We used nationally representative data to investigate health
disparities associated with sexual minority status among adults in the United
States.
We analyzed data from 11 114 adults who participated in the
2001 to 2010 waves of the National Health and Nutrition Examination Survey.
Using multiple logistic regressions, we examined the prevalence of HIV,
sexually transmitted infections, mental health problems, cigarette smoking, and
alcohol and illicit drug use in sexual minorities and heterosexual adults.
After adjusting for sociodemographic characteristics, sexual
minority men had greater odds of mental health problems, testing positive for
HIV and herpes simplex virus type 2 and self-reported gonorrhea and chlamydia.
Sexual minority women had greater odds of mental health problems, testing
positive for hepatitis C, smoking, heavy drinking, and illicit drug use.
Numerous health disparities continue to face sexual minority
men and women in the United States. Notably, health disparities persisted
beyond the role of sociodemographic factors, including access to insurance and
primary care, suggesting that further research is warranted to identify the
determinants of health inequity for sexual minorities.
TABLE 1—
Comparison of Heterosexual and Sexual Minority Men and Women on Socioeconomic Variables: National Health and Nutrition Examination Survey, United States, 2001–2010
| Variables | Heterosexual Men (n = 5053), Mean ±SE (95% CI) | Sexual Minority Men (n = 234), Mean ±SE (95% CI) | P | Heterosexual Women (n = 5450), Mean ±SE (95% CI) | Sexual Minority Women (n = 377), Mean ±SE (95% CI) | P |
| Age, y | 35.0 ±0.16 | 35.7 ±0.59 | .23 | 35.2 ±0.15 | 32.7 ±0.49 | < .001 |
| Race/ethnicity | .18 | .09 | ||||
| Non-Hispanic African American | 10.4 (9.1, 11.9) | 11.4 (8.4, 15.3) | 12.0 (10.4, 13.9) | 16.6 (13.2, 20.6) | ||
| Non-Hispanic White | 67.9 (65.0, 70.8) | 60.4 (52.8, 67.6) | 67.8 (64.6, 70.8) | 63.3 (56.8, 69.3) | ||
| Hispanic | 16.3 (14.0, 18.7) | 20.6 (14.8, 28.0) | 14.4 (12.4, 16.7) | 13.5 (9.6, 18.6) | ||
| Mixed or other | 5.4 (4.6, 6.4) | 7.6 (4.1, 13.6) | 5.8 (4.9, 6.9) | 6.7 (4.2, 10.5) | ||
| Highest education level | < .001 | < .001 | ||||
| < high school | 16.9 (15.5, 18.5) | 17.1 (12.9, 22.4) | 14.5 (13.2, 16.0) | 23.5 (18.7, 29.0) | ||
| High school or GED | 27.0 (25.2, 28.8) | 15.0 (10.4, 21.0) | 21.1 (19.9, 22.3) | 20.8 (16.3, 26.1) | ||
| Some college | 30.9 (29.4, 32.5) | 27.9 (21.9, 34.9) | 35.3 (33.5, 37.1) | 37.3 (30.9, 44.1) | ||
| ≥ college | 25.2 (23.1, 27.3) | 40.0 (31.1, 49.6) | 29.1 (27.0, 31.3) | 18.5 (13.6, 24.6) | ||
| Employment | < .01 | < .01 | ||||
| Employed | 86.5 (85.3, 87.7) | 77.0 (68.3, 83.9) | 71.6 (69.7, 73.5) | 63.1 (56.6, 69.2) | ||
| Unemployed | 13.5 (12.3, 14.7) | 23.0 (16.1, 31.7) | 28.4 (26.5, 30.3) | 36.9 (30.8, 43.4) | ||
| Marital status | < .001 | < .001 | ||||
| Married | 54.6 (52.9, 56.4) | 17.7 (12.3, 24.9) | 56.4 (54.6, 58.1) | 24.9 (20.0, 30.7) | ||
| Widowed, divorced, or separated | 9.5 (8.5, 10.5) | 8.8 (5.6, 13.4) | 13.2 (12.1, 14.5) | 14.0 (10.8, 17.8) | ||
| Never married | 25.2 (23.6, 27.0) | 56.2 (47.5, 64.5) | 21.0 (19.3, 22.8) | 41.8 (36.3, 47.6) | ||
| Living with partner | 10.7 (9.6, 11.8) | 17.3 (10.2, 27.9) | 9.4 (8.5, 10.4) | 19.3 (14.4, 25.3) | ||
| Place of birth | .52 | .41 | ||||
| Born in the US | 81.5 (79.2, 83.6) | 79.3 (71.5, 85.4) | 84.7 (82.6, 86.6) | 86.6 (81.3, 90.6) | ||
| Born outside the US | 18.5 (16.4, 20.8) | 20.7 (14.7, 28.5) | 15.3 (13.4, 17.4) | 13.4 (9.4, 18.7) | ||
| Family income, $ | .11 | < .001 | ||||
| < 20 000 | 16.2 (14.8, 17.7) | 20.5 (15.7, 26.5) | 19.0 (17.5, 20.6) | 34.6 (28.9, 40.7) | ||
| ≥ 20 000 | 83.8 (82.3, 85.2) | 79.5 (73.6, 84.3) | 81.0 (79.4, 82.5) | 65.5 (59.3, 71.1) | ||
| Health care insurance | .3 | < .001 | ||||
| Yes | 71.3 (69.7, 72.9) | 75.6 (67.2, 82.4) | 80.2 (78.5, 81.8) | 64.5 (58.9, 69.8) | ||
| No | 28.7 (27.1, 30.3) | 24.4 (17.6, 32.8) | 19.8 (18.2, 21.5) | 35.5 (30.2, 41.1) | ||
| Regular provider | .35 | .02 | ||||
| Yes | 73.4 (71.9, 74.9) | 76.8 (69.3, 83.0) | 88.4 (87.2, 89.5) | 83.5 (78.4, 87.7) | ||
| No | 26.6 (25.1, 28.1) | 23.2 (17.1, 30.7) | 11.6 (10.5, 12.8) | 16.5 (12.3, 21.6) |
Note. CI = confidence interval; GED = general equivalency diploma.
