Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Health Disparities Among Sexual Gender Minority Women in the United States: A Population-Based Study


There is a paucity of population-based research to identify health disparities experienced by sexual gender minority (SGM) women. The purpose of this study was to use a population-based data set to understand disparities in access to healthcare, preventive care, and health risk behaviors of lesbian and bisexual women compared to their straight counterparts and to each other. This was a cross-sectional study using the 2016 Behavioral Risk Factor Surveillance System data. SPSS with complex samples was used to calculate weighted descriptive statistics. Logistic regression was used to calculate odds and adjusted odds ratios. 9016 women were included in the analyses. Women who identified as lesbian were more likely to be from a minority group. Bisexual women were more likely to be in the younger age groups and were less likely to be college graduates or report a higher income. Lesbian and bisexual women were more likely to report depression, smoking, and heavy/binge drinking compared to straight women. They were also less likely to have received a pap test. Compare to lesbian women, bisexual women were more likely to report depression and poorer health. SGM women are at greater risk of depression and risky coping behaviors such as smoking and heavy/binge drinking. Within the SGM subgroup, bisexual women have a higher risk for depression and worse general health. Health promotion programs and interventions must be tailored to account for the unique stressors SGM women encounter and associated negative health outcomes.

This is a preview of subscription content, log in to check access.


  1. 1.

    Hutchinson, M. K., Thompson, A. C., & Cederbaum, J. A. (2006). Multisystem factors contributing to disparities in preventive health care among lesbian women. Journal of Obstetric, Gynecologic & Neonatal Nursing, 35(3), 393–402.

  2. 2.

    Coulter, R. W., Kenst, K. S., & Bowen, D. J. (2014). Research funded by the national institutes of health on the health of lesbian, gay, bisexual, and transgender populations. American Journal of Public Health, 104(2), e112.

  3. 3.

    Fredriksen-Goldsen, K. I., Simoni, J. M., Kim, H., Lehavot, K., Walters, K. L., Yang, J., et al. (2014). The health equity promotion model: Reconceptualization of lesbian, gay, bisexual, and transgender (LGBT) health disparities. American Journal of Orthopsychiatry, 84(6), 653.

  4. 4.

    Solarz, A. L. (1999). Lesbian health: Current assessment and directions for the future. Washington, DC: National Academies Press.

  5. 5.

    Graham, R., Berkowitz, B., Blum, R., Bockting, W., Bradford, J., de Vries, B., et al.(2011). The health of lesbian, gay, bisexual, and transgender people: Building a foundation for better understanding. Washington, DC: Institute of Medicine.

  6. 6.

    Conron, K. J., Mimiaga, M. J., & Landers, S. J. (2010). A population-based study of sexual orientation identity and gender differences in adult health. American Journal of Public Health, 100(10), 1953–1960.

  7. 7.

    Fredriksen-Goldsen, K. I., Kim, H., Barkan, S. E., Muraco, A., & Hoy-Ellis, C. P. (2013). Health disparities among lesbian, gay, and bisexual older adults: Results from a population-based study. American Journal of Public Health, 103(10), 1802–1809.

  8. 8.

    Ingraham, N., Eliason, M. J., Garbers, S., Harbatkin, D., Minnis, A. M., McElroy, J. A., & Haynes, S. G. (2016). Effects of mindfulness interventions on health outcomes in older lesbian/bisexual women. Women’s Health Issues, 26, S62.

  9. 9.

    Minnis, A. M., Catellier, D., Kent, C., Ethier, K. A., Soler, R. E., Heirendt, W., et al. (2016). Differences in chronic disease behavioral indicators by sexual orientation and sex. Journal of Public Health Management and Practice: JPHMP, 22(Suppl 1), S25.

  10. 10.

    Laska, M. N., VanKim, N. A., Erickson, D. J., Lust, K., Eisenberg, M. E., & Rosser, B. S. (2015). Disparities in weight and weight behaviors by sexual orientation in college students. American Journal of Public Health, 105(1), 111–121.

  11. 11.

    Baptiste-Roberts, K., Oranuba, E., Werts, N., & Edwards, L. V. (2017). Addressing health care disparities among sexual minorities. Obstetrics and Gynecology Clinics, 44(1), 71–80.

  12. 12.

    Corcoran, N. (2017). Promoting health in lesbian and bisexual women: It is not just about behaviour change. Journal of Clinical Nursing, 26(21–22), 3742–3750.

  13. 13.

    Ward, B. W., Dahlhamer, J. M., Galinsky, A. M., & Joestl, S. S. (2014). Sexual orientation and health among US adults: national health interview survey, 2013. National Health Statistics Reports, 77, 1–10

  14. 14.

    Tang, H., Greenwood, G. L., Cowling, D. W., Lloyd, J. C., Roeseler, A. G., & Bal, D. G. (2004). Cigarette smoking among lesbians, gays, and bisexuals: How serious a problem?(united states). Cancer Causes & Control, 15(8), 797–803.

