A recent study conducted by the Kaiser Family Foundation (KFF), a nonpartisan health policy research organization, reveals that LGBT patients face discrimination at higher rates than non-LGBT patients.
The results of the 2023 survey conclude that despite most LGBT adults reporting having mostly positive interactions with health care providers, they’re still twice as likely to have a negative experience as a non-LGBT patient. Those surveyed reported instances of having questions ignored and pain medications denied by a doctor.
Social scientist Carey Candrian, PhD, associate professor of internal medicine at the University of Colorado School of Medicine focuses her research on improving the way older LGBTQ+ people are cared for during serious illnesses, especially during end of life care.
She says the results of the survey emphasize the need for more work and research to prevent further discrimination. She explains there are many obstacles and barriers in preventing proper care, and she hopes to create a more inclusive and safe health care landscape for people of all backgrounds and orientations.
Accessibility difficulties
A significant amount of LGBTQ+ older adults live at or below the poverty line, making financial insecurity and lack of proper health care one of the biggest barriers to accessing quality care.
“Lack of affirming or safe clinicians is a huge factor, which results in a lot of people not going to get routine care, because they're fearful that they have to be silent about who they are or hide their identity to actually get the care they need,” Candrian says. “This is particularly true for the trans community. Because of this, they end up not going.”
LGBTQ+ adults who are disabled, impoverished, non-white, or dealing with mental health issues or addiction are even more likely to face discrimination when seeking health care. Of the adults surveyed by KFF, those who are Black or Hispanic, under the age of 30, and identify as women were more likely to experience discrimination than their non-LGBT counterparts.
“The fear mixed with a health care system that historically has not been inclusive and is not really designed for anyone who's not straight, white, and cisgendered makes it extremely hard to speak up,” Candrian explains. “Then there’s the issue of refusal of care. There is still no protection that prevents people from denying care based on a variety of personal reasons.”
Risks of improper care
The prevalence of osteoporosis, various cancers (including colon, breast, ovarian, prostate, and cervical), obesity, and mental health disorders are higher in LGBTQ populations. Suicide rates are also high, especially among trans people.
“In general, LGBT people are more likely to have estranged relationships with their family,” Candrian says. “They're less likely to be married, less likely to have kids. They are at a disadvantage insofar as they don't have a lot of people to help advocate on their behalf. That combines with an undercurrent of discrimination that we know is happening all around the health ecosystem.”
Beyond the mental health impact and the risk of medical issues going untreated, there are also underlying health issues that can be caused or exacerbated by the stress of experiencing discrimination. This stress can manifest in physical symptoms and can take a severe toll on cardiovascular health.
“Dealing with diseases like cancer or dementia are recognized as some of the hardest things you can go through. And if you are worrying about whether you’re going to be accepted, or going to have a trusting relationship with your caregivers, it adds to the burden in extraordinary ways,” Candrian says.
Patients are not required to disclose their identities or orientations during doctor’s visits – which can provide a layer of safety, but also reinforces a culture of silence. Because doctors do not regularly ask for information on gender and sexuality, they are working with limited information and potentially missing key details that could inform care.
The opportunity for growth
Candrian suggests that providers routinely ask about sexual orientation and gender identity the same way they ask for other pieces of information, such as race and ethnicity. Coupled with strong non-discrimination policies, this normalization can lead to deeper understanding and decrease discrimination.
“Asking for this data needs to be rolled out with training and education,” Candrian explains. “This is still very dangerous information, and learning how to ask these questions in a way that doesn't perpetuate discrimination lets 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 the LGBTQ+ Hub, campus mental health resources, and the UCHealth Integrated Transgender Program.
“When people are talking to patients, coworkers, family members, and friends, I would encourage them to ask themselves, ‘Does the way I ask this question give space for lots of different types of answers? What if they are trans? What if they are estranged from their family? What if they just lost a spouse? What if they have a partner of 33 years but are not legally married?’” Candrian says. “Does the way you frame your question shut them out, or invite them in?”
May 3, 2024