The Feasibility of Using Electronic Health Data for Research on Small Populations. Health needs of the LGBT population—what’s known


In its 2011 report on The Health of Lesbian, Gay, Bisexual, and Transgender People, the Institute of Medicine (IOM) summarized available evidence about health and health care issues faced by these populations in childhood/adolescence, early/middle adulthood, and later adulthood.85 The experience of stigma, discrimination, and violence is reported across the life course, as are elevated rates of HIV/AIDS among men, particularly young black men, who have sex with men. Among LGBT youth (as compared to heterosexual youth), there are higher risks for or rates of (a) suicide ideation and attempts; (b) depression, (c) smoking, alcohol consumption, and substance use; (d) homelessness; and (e) victimization through violence and harassment.

Elevated rates of suicidal ideation and attempts and depression have also been reported among LGBT people in early/middle adulthood, along with more mood and anxiety disorders, higher rates of smoking, alcohol and substance use, and experience of stigma, discrimination, and violence. Lesbians and bisexual women appear to use fewer preventive health services than heterosexual women and to have higher rates of obesity and breast cancer. Gay men and lesbians are also less likely than their heterosexual peers to be parents.

Evidence is more limited about later adulthood, but the greater experience of stigma, discrimination, and violence continues, although a degree of “crisis competence” and resilience may also develop. Lesbian and gay people in later life are also less likely than heterosexuals to have, and to receive care from, adult children. The IOM found some evidence of negative health outcomes among transgender people as a result of long-term hormone use. There is also evidence that individuals from same-sex couples have worse health care experiences in terms of access and satisfaction than do different-sex married couples.86

Experts concerned about the health of the LGBT population are frustrated by the thin body of available research and data.87 The IOM report emphasizes the limitations of available research about the health and health care of LGBT people, noting that most evidence pertains to lesbians and gays; that evidence about racial and ethnic minorities is particularly limited, and that most research is not based on probability samples, raising questions about generalizability. To improve understanding of LGBT health, the report pointed to the need for (a) more demographic data on these populations (and minority subpopulations) across the life course, (b) research on the influence of social influences (e.g., families, schools, workplaces, community organizations) on the lives and mental health of LGBT people, and (c) research on barriers to care that disproportionately affect LGBT people, and research on the effectiveness of interventions designed to address health inequities and negative health outcomes experienced by LGBT people.88 The IOM also called for development of standardized measures of sexual orientation and gender identity, for data on the LGBT population to be collected in federally-funded surveys, and for information on sexual orientation and gender identity to be collected in electronic health records.89

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