Prevalence of Chronic Conditions by Sexual Orientation and Rural-Urban Location


There are well-documented disparities in health by both sexual orientation and rurality, with lesbian, gay, and bisexual (LGB) adults experiencing poorer health outcomes than heterosexual adults, and rural residents experiencing poorer health outcomes than urban residents. There are many reasons for rural LGB health disparities, including homophobia and stigma, discriminatory policies, and structural urbanism – that is, when rural communities are disadvantaged relative to urban communities. Both LGB individuals and rural residents have more barriers to accessing health care, including transportation, insurance coverage, access to providers, and discrimination. There are also fewer social supports and reduced access to lesbian, gay, bisexual, transgender, and queer or questioning affirming providers in rural communities, since many are based in urban areas.

Despite the similar challenges that rural residents and LGB individuals face in accessing health care and achieving positive health outcomes, few studies focus on the intersection of rurality and sexual orientation. This policy brief addresses that gap using nationally representative data to examine rates of chronic conditions by rurality and sexual orientation. Chronic conditions require regular and reliable access to care and are among the most useful measures of population health in that they are relatively common and strongly associated with mortality and morbidity. Detecting differences in chronic conditions is one important way to reveal population-level health inequities.

Key Findings
  • Compared with heterosexual adults and urban LGB adults, rural LGB adults have the highest rates of chronic conditions overall and were the most likely to report having three or more chronic conditions (43.8% of rural LGB adults).
  • Rural LGB adults have statistically higher rates of arthritis, depression, and diabetes, compared with urban LGB adults.
  • Rural LGB adults have statistically higher rates of asthma, depression, and anxiety, compared with rural heterosexual adults.
  • More than half (54.0%) of rural LGB adults reported a diagnosis of depression, and 43.8% reported a diagnosis of anxiety — rural LGB adults reported higher levels of depression and anxiety than any other group.
University of Minnesota Rural Health Research Center
Carrie Henning-Smith, Gilbert Gonzales, Megan Lahr, Hannah MacDougall, Austen Ott