(see Poster Gallery) Rural/Urban Differences in Self-Rated Health and Access to Care Among LGBT Adults

Background and Purpose: Research shows that Lesbian, Gay, Bisexual and Transgender (LGBT) adults experience more adverse health outcomes compared to heterosexual and cisgender adults in the United States. This disparity is exacerbated by stigma, discrimination, and homophobic/transphobic legislation. Additionally, rural adults in the United States face more adverse health outcomes due to issues such as barriers to care, transportation barriers, and systemic urbanism. There is a dearth of research examining the intersection of rurality and sexual orientation/gender identity. This study explores this intersection to highlight the unique needs of these communities and provide recommendations to advance health equity.

Methods: This study uses 2019-2020 data from two nationally representative data sets: the Behavioral Risk Factor Surveillance System (BRFSS) and the National Health Interview Survey (NHIS). We conducted bivariate analyses examining rural/urban differences in self-rated health based on sexual orientation. We then conducted bivariate analyses examining rural/urban differences in access to care based on gender identity. Lastly, we conducted a multivariate logistic regression adjusting for age, sex, race/ethnicity, educational attainment, and income to examine the odds of reporting “good/very good or excellent” self-rated health for rural Lesbian, Gay, and Bisexual (LGB) adults compared to urban LGB adults.

Results: NHIS data revealed significant differences in self-rated health between rural LGB respondents and heterosexual respondents (p<0.01) with LGB respondents more likely to report poor or fair self-rated health and no significant difference in self-rated health between urban LGB and heterosexual respondents (p=0.43). BRFSS data revealed statistically significant differences among rural LGB and heterosexual respondents (p=.01) and urban LGB and heterosexual respondents (p<0.01) with LGB respondents being more likely to report poor or fair self-rated health in both geographic contexts.

Bivariate analyses indicated that rural transgender respondents were more likely than cisgender rural respondents to report that they could not see a doctor due to cost (p=.04). Rural transgender adults were also more likely than cisgender rural adults to report that they had no health coverage, no regular doctor, and no annual checkup however these differences were not statistically significant.

Multivariate logistic regression across BRFSS and NHIS data sets showed that when adjusting for age, sex, race/ethnicity, educational attainment, and income, LGB rural adults had lower odds of good/very good/excellent self-rated health, compared with heterosexual rural adults in both the NHIS (adjusted odds ratio [AOR]: 0.38, p<0.001 ,95% confidence interval [CI]: .24-.58) and the BRFSS (AOR: 0.79, p<0.01, 95% confidence interval [CI]: .70-.89).

Conclusions/Implications: This study advances health equity research by revealing the compounding effect of being LGBT and rural with regard to self-rated health and access to health care. Analyses of gender identity and rurality were inhibited by small sample size thereby demonstrating the need for additional national data on rurality and gender identity. These findings demonstrate the need for increased specialty care for rural LGBT populations and improvements in health access. Moreover, social workers should advocate for overturning discriminatory transphobic and homophobic policies to promote health equity with particular attention paid to rural LGBT communities.