Investigation of Geographic and Macrolevel Variations in LGBTQ Patient Experiences: Longitudinal Social Media Analysis

Abstract

Background: Discrimination in the health care system contributes to worse health outcomes among lesbian, gay, bisexual, transgender, and queer (LGBTQ) patients.

Objective: The aim of this study is to examine disparities in patient experience among LGBTQ persons using social media data.

Methods: We collected patient experience data from Twitter from February 2013 to February 2017 in the United States. We compared the sentiment of patient experience tweets between Twitter users who self-identified as LGBTQ and non-LGBTQ. The effect of state-level partisan identity on patient experience sentiment and differences between LGBTQ users and non-LGBTQ users were analyzed.

Results: We observed lower (more negative) patient experience sentiment among 13,689 LGBTQ users compared to 1,362,395 non-LGBTQ users. Increasing state-level liberal political identification was associated with higher patient experience sentiment among all users but had stronger effects for LGBTQ users.

Conclusions: Our findings highlight that social media data can yield insights about patient experience for LGBTQ persons and suggest that a state-level sociopolitical environment influences patient experience for this group. Efforts are needed to reduce disparities in patient care for LGBTQ persons while taking into context the effect of the political climate on these inequities.

Keywords: LGBTQ; digital health; health care disparities; health care quality; infodemiology; sentiment analysis; sexual and gender minorities; social media.

Figure 1

Map of patient experience tweets. LGBTQ: lesbian, gay, bisexual, transgender, and queer. (Note: Positive sentiment scores are ≥0.5; negative sentiment score ≤-0.5; neutral sentiment scores are between ±0.5).