Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 May 1;117(5):997-1007.
doi: 10.1093/jnci/djae350.

An intersectional analysis of behavioral financial hardship and healthcare utilization among lesbian, gay, bisexual, transgender, queer, plus cancer survivors

Austin R Waters  1   2 , Stephanie B Wheeler  1   2 , Jeremey Fine  1 , Christabel K Cheung  3   4 , Kelly R Tan  5   6 , Donald L Rosenstein  2   7   8 , Mya L Roberson  1   2 , Erin E Kent  1   2
Affiliations

An intersectional analysis of behavioral financial hardship and healthcare utilization among lesbian, gay, bisexual, transgender, queer, plus cancer survivors

Austin R Waters et al. J Natl Cancer Inst. .

Abstract

Background: Lesbian, gay, bisexual, transgender, queer, or another nonheterosexual or cisgender identity (LGBTQ+) cancer survivors experience high financial hardship. However, structural drivers of inequities do not impact all LGBTQ+ individuals equally. Using All of Us data, we conducted an intersectional analysis of behavioral financial hardship among LGBTQ+ cancer survivors.

Methods: LGBTQ+ inequities in behavioral financial hardship (ie, cost-related foregone care, delayed care, and medication alterations) and non-cost-related delayed care were estimated using All of Us data. Multivariable logit models were used to generate predicted probabilities, average marginal effects, and 95% confidence intervals. Models were then used to estimate inequities when disaggregating LGBTQ+ status and combing LGBTQ+ status with age, race, ethnicity, and treatment status.

Results: This analysis included N = 36 217 cancer survivors (6.6%, n = 2399 LGBTQ+). In multivariable models, LGBTQ+ identity was associated with higher probabilities of and significant average marginal effects for all types of behavioral financial hardship (foregone care 31.1% vs 19.4%; delayed care 22.6% vs 15.6%; medication alterations 19.2% vs 11.9%) and non-cost delayed care (14.3% vs 7.2%). Within the disaggregated analysis, cisgender bisexual and another/multiple orientation women and gender minority survivors had the highest predicted probabilities of all outcomes. In intersectional analyses, survivors who were aged 18-39 and LGBTQ+, Black and LGBTQ+, or Hispanic/Latine and LGBTQ+ had the highest predicted probabilities of all outcomes.

Conclusions: LGBTQ+ cancer survivors experience significantly more behavioral financial hardship and non-cost-related delayed care than non-LGBTQ+ cancer survivors. Interventions at the individual, system, and policy level are needed to address LGBTQ+ inequities in financial hardship.

PubMed Disclaimer

Conflict of interest statement

S.B.W. receives unrelated grant funding paid to her institution from Pfizer Foundation and Astra Zeneca. M.L.R. receives unrelated consulting fees from the National Committee for Quality Assurance. E.E.K. receives unrelated consulting fees from the National Alliance for Caregiving.

References

    1. Jones JM. LGBTQ+ identification in U.S. now at 7.6%. Gallup International. Published 2024. Accessed September 09, 2024. https://news.gallup.com/poll/611864/lgbtq-identification.aspx
    1. Jones JM. Growing LGBT ID seen across major U.S. racial, ethnic groups. Gallup International. 2022. Accessed August 06, 2022. https://news.gallup.com/poll/393464/growing-lgbt-seen-across-major-racia...
    1. Damaskos P, Amaya B, Gordon R, Walters CB.. Intersectionality and the LGBT cancer patient. Semin Oncol Nurs. 2018;34:30-36. - PMC - PubMed
    1. Hatzenbuehler ML, Lattanner MR, McKetta S, Pachankis JE.. Structural stigma and LGBTQ+ health: a narrative review of quantitative studies. Lancet Public Health. 2024;9:e109-e127. - PubMed
    1. Frey JJ, Hall WJ, Goldbach JT, Lanier P.. “Here in the Bible belt, it’s predominantly negative”: sexual identity stigma in the American South, 50 years after stonewall. Front Psychol. 2021;12:804064. - PMC - PubMed

MeSH terms