Original Article

Health Disparities among Lesbian, Gay, Bisexual, and Transgender (LGBT) Adults in Nashville, Tennessee

Authors: Gilbert Gonzales, PhD, MHA, Caroline Young, MS, Emily Masters, MA, Emilio Loret de Mola, BA


Objectives: Health disparities for lesbian, gay, bisexual, and transgender (LGBT) adults are well documented, but LGBT health data at the municipal and county levels are lacking, especially in the southern United States. The objective of this study was to compare access to care, health outcomes, and behavioral risk factors between LGBT and non-LGBT adults in Nashville and Davidson County, Tennessee.

Methods: Data for this study came from a randomly selected, population-based sample of LGBT (n = 128) and non-LGBT (n = 1583) adults in Nashville. Multivariable logistic regression models were used to compare health outcomes between LGBT and non-LGBT Nashvillians while adjusting for demographic characteristics and socioeconomic status.

Results: LGBT Nashvillians were more likely to be uninsured (odds ratio [OR] 3.96, 95% confidence interval [CI] 1.72–9.10), report unmet medical care needs because of cost (OR 2.20, 95% CI 1.14–4.25), exhibit worse mental health outcomes (eg, frequent mental distress; OR 4.53, 95% CI 2.33–8.80), and report high-risk behaviors for human immunodeficiency virus (OR 9.47, 95% CI 3.96–22.62) compared with non-LGBT Nashvillians.

Conclusions: To achieve health equity for LGBT individuals at the municipal level, Nashville and Tennessee should consider multifaceted approaches to expanding health insurance coverage and nondiscrimination protections and address mental health and human immunodeficiency virus risks among vulnerable populations.
Posted in: Infectious Disease42 Mental Health25 Acquired Immunodeficiency Syndrome (AIDS) And Human Immunodeficiency Virus (HIV) Infection7

This content is limited to qualifying members.

Existing members, please login first.

If you have an existing account please login now to access this article or view your purchase options.

Purchase only this article ($15)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.


1. Institute of Medicine. The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Washington, DC: The National Academies Press; 2011.
2. Gonzales G, Przedworski J, Henning-Smith C. Comparison of health and health risk factors between lesbian, gay, and bisexual adults and heterosexual adults in the United States: results from the National Health Interview Survey. JAMA Intern Med 2016;176:1344–1351.
3. Gonzales G, Henning-Smith C. Health disparities by sexual orientation: results and implications from the Behavioral Risk Factor Surveillance System. J Community Health 2017;42:1163–1172.
4. Blosnich JR, Farmer GW, Lee JGL, et al. Health inequalities among sexual minority adults. Am J Prev Med 2014;46:337–349.
5. Hatzenbuehler ML, Keyes KM, Hasin DS. State-level policies and psychiatric morbidity in lesbian, gay, and bisexual populations. Am J Public Health 2009;99:2275–2281.
6. Hatzenbuehler ML, McLaughlin KA, Keyes KM, et al. The impact of institutional discrimination on psychiatric disorders in lesbian, gay, and bisexual populations: a prospective study. Am J Public Health 2010;100:452–459.
7. Bockting WO, Miner MH, Swinburne Romine RE, et al. Stigma, mental health, and resilience in an online sample of the US transgender population. Am J Public Health 2013;103:943–951.
8. Feinstein BA, Goldfried MR, Davila J. The relationship between experiences of discrimination and mental health among lesbians and gay men: an examination of internalized homonegativity and rejection sensitivity as potential mechanisms. J Consult Clin Psychol 2012;80:917–927.
9. Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull 2003;129:674–697.
10. Hatzenbuehler ML. How does sexual minority stigma “get under the skin”? A psychological mediation framework. Psychol Bull 2009;135:707–730.
11. Sabin JA, Riskind RG, Nosek BA. Health care providers’ implicit and explicit attitudes toward lesbian women and gay men. Am J Public Health 2015;105:1831–1841.
12. Hsieh N, Ruther M. Despite increased insurance coverage, nonwhite sexual minorities still experience disparitiesin accessto care.Health Aff 2017;36:1786–1794.
13. Gonzales G, Blewett LA. National and state-specific health insurance disparities for adults in same-sex relationships. Am J Public Health 2014;104:e95–e104.
14. Dahlhamer JM, Galinsky AM, Joestl SS, et al. Barriers to health care among adults identifying as sexual minorities: a US national study. Am J Public Health 2016;106:1116–1122.
15. Ward BW, Dahlhamer JM, Galinsky AM, et al. Sexual orientation and health among U.S. adults: National Health Interview Survey, 2013. Natl Health Stat Report 2014;(77):1–10.
16. New York City Department of Health and Mental Hygiene. Community Health Survey Trends. https://www1.nyc.gov/site/doh/data/data-sets/community-health-survey.page. Accessed March 14, 2021.
17. Chicago Department of Public Health. Healthy Chicago Survey.
18. The University of Texas Health Science Center at Houston. Health of Houston Survey. https://sph.uth.edu/research/centers/ihp. Accessed March 14, 2021.
19. County of Los Angeles Department of Public Health. Health Assessment Unit - Los Angeles County Health Survey. http://publichealth.lacounty.gov/ha/hasurveyintro.htm. Accessed March 14, 2021.
20. Public Health Management Corporation. PHMC Releases 2018-2019 Southeastern PA Household Health Survey Results. https://www.phmc.org/site/newsroom/press/104-press-releases/2019/1326-phmc-releases-2018-2019-southeastern-pa-household-health-survey-results. Published June 25, 2019. Accessed March 14, 2021.
21. Nashville Pride. The Nashville and Middle Tennessee LGBTQIA+ Community Visioning Project. https://www.nashvillepride.org/cvp. Accessed March 14, 2021.
22. NashvilleHealth. The Nashville Community Health and Well-Being Survey. https://www.nashville.gov/Health-Department/Data-and-Publications/Community-Health-Survey.aspx. Accessed March 14, 2021.
23. NashvilleHealth. About NashvilleHealth. https://nashvillehealth.org/about/#overview. Accessed September 13, 2020.