A recent study published in JAMA Health Forum highlights significant disparities in social risk factors experienced by sexual and gender minority adults compared to their heterosexual and cisgender counterparts in the United States. The research, led by a team from the Boston University School of Public Health, found that these populations are more likely to face challenges such as housing instability, food insecurity, and social isolation.
Sexual and gender minority individuals, including those who identify as lesbian, gay, bisexual, transgender, or nonbinary, often face structural barriers such as discrimination and economic inequality. These factors contribute to worse health outcomes, including higher rates of mental health issues, chronic conditions, and delays in accessing care. Despite growing recognition of these disparities, research has historically focused on health outcomes rather than the upstream social conditions contributing to them.
Social risk factors, such as the inability to pay for housing or access food, play a crucial role in shaping health and well-being. However, national surveys have only recently begun collecting detailed data on these challenges. This study aimed to bridge this gap by examining how sexual and gender minorities experience social risk factors differently from other populations across the country.
“There is substantial evidence that sexual and gender minority adults often report limited access to care and worse health outcomes compared to heterosexual and cisgender adults, respectively. We know less, however, about how often they report social risk factors—dissatisfaction with life, social isolation, employment loss, insufficient food, and stress—which are linked to poor health outcomes,” said study author Kevin Nguyen, an assistant professor in the Department of Health Law, Policy, and Management at Boston University School of Public Health.
The study utilized data from the 2022 Behavioral Risk Factor Surveillance System, a national survey conducted by the Centers for Disease Control and Prevention. This survey collects information about health behaviors, access to care, and social conditions from a diverse sample of adults in the United States. For this study, researchers analyzed responses from more than 180,000 participants across 22 states that included optional survey modules on sexual orientation, gender identity, and social determinants of health.
The researchers focused on 10 specific social risk factors, including dissatisfaction with life, lack of emotional support, social isolation, recent job loss, food insecurity, difficulty paying housing or utility bills, lack of transportation, and perceived stress. They compared these factors between sexual and gender minority individuals and their heterosexual and cisgender counterparts. The analysis accounted for sociodemographic variables such as age, race, income, and state-level policies related to LGBTQ+ rights.
The study uncovered significant disparities in social risk factors between sexual and gender minority adults and their heterosexual and cisgender counterparts. These disparities were observed across nearly all measured social risk factors.
Among sexual minority women (such as lesbians, bisexual women, and those who identify as non-heterosexual), more than half (58%) reported experiencing at least one social risk factor, compared to 37% of heterosexual women. These women were significantly more likely to face social isolation, lack of emotional support, dissatisfaction with life, and perceived stress. Economic challenges were also more pronounced, with sexual minority women reporting higher rates of employment loss, difficulty paying housing bills, and inadequate transportation access.
Sexual minority men (such as gay, bisexual men, and those who identify as non-heterosexual) showed similar patterns of disparity. Over half (51%) of sexual minority men reported at least one social risk factor, compared to 34% of heterosexual men. These men were more likely to experience dissatisfaction with life, social isolation, and perceived stress. Additionally, financial strains, such as food insecurity and challenges in paying for housing or utilities, were more prevalent among this group.
The most striking disparities were found between gender minority adults (such as transgender and nonbinary individuals) and their cisgender counterparts. Nearly two-thirds (64%) of gender minority adults reported experiencing at least one social risk factor, compared to 37% of cisgender adults. Gender minority individuals faced significantly higher rates of dissatisfaction with life, social isolation, and stress. Economic hardships, including job loss, food insecurity, and inability to pay for basic utilities, were also more common among gender minorities.
Social isolation emerged as a particularly critical issue for gender minority adults, with the study finding significantly higher levels of loneliness and lack of emotional support compared to cisgender participants. These experiences of isolation likely stem from the compounded effects of stigma, discrimination, and exclusion in both social and professional contexts.
“Social risk factors, which are individual-level negative experiences like insufficient food, disproportionately impact sexual and gender minority adults when compared to heterosexual and cisgender adults,” Nguyen told PsyPost. “More than half of sexual minority adults and about two-thirds of gender minority adults experienced at least one social risk factor in 2022.”
The findings underscore the interconnected nature of these social risk factors. For instance, the inability to pay housing or utility bills can exacerbate stress, while social isolation may contribute to dissatisfaction with life and reduced access to emotional support. These interconnected challenges reveal how structural inequities ripple through various aspects of life for sexual and gender minority individuals.
“The study focused on health data for nearly 180,000 US adults living in 22 states from January 2022 to February 2023,” Nguyen said. “These disparities are consequences of structural discrimination and stigmatization of marginalized populations. Public policies that codify equality by sexual orientation and gender identity may have long-term effects on financial security and mental wellbeing for sexual and gender minorities.”
The study, “Inequities in Self-Reported Social Risk Factors by Sexual Orientation and Gender Identity,” was authored by Kevin H. Nguyen, Timothy W. Levengood, Allegra R. Gordon, Leesh Menard, Heidi L. Allen, and Gilbert Gonzales.
