Disparities in Health Insurance Coverage, Access, and Outcomes for Individuals in Same-Sex Versus Different-Sex Relationships, 2000–2007

摘要

Objectives. We used data from the Behavioral Risk Factor Surveillance System to compare health insurance coverage, access to care, and women's cancer screenings for individuals in same-sex versus different-sex relationships. Methods. We estimated logistic regression models by using data on 5265 individuals in same-sex relationships and 802 659 individuals in different-sex relationships. Results. Compared with women in different-sex relationships, women in same-sex relationships were significantly less likely to have health insurance coverage, were less likely to have had a checkup within the past year, were more likely to report unmet medical needs, and were less likely to have had a recent mammogram or Pap test. Compared with men in different-sex relationships, men in same-sex relationships were significantly less likely to have health insurance coverage and were more likely to report unmet medical needs, although they were more likely to have had a checkup in the past year. Conclusions. In the largest and most recent nationally representative sample, we found important differences in health insurance coverage and access to care between individuals in same-sex relationships and those in different-sex relationships for both men and women. Sexual minorities have received increasing research attention in social science and public health, in part as the result of increasing recognition of health disparities associated with sexual orientation. 1 The earliest research on sexual minorities generally used convenience samples of gay men and lesbians because large-scale representative surveys rarely ask questions about sexual orientation. 2 , 3 Although a handful of large surveys now do ask direct questions about sexual orientation, most are concentrated to a single city or state (such as the Los Angeles County Health Survey 4 or the California Health Interview Survey 5 ) or provide very small samples of sexual minorities at a point in time (such as the National Health and Social Life Survey or the National Survey of Family Growth). An alternative approach to identifying sexual minorities in large, nationally representative social science data sources has therefore been to use information on intra-household relationships. This information can be used to create samples of gay men and lesbians in same-sex cohabiting relationships whose outcomes can be compared with heterosexual men and women—both married and unmarried—in cohabiting relationships. This approach has the benefit that samples of individuals in same-sex relationships can be created from large household datasets that routinely collect information on socioeconomic outcomes of interest to social science and public health researchers. Recent work has applied this couples-based strategy in the 1997 to 2003 National Health Interview Survey to document differences in health insurance coverage and access to care for 614 individuals in same-sex relationships compared with 93 418 individuals in different-sex relationships. 6 That study found that women in same-sex relationships were significantly less likely to have health insurance coverage, were significantly less likely to have visited a health professional in the past 12 months, and were significantly more likely to have unmet medical needs than were women in different-sex relationships. In contrast, that study found no statistically significant differences in insurance coverage or unmet medical needs for men in same-sex relationships compared with men in different-sex relationships. Another recent study used a similar approach to look at individuals from the 1996 through 2003 pooled March Current Population Surveys and found that individuals in same-sex relationships were significantly less likely to have health insurance coverage than were married individuals in different-sex relationships. 7 In the present analysis, we studied differences between individuals in same-sex relationships and those in different-sex relationships with respect to health insurance coverage, access to care, and health outcomes by using large samples of data from the 2000 through 2007 Behavioral Risk Factor Surveillance System (BRFSS). We used information on the gender composition of the household combined with information on the respondent's marital status to mimic previous approaches for identifying samples of men and women in same-sex relationships. The key advantage of using the BRFSS was that we could identify over 5000 men and women in same-sex relationships, which is several times larger than the numbers used in previous studies. We hypothesized that these additional observations would provide important precision with which we could identify differences in relevant outcomes for individuals in same-sex relationships compared with individuals in different-sex relationships.