New research shows that LGBT adults face more discrimination in health care

A recent study conducted by the Kaiser Family Foundation (KFF), a nonpartisan health policy research organization, found that LGBTQ+ patients are more likely to experience discrimination than non-LGBT patients.

The results of the 2023 study conclude that even though most LGBT adults report having mostly positive interactions with healthcare providers, they are still twice as likely to have a negative experience as non-LGBT patients. Respondents reported instances in which questions were ignored and painkillers refused by a doctor.

Social scientist Carey Candrian, PhD, associate professor of internal medicine at the The University of Colorado School of Medicine focuses its research on improving the way older LGBT people are cared for during serious illness, especially during end-of-life care.

She says the survey results highlight the need for more work and research to prevent further discrimination. She explains that there are many obstacles and barriers to good care, and she hopes to create a more inclusive and safe healthcare landscape for people of all backgrounds and orientations.

Accessibility issues

A significant number of LGBT older adults live at or below the poverty line, making financial insecurity and a lack of quality health care one of the biggest barriers to accessing quality care.

“The lack of affirming or safe doctors is a huge factor, leading to many people not receiving routine care because they fear they will have to remain silent about who they are or hide their identity to actually receive care. they need,” says Candrian. “This is especially true for the trans community. Because of this they ultimately don’t go.”

LGBT adults who are disabled, poor, non-white, or dealing with mental health issues or addiction are even more likely to face discrimination when seeking health care. Among adults surveyed by KFF, those who are black or Hispanic, under age 30 and identify as female were more likely to experience discrimination than their non-LGBT counterparts.

“The fear combined with a healthcare system that has historically not been inclusive and not really designed for anyone who is not straight, white, and cisgender, makes it extremely difficult to speak up,” Candrian explains. “Then there is the issue of denial of care. There is still no protection that prevents people from refusing care based on a variety of personal reasons.”

Risks of improper care

The prevalence of osteoporosis, several cancers (including colon, breast, ovarian, prostate and cervical cancer), obesity and mental disorders is higher in LGBTQ populations. Suicide rates are also high, especially among transgender people.

“In general, LGBT people are more likely to have estranged relationships with their families,” Candrian says. ‘They are less likely to get married and have children less often. They are at a disadvantage because they don’t have many people to advocate on their behalf. “That comes with an undercurrent of discrimination that we know exists throughout the health ecosystem.”

In addition to the mental health impact and the risk of medical problems going untreated, there are also underlying health conditions that can be caused or exacerbated by the stress of discrimination. This stress can manifest itself in physical symptoms and can take a serious toll on cardiovascular health.

“Dealing with diseases such as cancer or dementia is recognized as one of the most difficult things you can experience. And worrying about whether you will be accepted or have a trusting relationship with your healthcare providers increases the burden in extraordinary ways,” says Candrian.

Patients do not have to reveal their identity or orientation during doctor visits – which can provide a layer of security, but also reinforces a culture of silence. Because doctors do not regularly ask for information about gender and sexuality, they are working with limited information and may miss important details that could inform care.

The opportunity for growth

Candrian suggests that providers routinely ask about sexual orientation and gender identity in the same way they ask for other pieces of information such as race and ethnicity. Combined with a strong non-discrimination policy, this normalization can lead to deeper understanding and a reduction in discrimination.

“Requesting this data needs to be rolled out with training and education,” Candrian explains. “This is still very dangerous information, and learning to ask these questions in a way that does not perpetuate discrimination helps people know that this is being asked to provide better care.”

Resources are available for the LGBTQ community on the CU Anschutz Campus, including the LGBTQ+ Hub, mental health resources on campusand the UCHealth Integrated Transgender Program.

“When people talk to patients, colleagues, family members and friends, I encourage them to ask themselves, ‘Does the way I ask this question allow for many different types of answers? What if they are trans? What if they become estranged from their family? What if they just lost a spouse? What if they’ve been together for 33 years, but they’re not legally married?’” Candrian says. “Does the way you phrase your question exclude them or invite them in?”