TABLE 2—
Comparison of Heterosexual and Sexual Minority Men and Women on HIV and STIs: National Health and Nutrition Examination Survey, United States, 2001–2010
| HIV and STI variables | Heterosexual Men (n = 5053), Mean ±SE (95% CI) | Sexual Minority Men (n = 234), Mean ±SE (95% CI) | P | Heterosexual Women (n = 5450), Mean ±SE (95% CI) | Sexual Minority Women (n = 377), Mean ±SE (95% CI) | P |
| HIV and STIs (biomarker) | ||||||
| HIV antibody | < .001 | .01 | ||||
| Yes | 0.2 (< 0.01, 0.3) | 10.8 (7.1, 16.3) | 0.2 (< 0.01, 0.3) | 0.7 (0.2, 2.3) | ||
| No | 99.8 (99.7, 99.9) | 89.2 (83.7, 93.0) | 99.8 (99.7, 99.9) | 99.3 (97.8, 99.8) | ||
| Urine chlamydia (years 2001–2008 only) | .53 | .53 | ||||
| Yes | 1.4 (1.1, 1.9) | 0.8 (0.1, 5.4) | 1.4 (0.9, 2.0) | 2.1 (0.6, 7.2) | ||
| No | 98.6 (98.1, 98.9) | 99.2 (94.6, 99.9) | 98.6 (98.0, 99.1) | 97.9 (92.8, 99.4) | ||
| HSV-2 | < .01 | .63 | ||||
| Yes | 12.6 (11.4, 13.9) | 20.3 (15.5, 26.2) | 24.5 (23.1, 26.0) | 25.6 (21.5, 30.2) | ||
| No | 87.4 (86.1, 88.6) | 79.7 (73.8, 84.5) | 75.5 (74.0, 76.9) | 74.4 (69.8, 78.5) | ||
| Hepatitis C antibody | .77 | < .001 | ||||
| Yes | 2.1 (1.7, 2.7) | 2.5 (1.0, 6.0) | 1.2 (0.9, 1.5) | 4.6 (2.7, 7.8) | ||
| No | 97.9 (97.3, 98.3) | 97.5 (94.0, 99.0) | 98.8 (98.5, 99.1) | 95.4 (92.2, 97.3) | ||
| STIs (self-reported) | ||||||
| Ever had STI | < .01 | .96 | ||||
| Yes | 6.0 (5.2, 6.8) | 11.3 (7.4, 16.8) | 12.5 (11.3, 13.8) | 12.3 (8.5, 17.5) | ||
| No | 94.0 (93.2, 94.8) | 88.7 (83.2, 92.6) | 87.5 (86.2, 88.7) | 87.7 (82.5, 91.5) | ||
| Ever had gonorrhea | < .001 | .01 | ||||
| Yes | 0.2 (0.2, 0.4) | 2.0 (0.8, 5.0) | 0.3 (0.2, 0.5) | 1.2 (0.5, 2.8) | ||
| No | 99.8 (99.6, 99.8) | 98.0 (95.0, 99.3) | 99.7 (99.5, 99.8) | 98.9 (97.2, 99.5) | ||
| Ever had chlamydia | < .01 | .06 | ||||
| Yes | 0.5 (0.4, 0.8) | 2.4 (0.9, 6.1) | 1.0 (0.7, 1.3) | 2.2 (1.0, 4.8) | ||
| No | 99.5 (99.2, 99.6) | 97.7 (93.9, 99.1) | 99.0 (98.7, 99.3) | 97.8 (95.2, 99.0) | ||
| Ever had herpes | .15 | .38 | ||||
| Yes | 2.2 (1.8, 2.8) | 3.9 (1.9, 7.8) | 5.8 (5.1, 6.7) | 4.5 (2.6, 7.8) | ||
| No | 97.8 (97.2, 98.2) | 96.1 (92.2, 98.1) | 94.2 (93.3, 95.0) | 95.5 (92.2, 97.5) | ||
| Ever had warts | .03 | .91 | ||||
| Yes | 3.6 (3.0, 4.4) | 6.6 (3.9, 11.0) | 7.1 (6.2, 8.1) | 6.9 (4.2, 11.2) | ||
| No | 96.4 (95.6, 97.0) | 93.4 (89.0, 96.1) | 92.9 (91.9, 93.8) | 93.1 (88.8, 95.8) | ||
| Ever tested for HIV | < .001 | .05 | ||||
| Yes | 40.5 (39.0, 41.9) | 71.1 (61.9, 78.8) | 52.3 (50.6, 54.0) | 58.4 (52.3, 64.4) | ||
| No | 59.6 (58.1, 61.0) | 29.0 (21.2, 38.1) | 47.7 (46.0, 49.4) | 41.6 (35.6, 47.8) | ||
Note. CI = confidence interval; HSV-2 = herpes simplex virus type 2; STI = sexually transmitted infection.
