From Department of Medicine, Health, and Society, Vanderbilt University, Nashville, and NashvilleHealth, Nashville, Tennessee.
South Med J. 2021 May;114(5):299-304. doi: 10.14423/SMJ.0000000000001251.
Health disparities for lesbian, gay, bisexual, and transgender (LGBT) adults are well documented, but LGBT health data at the municipal and county levels are lacking, especially in the southern United States. The objective of this study was to compare access to care, health outcomes, and behavioral risk factors between LGBT and non-LGBT adults in Nashville and Davidson County, Tennessee.
Data for this study came from a randomly selected, population-based sample of LGBT (n = 128) and non-LGBT (n = 1583) adults in Nashville. Multivariable logistic regression models were used to compare health outcomes between LGBT and non-LGBT Nashvillians while adjusting for demographic characteristics and socioeconomic status.
LGBT Nashvillians were more likely to be uninsured (odds ratio [OR] 3.96, 95% confidence interval [CI] 1.72-9.10), report unmet medical care needs because of cost (OR 2.20, 95% CI 1.14-4.25), exhibit worse mental health outcomes (eg, frequent mental distress; OR 4.53, 95% CI 2.33-8.80), and report high-risk behaviors for human immunodeficiency virus (OR 9.47, 95% CI 3.96-22.62) compared with non-LGBT Nashvillians.
To achieve health equity for LGBT individuals at the municipal level, Nashville and Tennessee should consider multifaceted approaches to expanding health insurance coverage and nondiscrimination protections and address mental health and human immunodeficiency virus risks among vulnerable populations.
已充分记录了女同性恋、男同性恋、双性恋和跨性别（LGBT）成年人的健康差距，但在市和县一级缺乏 LGBT 健康数据，尤其是在美国南部。本研究的目的是比较田纳西州纳什维尔和戴维森县的 LGBT 和非 LGBT 成年人在获得医疗服务、健康结果和行为风险因素方面的差异。
本研究的数据来自纳什维尔随机选择的基于人群的 LGBT（n=128）和非 LGBT（n=1583）成年人样本。使用多变量逻辑回归模型比较 LGBT 和非 LGBT 纳什维尔居民的健康结果，同时调整人口统计学特征和社会经济地位。
LGBT 纳什维尔居民更有可能没有医疗保险（优势比[OR]3.96，95%置信区间[CI]1.72-9.10），因为费用而报告未满足的医疗需求（OR 2.20，95%CI 1.14-4.25），表现出更差的心理健康结果（例如，经常感到精神困扰；OR 4.53，95%CI 2.33-8.80），并且报告了人类免疫缺陷病毒（OR 9.47，95%CI 3.96-22.62）的高危行为，与非 LGBT 纳什维尔居民相比。
为了在市级实现 LGBT 个人的健康公平，纳什维尔和田纳西州应考虑采取多方面的方法来扩大医疗保险覆盖范围和非歧视保护，并解决弱势人群的心理健康和人类免疫缺陷病毒风险。
