Self-Rated Health Among Gay, Lesbian, and Bisexual Adults: Rural/Urban Differences


Discriminatory and homophobic place-based policies can perpetuate poor health outcomes and constrained access to care for lesbian, gay, and bisexual (LGB) adults. This study examines the intersections of sexual orientation, geographic context, and race/ethnicity and their associations with self-rated health. We leveraged three nationally representative and population-based datasets in this brief to document the robustness of our findings; the National Health Interview Survey (NHIS), the Behavioral Risk Factor Surveillance System (BRFSS), and the Health Information National Trends Survey (HINTS). The data sets we used are unique in their data collection and availability on sexual orientation and rurality — and the surveys used here are among the most widely used to monitor health and access to care in the United States.

Key Findings
  • Two national datasets (NHIS and BRFSS) revealed statistically significant differences in self-rated health between rural LGB respondents and heterosexual respondents with LGB respondents more likely to report fair or poor self-rated health.
  • In multivariable models adjusting for age, sex, race, ethnicity, educational attainment, and income, LGB rural adults had lower likelihood of excellent/very good/good self-rated health, compared with heterosexual rural adults in both the NHIS and the BRFSS datasets.
  • Among rural adults, there were differences in self-rated health by race and ethnicity and sexual orientation.
University of Minnesota Rural Health Research Center
Hannah MacDougall, Carrie Henning-Smith, Courtney Sarkin, Gilbert Gonzales