Until last year, few national surveys collected information about the prevalence of social risk factors—individual-level adverse experiences such as food insecurity or housing instability—and whether certain populations in the US experience these challenges more than others.

A new study led by a Boston University School of Public Health (BUSPH) researcher closes this knowledge gap, shedding light on how social conditions disproportionately affect sexual and gender minority populations (SGM).

Published in JAMA Health Forum, the study found that SGM adults were significantly more likely to experience a variety of social risk factors, compared to heterosexual and cisgender adults. On almost all measures, the largest magnitude of inequity was between gender minority and cisgender adults.

Since ample data also show that SGM adults experience poorer health outcomes and cost-related delays in care compared to their heterosexual and cisgender counterparts, it is important to understand the nonclinical factors that may be contributing to these inequitable health outcomes.

Utilizing health data from 2022 and 2023, the study also provides new insight into the longer-term effects of the COVID-19 pandemic, which took a disproportionate toll on SGM adults in terms of job loss, COVID exposure, isolation, and access to care, among other factors.

“There is substantial evidence that sexual and gender minority adults often report limited access to care and worse health outcomes compared to heterosexual and cisgender adults, respectively,” says study lead and corresponding author Dr. Kevin Nguyen, assistant professor of health law, policy & management at BUSPH.

“We know less, however, about how often they report social risk factors—dissatisfaction with life, social isolation, employment loss, insufficient food, and stress—which are linked to poor health outcomes.”

For the study, Dr. Nguyen and colleagues from BUSPH, Columbia University School of Social Work, and Vanderbilt University School of Medicine utilized data from the Behavioral Risk Factor Surveillance System, an annual survey administered by the Centers for Disease Control and Prevention to monitor US adults’ health status, health behaviors, and access to care. The study focused on health data for 178,803 US adults living in 22 states from January 2022 to February 2023.

The team assessed a variety of social factors that can affect one’s health and well-being, including dissatisfaction with life, lack of emotional support, social isolation, job loss within the past year, stress, Supplemental Nutrition Assistance Program (SNAP) participation within the past year, insufficient amount of food, inability to pay bills or utilities, and lack of transportation.

About 58% of sexual minority women reported that they experienced at least one of these risk factors compared to about 37% of heterosexual women, and they were more likely to experience social isolation and stress.

About 51% of sexual minority men experienced at least one risk factor, compared to 34% of heterosexual men, and they were more likely to experience stress and feel dissatisfied with life. Of gender minority adults, about 64% experienced at least one risk factor compared to 37% of cisgender adults, and they were significantly more likely to report social isolation and stress.

These inequities in social risk factors are consequences of structural discrimination and stigmatization of marginalized populations, the researchers say. Biased attitudes and discriminatory policies—such as the hundreds of anti-LGBTQ+ bills that target SGM populations across the country—often result in a loss of resources and support for the affected groups, which contributes to stress, isolation, and economic hardship.

“Public policies that codify equality by sexual orientation and gender identity may have long-term effects on financial security, socioeconomic mobility, and mental well-being for sexual and gender minorities,” Dr. Nguyen says. “Collection of sexual orientation and gender identity data may also help us better measure, identify, and address disparities in social risk factors experienced by sexual and gender minority adults.”

The study’s senior author is Dr. Gilbert Gonzales, associate professor at the Department of Medicine, Health & Society, the Program for Public Policy Studies, and the Department of Health Policy at Vanderbilt University.