Sexual orientation-related disparities in healthcare access in three cohorts of U.S. adults.

The objective of this study was to quantify sexual orientation differences in insurance access, healthcare utilization, and unmet needs for care. We analyzed cross-sectional data from three longitudinal U.S.-based cohorts (N = 31,172) of adults ages 20-54 years in the Growing Up Today Studies 1 and 2 and the Nurses' Health Study 3 from 2015 to 2019. Adjusted log-binomial models examined sexual orientation differences (reference: completely heterosexual) in insurance access, healthcare utilization, and unmet needs for care. Compared to completely heterosexuals, mostly heterosexual and bisexual adults were more likely to report emergency departments as a usual source of care and less likely to be privately insured. Sexual minorities (mostly heterosexual, bisexual, gay/lesbian) were also more likely than completely heterosexuals to delay needed care for reasons of not wanting to bother a healthcare provider, concerns over cost/insurance, bad prior healthcare experiences, and being unable to get an appointment. Differences by sex and sexual orientation also emerged for healthcare utilization and unmet needs. For example, mostly heterosexual women were more likely than completely heterosexual women to delay care due to perceiving symptoms as not serious enough, while gay men were less likely than lesbian women to delay for this reason. Findings indicate that sexual minorities experience disparities in unmet needs for and continuity of care. Provider education should be attentive to how perceptions, like perceived severity, can shape healthcare access in tandem with socioeconomic barriers.