Primary sources of health care among LGBTQ+ veterans: Findings from the Behavioral Risk Factor Surveillance System

Abstract

Objective This study examined the primary source of health care between veterans with lesbian, gay, bisexual, queer and similar identities (LGBTQ+) and non‐LGBTQ+ veterans. Data Sources and Study Setting Veterans (N = 20,497) from 17 states who completed the CDC's Behavioral Risk Factor Surveillance System from 2016 to 2020, including the Sexual Orientation and Gender Identity and Health Care Access modules. Study Design We used survey‐weighted multiple logistic regression to estimate average marginal effects of the prevalence of utilization of Veteran's Health Administration (VHA)/military health care reported between LGBTQ+ and non‐LGBTQ+ veterans. Prevalence estimates were adjusted for age group, sex, race and ethnicity, marital status, educational attainment, employment status, survey year, and US state. Data Collection Methods Study data were gathered via computer‐assisted telephone interviews with probability‐based samples of adults aged 18 and over. Data are publicly available. Principal Findings Overall, there was not a statistically significant difference in estimated adjusted prevalence of primary use of VHA/military health care between LGBTQ+ and non‐LGBTQ+ veterans (20% vs. 23%, respectively, p = 0.13). When examined by age group, LGBTQ+ veterans aged 34 and younger were significantly less likely to report primary use of VHA/military health care compared to non‐LGBTQ+ veterans (25% vs. 44%, respectively; p = 0.009). Similarly, in sex‐stratified analyses, fewer female LGBTQ+ veterans than female non‐LGBTQ+ veterans reported VHA/military health care as their primary source of care (13% vs. 29%, respectively, p = 0.003). Implications and limitations to these findings are discussed. Conclusions Female and younger LGBTQ+ veterans appear far less likely to use VHA/military for health care compared to their cisgender, heterosexual peers; however, because of small sample sizes, estimates may be imprecise. Future research should corroborate these findings and identify potential reasons for these disparities.

Examining differences in mental health and mental health service use among lesbian, gay, bisexual, and heterosexual veterans.

“…Additionally, in analyses examining likelihood of mental health treatment, we further controlled for whether participants endorsed utilizing VA health care as their main source of health care coverage. Consistent with previous research on health care utilization with sexual minority veterans (Hahn et al, 2023) and research on mental health care utilization with sexual minority nonveterans (S. D. Cochran et al, 2017), we stratified our analyses by gender.…”

“…Blosnich, Bossarte, et al, 2013;J. Blosnich, Foynes, & Shipherd, 2013;Hahn et al, 2023;Mattocks et al, 2013;Shipherd, Darling, et al, 2018), few studies have examined mental health care service use (Mattocks et al, 2013;Shipherd et al, 2021;Shipherd, Ruben, et al, 2018;Simpson et al, 2013). Similar to nonveteran sexual minority people, sexual minority veterans report experiencing discrimination and stigma when seeking health care services (Livingston et al, 2019;Mattocks et al, 2015;Sherman et al, 2014;Shipherd, Darling, et al, 2018), which may impact comfort and motivation to engage in health care, including mental health care.…”