  15. 15.

    Gonzales, G., & Henning-Smith, C. (2017). Health disparities by sexual orientation: Results and implications from the behavioral risk factor surveillance system. Journal of Community Health, 42(6), 1163–1172.

  16. 16.

    Jackson, C. L., Agénor, M., Johnson, D. A., Austin, S. B., & Kawachi, I. (2016). Sexual orientation identity disparities in health behaviors, outcomes, and services use among men and women in the united states: A cross-sectional study. BMC Public Health, 16(1), 807.

  17. 17.

    Sanchez, J. P., Meacher, P., & Beil, R. (2005). Cigarette smoking and lesbian and bisexual women in the bronx. Journal of Community Health, 30(1), 23–37.

  18. 18.

    Reczek, C., Liu, H., & Brown, D. (2014). Cigarette smoking in same-sex and different-sex unions: The role of socioeconomic and psychological factors. Population Research and Policy Review, 33(4), 527–551.

  19. 19.

    Matthews, D. D., & Lee, J. G. (2014). A profile of north carolina lesbian, gay, and bisexual health disparities, 2011. American Journal of Public Health. 104(6), e105.

  20. 20.

    Cochran, S. D., & Mays, V. M. (2011). Sexual orientation and mortality among US men aged 17 to 59 years: Results from the national health and nutrition examination survey III. American Journal of Public Health, 101(6), 1133–1138.

  21. 21.

    Centers for Disease Control and Prevention. (2017). Behavioral risk factor surveillance system, 2016 BRFSS modules used by category Retrieved from https://www.cdc.gov/brfss/questionnaires/modules/category2016.htm.

  22. 22.

    Healthy People 2. (2018). Lesbian, gay, bisexual, and transgender health. Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/lesbian-gay-bisexual-and-transgender-health.

  23. 23.

    Centers for Disease Control and Prevention. (2014). Behavioral risk factor surveillance system overview: BRFSS 2013. Retrieved from http://www.cdc.gov/brfss/annual_data/2013/pdf/overview_2013.pdf.

  24. 24.

    Centers for Disease Control and Prevention. (2014). Behavioral risk factor surveillance sytstem: 2013 codebook report. Retrieved from http://www.cdc.gov/brfss/annual_data/2013/pdf/codebook13_llcp.pdf.

  25. 25.

    Khalilzadeh, J., & Tasci, A. D. (2017). Large sample size, significance level, and the effect size: Solutions to perils of using big data for academic research. Tourism Management, 62, 89–96.

  26. 26.

    Sullivan, G. M., & Feinn, R. (2012). Using effect size—Or why the P value is not enough. Journal of Graduate Medical Education, 4(3), 279–282.

  27. 27.

    Mays, V. M., Yancey, A. K., Cochran, S. D., Weber, M., & Fielding, J. E. (2002). Heterogeneity of health disparities among african american, hispanic, and asian american women: Unrecognized influences of sexual orientation. American Journal of Public Health, 92(4), 632–639.

  28. 28.

    Burton, C. M., Marshal, M. P., Chisolm, D. J., Sucato, G. S., & Friedman, M. S. (2013). Sexual minority-related victimization as a mediator of mental health disparities in sexual minority youth: A longitudinal analysis. Journal of Youth and Adolescence, 42(3), 394–402.

  29. 29.

    Rankow, E. J. (1995). Breast and cervical cancer among lesbians. Women’s Health Issues, 5(3), 123–129.

  30. 30.

    Durso, L. E., & Meyer, I. H. (2013). Patterns and predictors of disclosure of sexual orientation to healthcare providers among lesbians, gay men, and bisexuals. Sexuality Research and Social Policy, 10(1), 35–42.

  31. 31.

    Gangamma, R., Slesnick, N., Toviessi, P., & Serovich, J. (2008). Comparison of HIV risks among gay, lesbian, bisexual and heterosexual homeless youth. Journal of Youth and Adolescence, 37(4), 456–464.

  32. 32.

    Aschengrau, A., & Seage, G. R. (2003). Essentials of epidemiology in public health. Sudbury, MA: Jones & Bartlett Learning.

  33. 33.

    Adams, A. S., Soumerai, S. B., Lomas, J., & Ross-Degnan, D. (1999). Evidence of self-report bias in assessing adherence to guidelines. International Journal for Quality in Health Care, 11(3), 187.

Download references

Author information

Correspondence to Jennifer R. Pharr.

Ethics declarations

Conflict of interest

Authors do not have conflicts of interests to report.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Pharr, J.R., Kachen, A. & Cross, C. Health Disparities Among Sexual Gender Minority Women in the United States: A Population-Based Study. J Community Health 44, 721–728 (2019). https://doi.org/10.1007/s10900-019-00631-y

Download citation


  • Sexual gender minority
  • Health disparities
  • Lesbian and bisexual women’s health
  • Behavioral Risk Factor Surveillance System