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Differences in Health Insurance and Usual Source of Care Among Racial/Ethnic and Sexual Orientation Subgroups of U.S. Women and Men

Author

Listed:
  • Madina Agénor

    (Brown University School of Public Health
    Brown University School of Public Health
    The Fenway Institute, Fenway Health)

  • J. Wyatt Koma

    (Harvard University)

  • Ashley E. Pérez

    (University of California)

  • Alex McDowell

    (Mongan Institute Health Policy Center, Massachusetts General Hospital
    Harvard Medical School)

  • Gilbert Gonzales

    (Vanderbilt University)

Abstract

Researchers have identified inequities in health insurance and usual source of care in relation to either race/ethnicity or sexual orientation among U.S. women and men. However, intersectionality suggests that racism and heterosexism may have a compounding negative impact on health care outcomes in relation to both race/ethnicity and sexual orientation. Using 2013–2018 National Health Interview Survey data, we used multivariable logistic regression to examine differences in health insurance and usual source of care among U.S. women (N = 70,855) and men (N = 61,032) aged 18–64 years in relation to both race/ethnicity and sexual orientation. Compared to white heterosexual women, Black ([odds ratio =]0.89; [95% confidence interval:] 0.80–0.98) and Latina (OR = 0.42; 0.38–0.46) heterosexual women and white (0.78; 0.64–0.95), Black (0.51; 0.35–0.73), and Latina (0.53; 0.36–0.78) sexual minority women (SMW) had significantly lower adjusted odds of having health insurance. Latina heterosexual women (0.80; 0.73–0.88) and white (0.79; 0.65- 0.95), Black (0.56; 0.37–0.83), and Latina (0.60; 0.41–0.88) SMW also had significantly lower adjusted odds of having a usual source of care. Compared to white heterosexual men, Black (0.74; 0.67–0.81) and Latino (0.42; 0.39–0.46) heterosexual men had significantly lower adjusted odds of health insurance coverage, and Latino heterosexual men (0.73; 0.67–0.80) had significantly lower adjusted odds of having a usual source of care. Some observed disparities were attenuated upon adjustment for socioeconomic factors. Additional research is needed to identify and address the other structural and social factors that contribute to health insurance disparities among marginalized populations at diverse intersections of race/ethnicity, sexual orientation, and gender identity.

Suggested Citation

  • Madina Agénor & J. Wyatt Koma & Ashley E. Pérez & Alex McDowell & Gilbert Gonzales, 2023. "Differences in Health Insurance and Usual Source of Care Among Racial/Ethnic and Sexual Orientation Subgroups of U.S. Women and Men," Population Research and Policy Review, Springer;Southern Demographic Association (SDA), vol. 42(3), pages 1-26, June.
    • Handle: RePEc:kap:poprpr:v:42:y:2023:i:3:d:10.1007_s11113-023-09774-2
    DOI: 10.1007/s11113-023-09774-2
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    References listed on IDEAS

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    1. Bauer, Greta R. & Scheim, Ayden I., 2019. "Methods for analytic intercategorical intersectionality in quantitative research: Discrimination as a mediator of health inequalities," Social Science & Medicine, Elsevier, vol. 226(C), pages 236-245.
    2. Gonzales, G. & Ortiz, K., 2015. "Health insurance disparities among racial/ethnic minorities in same-sex relationships: An intersectional approach," American Journal of Public Health, American Public Health Association, vol. 105(6), pages 1106-1113.
    3. Cagdas Agirdas & Jordan G. Holding, 2018. "Effects of the ACA on Preventive Care Disparities," Applied Health Economics and Health Policy, Springer, vol. 16(6), pages 859-869, December.
    4. Srinivasan, S. & Guillermo, T., 2000. "Toward improved health: Disaggregating Asian American and Native Hawaiian/Pacific Islander data," American Journal of Public Health, American Public Health Association, vol. 90(11), pages 1731-1734.
    5. Buchmueller, T. & Carpenter, C.S., 2010. "Disparities in health insurance coverage, access, and outcomes for individuals in same-sex versus different-sex relationships, 2000-2007," American Journal of Public Health, American Public Health Association, vol. 100(3), pages 489-495.
    6. Shi, Leiyu, 2001. "The convergence of vulnerable characteristics and health insurance in the US," Social Science & Medicine, Elsevier, vol. 53(4), pages 519-529, August.
    7. Eaton, L.A. & Driffin, D.D. & Kegler, C. & Smith, H. & Conway-Washington, C. & White, D. & Cherry, C., 2015. "The role of stigma and medical mistrust in the routine health care engagement of black men who have sex with men," American Journal of Public Health, American Public Health Association, vol. 105(2), pages 75-82.
    8. Shavers, V.L. & Fagan, P. & Jones, D. & Klein, W.M.P. & Boyington, J. & Moten, C. & Rorie, E., 2012. "The state of research on racial/ethnic discrimination in the receipt of health care," American Journal of Public Health, American Public Health Association, vol. 102(5), pages 953-966.
    9. Buchmueller, T.C. & Levinson, Z.M. & Levy, H.G. & Wolfe, B.L., 2016. "Effect of the affordable care act on racial and ethnic disparities in health insurance coverage," American Journal of Public Health, American Public Health Association, vol. 106(8), pages 1416-1421.
    10. Heck, J.E. & Sell, R.L. & Gorin, S.S., 2006. "Health care access among individuals involved in same-sex relationships," American Journal of Public Health, American Public Health Association, vol. 96(6), pages 1111-1118.
    11. Dahlhamer, J.M. & Galinsky, A.M. & Joestl, S.S. & Ward, B.W., 2016. "Barriers to health care among adults identifying as sexual minorities: A US national study," American Journal of Public Health, American Public Health Association, vol. 106(6), pages 1116-1122.
    12. Bowleg, L., 2012. "The problem with the phrase women and minorities: Intersectionality-an important theoretical framework for public health," American Journal of Public Health, American Public Health Association, vol. 102(7), pages 1267-1273.
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