Sexual Orientation, Healthcare Access, and Structural Stigma Open Access
Tao, Haoran (Spring 2024)
Abstract
Abstract
Introduction: This study examined (1) the association between sexual orientation (straight, gay/lesbian, bisexual) and healthcare access; (2) the moderating impact of structural stigma on the relationship between sexual orientation and healthcare access.
Methods: Using pooled cross-sectional data from the Behavioral Risk Factor Surveillance System (BRFSS) combined with the State Equality Index (SEI) from Human Rights Campaign from 2014 to 2019, the sample included 259,532 men (248,929 straight men, 6,588 gay men, and 4,015 bisexual men) and 242,910 women (231,477 straight women, 3,634 lesbian women, and 7,799 bisexual women). State-level structural stigma was measured as time-varying dichotomous variable (0=lower level of structural stigma; 1=higher level of structural stigma) measuring the policy environment captured by the SEI. Stratified by sex and accounting for the complex survey design, state fixed effect and year fixed effect were included in the logistic regression models to examine the association between sexual orientation and healthcare access measured by five binary variables: whether have usual sources of care, whether have annual routine check-ups, whether could not see doctors because of cost, whether have annual flu shots, and ever received HIV testing. Structural stigma and its interaction term with sexual orientation were included in the model to examine the impact of structural stigma by sexual orientation on healthcare access.
Results: Compared with straight men, gay men were more likely to have usual sources of care, have annual routine check-ups, have annual flu shots, and receive HIV testing, and bisexual men were more likely to experience cost barriers in accessing health care, have annual flu shots, and receive HIV testing. Compared with straight women, lesbian women were less likely to have usual sources of care, annual routine check-ups, and annual flu shots, and bisexual women were less likely to have usual sources of care, annual routine check-ups, and annual flu shots and more likely to experience cost barriers in accessing health care and receive HIV testing. This study identified two moderating impacts of structural stigma on disparities in accessing health care for different sexual orientation groups--bisexual men had a greater increase in the likelihood of having cost-related barriers in accessing health care, and gay men had a lesser increase in the likelihood of receiving HIV tests--when exposed to a higher level of structural stigma.
Conclusions: Different sexual minority populations have differential access to healthcare. Structural stigma can interact with that disparity in ways that can perpetuate healthcare access disparities in sexual minorities. Findings emphasized the healthcare access disparities across different sexual orientations, underscored the heterogeneity within the sexual minority community, and highlighted the importance of structural stigma as a starting point for developing more tailored interventions to tackle the disparities in healthcare access across different sexual orientations.
Table of Contents
Chapter I: Introduction
Chapter II: Methods
Chapter III: Results
Chapter IV: Discussion
References
Chapter V: Appendix
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