Health-Related Social Needs Among LGB+ Veterans

Veterans identifying as lesbian, gay, bisexual, additional orientations, or not sure (LGB+) may have unique health-related social needs. By addressing social needs, health systems can take steps to alleviate persistent health disparities in this population.

To evaluate associations between sexual orientation and need for support for social needs among primary care patients served by the Veterans Health Administration (VHA).

This cross-sectional study used data from a national sample of VHA primary care patients seen in January or February 2023 who were invited to participate in a survey online or by mail. Data collection occurred from March 2 through May 9, 2023.

Self-reported sexual orientation (straight or LGB+).

Unadjusted prevalence ratios (PRs) and adjusted PRs (APRs) of need for support across 13 health-related social domains.

Of 38 759 veterans invited to participate in the survey, 7095 (18.3%) responded and 6296 (16.2%) with complete data were included. Weighted responses represented 903 714 veterans. The unweighted number (weighted percentage) identifying as straight was 5874 (94.2%) and as LGB+ was 422 (5.8%); 3585 (89.1%) were male. In unadjusted comparisons, LGB+ veterans had a higher prevalence of need for support for feeling socially isolated (PR, 1.40; 95% CI, 1.04-1.87), feeling lonely (PR, 1.59; 95% CI, 1.20-2.09), finding or keeping work (PR, 1.71; 95% CI, 1.07-2.75), paying for food (PR, 1.71; 95% CI, 1.19-2.46), paying for basics such as housing, medical care, and heating (PR, 1.89; 95% CI, 1.29-2.75), managing experiences of discrimination (PR, 2.31; 95% CI, 1.54-3.48), and getting or maintaining housing (PR, 2.41; 95% CI, 1.40-4.15). After adjusting for age and for a combined race, ethnicity, and sex variable, LGB+ veterans had higher prevalence of need for support for managing experiences of discrimination (APR, 1.79; 95% CI, 1.21-2.64) and getting or maintaining housing (APR, 1.91; 95% CI, 1.10-3.34).

This cross-sectional study found that LGB+ veterans reported a higher prevalence of social needs related to managing experiences of discrimination and housing instability compared with their straight counterparts. Expansion of support systems to address social needs in general and to ensure that systems are tailored for groups that more often experience certain needs should be considered.