Investigating LGBT health disparities in Massachusetts

The findings have pointed to certain categories of relatively poor health among the lesbian, gay, bisexual and transgender community (LGBT). Broader surveillance of potential health disparities between LGBT and mainstream Americans has been far less common.

But two recent studies in Massachusetts, one completed in 2008 and the other in 2009, have added new features to the statistical health profiles of sexual minorities. The studies indicate the existence of a wider array of disparities than earlier studies had established.

Both studies were conducted by JSI Research & Training Institute, Inc. for the Massachusetts Department of Public Health (DPH). In its work on the 2008 study JSI had funding from the DPH and the Ford Foundation. Collaborating with JSI on the 2009 study were the Williams Institute at the UCLA School of Law and MassEquality, a Massachusetts group that promotes LGBT causes.

"From our analysis of the Massachusetts surveys we've developed a better understanding of a number of health disparities that impact the LGBT community. In some respects, however, the health of sexual minorities does not appear to differ from that prevailing among the rest of the state's residents," says Stewart Landers, the lead JSI consultant on the two studies.

Based on six years of data from the DPH's annual Behavioral Risk Factor Surveillance System surveys -- which are conducted by random telephone calls -- the study completed in 2008 looked at 22 categories of self-reported health conditions. In 16 of the categories, of 38,910 responding Massachusetts residents, the 3% who identified as gay, lesbian or bisexual were identified as having worse health outcomes compared to heterosexuals, the study showed.

One such health outcome, having a diagnosis of asthma sometime in your life, was shown in the 2008 study to be more frequent among sexual minorities than heterosexuals.

Sexual minorities were more likely than heterosexuals to report tension and worry, smoking, drug use, and lifetime sexual victimization. Bisexual adults reported more barriers to health care, current sadness, and greater cardiovascular disease risk, and binge-drinking was more common among bisexual women. Unlike gay men, lesbians were more likely to be obese. Lesbians also had more of other kinds of risks for cardiovascular disease.

The 2009 findings, which the DPH compiled in conjunction with JSI, relied on data from 1,598 respondents to online survey questions. They were among the 38,000 people on MassEquality's e-mail list who were invited to participate.

That methodology differed from the 2008 "population-based" study, which was structured to produce a sample representative of the larger population whose health was being evaluated. "The 2009 study may have been statistically less rigorous, but it was nonetheless important as one of the few studies to look at leading health indicators by both sexual orientation and gender identity," Landers notes.

Included in the 2009 study were people who identified their sexual orientation as transgender, about whom there is a scarcity of health-status data. To the question whether they considered their general health to be excellent or very good, 78% of gay men or lesbians said it was, compared to a lower proportion for bisexuals (73.5%) and a still smaller rate for transgender people (67.3%). As for psychological wellbeing, the transgender respondents to the 2009 survey said they suffered from a strikingly high incidence of depression and suicidal inclinations. Asked if they had seriously considered suicide within the past year, 30.8% of the transgender respondents said yes, in contrast with 7.4% of bisexuals, 4.4% of gays and lesbians and 2.3% of heterosexuals who answered affirmatively. The results from the two studies diverged in some respects, such as how frequently lesbians have Pap smears compared to heterosexual women. The 2008 study revealed no difference. In the 2009 survey 89.9% of lesbians said they had had the cervical screening within the previous three years, a lower rate than the 94.2% reported by heterosexual women.

As a technical consultant on LGBT health matters, JSI has been involved for years with a variety of organizations in addition to the Massachusetts DPH. JSI worked in concert with the Williams Institute to produce a report in November 2009 about "best practices" when asking question about sexual-orientation in surveys.

Among other related projects that have benefited from JSI's expertise: Support in developing the 2009 Gay Men's Health Agenda, a series of eight recommendations to promote gay men's health nationwide; And technical assistance in forging a similar agenda and strategic priorities for bisexual activists at a "summit" meeting held in Chicago in 2009.