TABLE 3—
Comparison of Heterosexual and Sexual Minority Men and Women on Mental Health, Alcohol, Smoking, and Drug Use: National Health and Nutrition Examination Survey, United States, 2001–2010
| Alcohol, Smoking, and Drug Use Variables | Heterosexual Men (n = 5053), Mean ±SE (95% CI) | Sexual Minority Men (n = 234), Mean ±SE (95% CI) | P | Heterosexual Women (n = 5450), Mean ±SE (95% CI) | Sexual Minority Women (n = 377), Mean ±SE (95% CI) | P |
| > 15 d of poor mental health in past 30 d | < .001 | < .001 | ||||
| Yes | 8.2 (7.3, 9.2) | 15.9 (11.5, 21.4) | 12.6 (11.7, 13.7) | 20.6 (16.0, 26.1) | ||
| No | 91.8 (90.8, 92.7) | 84.1 (78.6, 88.5) | 87.4 (86.4, 88.3) | 79.4 (73.9, 84.0) | ||
| Average no. of drinks per day in past year (mean) | 4.0 ±0.08 | 3.6 ±0.32 | .30 | 2.4 ±0.04 | 3.3 ±0.17 | < .001 |
| Ever heavy alcohol user (> 5 per day) | 0.80 | < .001 | ||||
| Yes | 22.7 (21.1, 24.4) | 21.9 (16.3, 28.6) | 8.3 (7.4, 9.2) | 21.3 (16.8, 26.6) | ||
| No | 77.3 (75.6, 78.9) | 78.1 (71.4, 83.7) | 91.7 (90.8, 92.6) | 78.7 (73.4, 83.2) | ||
| Smoked > 100 cigarettes in life | .61 | < .001 | ||||
| Yes | 49.5 (47.2, 51.8) | 46.8 (37.5, 56.4) | 40.5 (38.3, 42.9) | 54.3 (47.7, 60.8) | ||
| No | 50.5 (48.2, 52.8) | 53.2 (43.6, 62.5) | 59.5 (57.1, 61.8) | 45.7 (39.2, 52.3) | ||
| Ever used marijuana or hashish (years 2005–2010 only) | .56 | < .001 | ||||
| Yes | 66.5 (63.8, 69.1) | 63.6 (53.1, 72.9) | 56.1 (53.2, 59.0) | 73.9 (67.6, 79.3) | ||
| No | 33.5 (30.9, 36.2) | 36.4 (27.1, 46.9) | 43.9 (41.0, 46.8) | 26.1 (20.7, 32.4) | ||
| Ever used cocaine, heroin, or methamphetamine (years 2005–2010 only) | .4 | < .001 | ||||
| Yes | 26.5 (24.2, 29.0) | 30.9 (21.6, 42.2) | 15.9 (14.1, 17.8) | 34.7 (27.4, 42.7) | ||
| No | 73.5 (71.1, 75.8) | 69.1 (57.8, 78.4) | 84.1 (82.2, 85.9) | 65.3 (57.3, 72.6) | ||
| Ever injected drugs (years 2005–2010 only) | .76 | < .001 | ||||
| Yes | 3.3 (2.5, 4.2) | 2.8 (1.1, 7.3) | 1.3 (0.9, 1.8) | 9.0 (5.4, 14.6) | ||
| No | 96.7 (95.8, 97.5) | 97.2 (92.7, 99.0) | 98.7 (98.2, 99.1) | 91.0 (85.4, 94.6) |
Note. CI = confidence interval.
Full article at:
By: 
Kristi E. Gamarel, PhD, EdM, Benjamin M. Grin, MD, MPH, Ji Hyun Lee, MD, MPH, Christopher W. Kahler, PhD, Brandon D. L. Marshall, PhD, Jacob J. van den Berg, PhD, and Nickolas D. Zaller, PhD
Kristi E. Gamarel, PhD, EdM, Benjamin M. Grin, MD, MPH, Ji Hyun Lee, MD, MPH, Christopher W. Kahler, PhD, Brandon D. L. Marshall, PhD, Jacob J. van den Berg, PhD, and Nickolas D. Zaller, PhD
Brown University School of Public Health, 121 South Main St., 4th Floor, Providence, RI 02903
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