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Examining Sexual Orientation Disparities in Unmet Medical Needs Among Men and Women

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Abstract

Using the National Longitudinal Study of Adolescent Health (N = 13,810), this study examines disparities in unmet medical needs by sexual orientation identity during young adulthood. We use binary logistic regression and expand Andersen’s health care utilization framework to identify factors that shape disparities in unmet medical needs by sexual orientation. We also investigate whether the well-established gender disparity in health-seeking behaviors among heterosexual persons holds for sexual minorities. The results show that sexual minority women are more likely to report unmet medical needs than heterosexual women, but no differences are found between sexual minority and heterosexual men. Moreover, we find a reversal in the gender disparity between heterosexual and sexual minority populations: heterosexual women are less likely to report unmet medical needs than heterosexual men, whereas sexual minority women are more likely to report unmet medical needs compared to sexual minority men. Finally, this work advances Andersen’s model by articulating the importance of including social psychological factors for reducing disparities in unmet medical needs by sexual orientation for women.

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Notes

  1. Supplementary analyses revealed that the results for exclusively gay and mostly gay respondents were not statistically different. Thus, these two categories were combined to increase statistical power.

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Acknowledgments

This work was supported by the Eunice Shriver National Institute of Child Health and Human Development (NICHD) Grant R03 HD062597, NICHD and Office of Research on Women’s health (ORWH) Grant Number K12HD055892, and by the University of Colorado Population Center (Grant R24 HD066613) through administrative and computing support.

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Authors and Affiliations

  1. Department of Sociology, University of Illinois-Chicago, 4112 BSB, 1007 W Harrison St, Chicago, IL, 60607-7140, USA

    Bethany G. Everett

  2. Stefanie Mollborn, Sociology and Institute of Behavioral Science,University of Colorado at Boulder, 483 UCB, Boulder, CO, 80309-0483, USA

    Stefanie Mollborn

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Correspondence to Bethany G. Everett.

Appendix

Appendix

Descriptive statistics by gender and sexual orientation identity

 

Exclusively heterosexual

Mostly heterosexual

Bisexual

Exclusively gay/mostly gay

Women

Men

Women

Men

Women

Men

Women

Men

M/%

M/%

M/%

M/%

M/%

M/%

M/%

M/%

Predisposing factors

 Race/ethnicity (%)

  Non-Hispanic white

66.94

66.57

76.66

71.93

82.00

74.37

69.71

64.54

  Non-Hispanic black

16.97

15.32

7.16

9.30

6.57

13.71

12.83

9.90

  Hispanic

11.08

12.08

9.97

11.94

10.96

9.87

12.49

13.50

  Other race/ethnicity

5.06

6.02

6.20

6.83

0.47

2.05

12.49

13.50

 Age (M)

22.21***

22.41

22.20*

22.57

21.92†

21.29

22.50

22.69

 Education (M)

13.28***

12.91

13.24

13.45

12.76

12.54

13.13

13.63

 Relationship-related living arrangement

  Married

23.72***

15.50

17.46***

3.24

17.47***

0.00

5.38

1.28

  Cohabitating

29.69

30.27

44.65***

28.96

56.84*

35.77

61.20***

31.24

  Not living with a partner

46.59***

54.23

37.89***

67.80

25.69***

64.23

33.42***

67.47

 Not a U.S. citizen (%)

2.69

2.84

1.76

0.84

2.54

4.45

1.49

4.66

Enabling factors

 Insurance coverage (%)

  No coverage

15.11***

21.79

16.54

21.36

28.73

30.78

12.28

22.02

  Covered by parents insurance

27.90†

26.08

29.97

29.27

24.90*

52.24

27.06

25.53

  Covered by spouse/partner’s insurance

7.50***

1.32

5.60**

1.30

4.41

0.00

1.70

0.00

  Other coverage

49.98

54.23

48.69

48.07

41.91**

16.98

59.18

54.44

 Income (%)

  <$5,000

26.77***

19.50

25.97

26.30

22.60

29.50

  

  >$5,000 and <$20,000

35.07

34.69

34.57

37.81

40.46

32.78

32.65

31.31

  >$20,000

16.58***

28.13

19.11

19.83

15.19

23.37

29.68

38.40

  Missing

21.59

17.68

20.36

16.06

21.75

14.34

17.12

12.39

 Does not own a car (%)

27.49***

23.09

26.94

29.45

30.31

43.74

20.45

25.54

 Does not own a computer (%)

42.04*

45.04

40.23

34.97

40.04

32.56

39.99

25.21

 Self-esteem (M)

16.05**

16.26

14.82

15.39

14.70

14.74

14.89

15.16

Need-based factors

 Self-rated health (M)

2.04***

1.90

2.24

2.20

2.52***

1.76

2.26*

1.93

 Medically prescribed drug (%)

74.39***

50.70

79.33***

46.70

64.44*

37.43

64.25†

72.54

 CESD Scale (M)

5.88***

4.59

7.88***

6.09

7.85

6.49

6.84

5.86

 Functional limitation (%)

1.49

1.16

1.67†

0.48

1.50

0.00

0.01

0.00

 Physical victimization, previous 12 months

4.47***

15.72

9.23

17.81

10.25

13.49

8.96†

3.61

Unmet medical needs (%)

 Yes

20.31*

22.68

33.97*

22.64

33.68

29.59

33.49†

18.50

 No

79.69*

77.32

66.03*

77.36

66.32

70.41

66.51†

81.51

  1. Source: National Longitudinal Study of Adolescent Health
  2. Note: All significance tests are compared to women
  3. M mean, CI confidence interval
  4. † p < .10, * p < .05, ** p < .01, *** p < .001

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Everett, B.G., Mollborn, S. Examining Sexual Orientation Disparities in Unmet Medical Needs Among Men and Women. Popul Res Policy Rev 33, 553–577 (2014). https://doi.org/10.1007/s11113-013-9282-9

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