Author ORCID Identifier
Shiya Cao: 0000-0002-7762-5610
Sophia Silovsky: 0009-0006-5759-5019
Nicole Tresvalles: 0009-0005-8916-7556
Document Type
Article
Publication Date
12-6-2025
Publication Title
International Journal of Environmental Research and Public Health
Volume
22
Abstract
In the United States, although the gaps in health insurance coverage by sexual orientation have been closing since the implementation of the Affordable Care Act and legalization of same-sex marriage, the LGB group (i.e., lesbian, gay, bisexual) continues to report healthcare utilization and access inequities such as more delayed or unmet care. The extant research has often examined healthcare utilization and access inequities due to affordability (e.g., out-of-pocket costs). However, healthcare utilization and access inequities are only partially explained by cost reasons; there are non-cost reasons that have not been adequately empirically examined. The present study innovatively includes discrimination structural variables to understand how social structure is associated with healthcare utilization and access inequities of LGB people. It focuses on two routine health services—regular check-ups and prescription medications—for LGB people who have chronic diseases. Additionally, sexual orientation may intersect with sex assigned at birth (sex, hereafter, i.e., male, female) to impact healthcare utilization and access inequities. The current study applies quantitative intersectional analysis to understand healthcare utilization and access inequities from a sexual orientation and sex intersectional lens and for easier and clearer interpretations of intersectional results and more actionable policy implications for inter-categorical groups. Using the 2023 National Health Interview Survey (weighted N = 136,231,053), we con- ducted quantitative intersectional analysis for logistic regression using complex survey data. First, we fit a series of logistic regression models with sexual orientation–sex inter- actions for routine healthcare utilization and access outcomes, adjusting for covariates. Second, we calculated average marginal predictions for inter-categorical groups by inter- acting sexual orientation and sex and other covariates. Third, we computed risk ratios of average marginal predictions for all the covariates. Lastly, we examined the interaction of inter-categorical groups/sexual orientation and structural variables. Our results show that experiencing a higher level of discrimination is positively associated with underutilization of regular check-ups and lower access to prescription medications, and this effect is stronger for LGB people. Further, LGB women are least likely to utilize regular check-ups and LGB men are least likely to access prescription medications among the inter-categorical groups. Highlighting structural issues of healthcare utilization and access offers new evidence on healthcare utilization and access inequities that can inform policies for raising awareness of and addressing structural issues. The intersectional analyses suggest that relevant policies target LGB women and LGB men.
Recommended Citation
Cao, Shiya; Mirza, Mehreen; Silovsky, Sophia; Tresvalles, Nicole; Qin, Lucia; and Susnea, Sarah, "Examining the Intersectional and Structural Issues of Routine Healthcare Utilization and Access Inequities for LGB People with Chronic Diseases" (2025). Statistical and Data Sciences: Faculty Publications, Smith College, Northampton, MA.
https://scholarworks.smith.edu/sds_facpubs/87
Digital Object Identifier (DOI)
https://doi.org/10.3390/ijerph22121830
Rights
© 2025 by the authors.
Version
Version of Record
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Included in
Data Science Commons, Other Computer Sciences Commons, Statistics and Probability Commons