Understanding Lesbian, Gay, Bisexual Aging Through a Patient-Centered Lens in the Health and Retirement Study

Guided by Andersen's Behavioral Model of Health Services Use, this study examined how predisposing, enabling, and need factors shape self-rated health, healthcare utilization, and financial burden among lesbian, gay, and bisexual (LGB) and non-LGB midlife and older adults over time, and incorporated patient expert perspectives.

This multi-method study used the 2016, 2018, and 2020 waves of the RAND 2020 longitudinal file of the Health and Retirement Study for respondents aged ≥51 years with sexual orientation data. Generalized linear mixed model estimated odds of hospital nights, doctor visits, prescription drug use, chronic conditions, self-rated health, and out-of-pocket (OOP) expenditures by LGB status and time, with interaction terms assessing changes across waves. Patient engagement studio sessions with adults aged ≥50 years provided perspectives on healthcare experiences and barriers.

Among 13,376 respondents, LGB midlife and older adults had similar self-rated health and chronic condition burden as non-LGB peers but higher odds of prescription drug use, fewer doctor visits, and lower OOP expenditures across waves. No significant LGB x time interaction terms were observed, indicating stable disparities over 2016-2020. Patient experts reported mistrust of providers, difficulty finding affirming clinicians, social isolation, mental health needs, and limited insurance literacy.

Findings suggest underuse of ambulatory care and potential unmet needs among LGB midlife and older adults despite comparable health status, driven by enabling and contextual barriers rather than need alone. Implications include affirming geriatric and primary care models, tailored navigation support, and co-designed multilevel interventions to advance health equity in aging.