to −7.5; 46 + −24.3 pp, −30.4 to −18.1; male LGB+ −22.1 pp, −26.4 to −17.7). Physical-condition differences were mixed (e.g. male LGB+ fewer chronic conditions −10.1 pp, −14.4 to −5.7; fewer functional limitations −13.1 pp, −16.7 to −9.4).

The WPHS tool highlighted substantial disparities in mental health, substance use, and economic challenges among LGB+ individuals, emphasizing the importance of tailored interventions. Our findings advocate for the routine collection of SOGI data and integrating social and non-medical needs in patient care to effectively address these disparities.

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