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

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.