Table 2.
Adjusted1 log binomial models of sexual orientation differences in healthcare utilization, reasons for having an unmet need for care, and insurance access in three cohorts of U.S. men and women (N = 31,172) collected from 1996 to 2019.
| Mostly heterosexual vs. completely heterosexual | Bisexual vs. completely heterosexual | Gay/lesbian vs. completely heterosexual | ||||
|---|---|---|---|---|---|---|
| RR2 | (95% CI)2 | RR2 | (95% CI)2 | RR2 | (95% CI)2 | |
| Health insurance in last year | ||||||
| Some kind of coverage3 | 0.99 | (0.98, 0.99) | 0.98 | (0.96, 0.99) | 0.98 | (0.97, 1.00) |
| Any lapse in coverage | 1.73 | (1.55, 1.93) | 2.01 | (1.60, 2.53) | 1.35 | (1.04, 1.76) |
| Type of plan | ||||||
| Private | 0.98 | (0.97, 0.99) | 0.94 | (0.91, 0.97) | 1.00 | (0.97, 1.02) |
| Government | 1.13 | (0.98, 1.30) | 1.84 | (1.40, 2.42) | 0.98 | (0.69, 1.39) |
| Single-service | 1.14 | (1.04, 1.25) | 1.19 | (0.96, 1.47) | 1.23 | (1.01, 1.50) |
| Other | 1.24 | (0.97, 1.57) | 1.10 | (0.61, 2.01) | 1.20 | (0.71, 2.03) |
| Healthcare use | ||||||
| Over 1 year since last routine physical exam3 | 1.11 | (1.07, 1.16) | 1.15 | (1.04, 1.26) | 1.01 | (0.93, 1.11) |
| Place of usual care | ||||||
| Private practice or HMO+ | 0.96 | (0.94, 0.97) | 0.91 | (0.87, 0.95) | 0.97 | (0.94, 1.01) |
| Public clinic4 | 1.92 | (1.72, 2.13) | 2.72 | (2.25, 3.30) | 2.32 | (1.90, 2.82) |
| Urgent care/hospital emergency room | 1.19 | (1.10, 1.29) | 1.36 | (1.15, 1.62) | 1.04 | (0.86, 1.25) |
| Other | 1.09 | (1.00, 1.18) | 1.32 | (1.11, 1.57) | 1.03 | (0.86, 1.23) |
| Delayed care | ||||||
| Delayed care for at least 1 reason3 | 1.09 | (1.07, 1.11) | 1.11 | (1.07, 1.16) | 1.01 | (0.96, 1.05) |
| Reasons for delay | ||||||
| Symptoms not serious enough | 1.06 | (1.03, 1.08) | 1.05 | (0.99, 1.11) | 0.99 | (0.93, 1.04) |
| Avoid bothering healthcare provider | 1.17 | (1.04, 1.31) | 1.40 | (1.08, 1.80) | 1.46 | (1.15, 1.86) |
| Nothing can help | 1.33 | (1.25, 1.42) | 1.48 | (1.28, 1.71) | 1.14 | (0.97, 1.33) |
| Concerns over cost/insurance | 1.48 | (1.38, 1.58) | 1.75 | (1.52, 2.00) | 1.19 | (1.01, 1.41) |
| Bad prior healthcare experiences | 1.82 | (1.58, 2.10) | 2.96 | (2.31, 3.81) | 2.31 | (1.76, 3.03) |
| Could not get appointment | 1.59 | (1.42, 1.79) | 2.23 | (1.79, 2.78) | 1.55 | (1.19, 2.01) |
Models adjusted for sex, race/ethnicity, study cohort, and age; “some kind of coverage” model also adjusted for questionnaire year; reference group is completely heterosexuals.
RR is “risk ratio,” CI is “confidence interval.”
Sensitivity analyses were performed for the “over 1 year since last routine physical exam” and “some kind of coverage” models with outcome variables that were not imputed; only small coefficient discrepancies emerged between the imputed and non-imputed models. Another sensitivity analysis was conducted by adding “any insurance coverage” as a covariate in the healthcare utilization and unmet needs for care models, but associations were not attenuated.
The “public clinic” model used Poisson distribution estimation.
HMO is “Health Maintenance Organization.”