Health Equity for the LGBTQ+ Community
A 2024 Gallup Poll reported that 9.3% of U.S. adults identify as lesbian, gay, bisexual, transgender, queer, or another non‑heterosexual or non‑cisgender identity (Gallup, 2025). This figure—nearly one in ten Americans—should fundamentally change how healthcare systems, clinicians, and policymakers think about patient populations. It's a segment large enough to shape outcomes in public health, hospital quality scores, and the overall patient experience. Yet, in many care settings, LGBTQ+ patients’ unique needs remain under recognized or misunderstood.
Patient Safety and Clinical Outcomes
In healthcare, the absence of cultural and clinical competency toward any population can lead to serious safety failures. Hospitals have long recognized this with specific
communities. For example, interpreters and bilingual signage improve care for Hispanic patients, while culturally respectful practices guide care for Muslim families regarding
gender roles, end‑of‑life customs, and visitation patterns. Each of these efforts stems from a recognition that group‑sensitive approaches reduce errors and improve satisfaction.
This is an urgent question for LGBTQ+ patients, their families and health care providers. Studies show that barriers to communication and a lack of psychological safety present risks to patient safety, increasing the likelihood that individuals will not receive appropriate healthcare, with negative consequences for their health and well-being. Patient discomfort in communicating with providers, for instance, increases such safety risks as missed screenings, misdiagnoses, and a lack of appropriate prevention interventions.
However, comparable attention has not always extended to LGBTQ+ patients. The lack of structured training on sexual orientation and gender identity contributes to gaps in screening, diagnosis, and communication. According to the Kaiser Family Foundation, LGBTQ+ adults are 2.3 times more likely to delay or avoid medical care due to anticipated discrimination (Kaiser Family Foundation, 2023). Among transgender patients, 41% have never received cervical cancer screening despite eligibility (Reisner et al., 2018). Transgender and gender-diverse individuals also remain under‑screened for cancers despite elevated risk. These gaps don’t have to be inevitable—they are the result of insufficient education and training.
Behavioral Health and Trust
Behavioral health disparities further illustrate the cost of invisibility. LGBTQ+ youth face nearly four times higher risk of suicide than their heterosexual peers (The Trevor Project, 2024). Studies consistently link poor mental health outcomes, not to identity itself, but to chronic stress from stigma and discrimination (Becerra‑Culqui et al., 2025). When providers create environments that acknowledge identity and demonstrate understanding, patient trust increases, and mental health outcomes improve.
Lack of acknowledgment fosters silence. Patients who fear judgment may withhold critical information such as medication use, sexual behavior, or support needs—information essential to accurate diagnosis and effective treatment. In behavioral health contexts, this lack of disclosure can lead to misdiagnosis or under‑treatment. For example, anxiety symptoms linked to chronic minority stress might be mislabeled as personality disorders, or depression may go untreated when patients feel unsafe sharing their experiences. Recognition and proper training enable clinicians to distinguish between mental health conditions caused by life stressors versus those rooted in neurochemical imbalance.
Clinical Impact of Competency Training
Behavioral and physical health outcomes are deeply connected. Individuals who experience discrimination may avoid preventive screenings, leading to advanced chronic disease. Conversely, trust and rapport in healthcare settings encourage early intervention, adherence to medication, and improved management of chronic conditions such as diabetes or hypertension. Affirming behavioral health practices also reduce emergency department visits related to crisis episodes.
Examples from clinical practice highlight this relationship:
- Ovarian cancer misdiagnosis: A transgender man’s abdominal pain was dismissed until late‑stage diagnosis revealed ovarian cancer (Reisner et al., 2018; Harvard School of Medicine, 2024).
- Refused care: 29% of transgender individuals report being denied care, and 19 percent were misgendered during emergencies (James et al., 2016).
- Avoided screenings: 23% of transgender adults avoided healthcare because of anticipated discrimination (Kcomt, 2020).
- HIV prevention gaps: Failure to offer PrEP or appropriate counseling due to provider discomfort (Cahill et al., 2020; The Trevor Project, 2024).
- Behavioral health neglect: LGBTQ+ youth dismissed or misunderstood, leading to heightened suicide risk (Becerra‑Culqui et al., 2025; The Trevor Project, 2024).
Every one of these scenarios is preventable when healthcare professionals are educated to understand how identity and lived experience intersect with clinical care. Each failure represents a missed opportunity to prevent harm through education and awareness. Each underscore why competency training is a safety requirement, not a social initiative.
Summary
Nearly one in ten U.S. adults identifies as LGBTQ+. These individuals access every sector of healthcare—primary care, oncology, emergency medicine, behavioral health—and need care that recognizes their realities. Competency education in LGBTQ+ healthcare is not about advocacy; it's about precision, accuracy, and safety. It allows providers to gather complete patient histories, interpret test results accurately, and build trust that supports better adherence and outcomes.
Health providers and health systems that invest in evidence‑based competency education stand to gain across all key metrics: improved patient outcomes, reduced liability, higher satisfaction scores, and stronger reputations for excellence. When care is designed to work for LGBTQ+ patients, it becomes safer and more effective for everyone.
Read more about ways to address LGBTQ+ patient outcomes and how to improve the care provided to LGBTQ+ individuals.
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References:
Becerra‑Culqui, T. A., et al. (2025). Mental health outcomes in transgender and nonbinary people: An umbrella review. JAMA Psychiatry, 82(3), 210–222.
Cahill, S., et al. (2020). LGBTQ competency training and patient satisfaction outcomes. Journal of General Internal Medicine, 35(8), 2305–2312.
Centers for Medicare & Medicaid Services (CMS). (2022). Hospital value‑based purchasing program. https://www.cms.gov/medicare/value-based-programs/hospital-value-based-purchasing
CRICO Strategies. (2019). Annual benchmark report: Malpractice data. https://www.rmf.harvard.edu/Malpractice-Data/Annual-Benchmark-Reports
Gallup. (2025, February 20). More U.S. adults identify as LGBTQ+ in 2024, Gallup polling shows. UPI. https://www.upi.com/Top_News/US/2025/02/20/gallup-polling-lgbtq/7041740078808/
Harvard School of Medicine. (2024). Studies deepen understanding of LGBTQ health disparities. https://hms.harvard.edu/news/studies-deepen-understanding-lgbtq-health-disparities
HealthStream. (2022). The power of microlearning in clinical education. https://www.healthstream.com
Human Rights Campaign. (2021). Healthcare equality index. https://www.hrc.org/hei
James, S. E., et al. (2016). The report of the 2015 U.S. transgender survey. National Center for Transgender Equality.
Kaiser Family Foundation. (2023). Major findings on LGBTQ+ health and discrimination. https://www.kff.org/report-section/lgbtq-survey-major-findings/
Kcomt, L. (2020). Profound health‑care discrimination experienced by transgender people: Rapid systematic review. Social Science & Medicine, 256, 113089.
Reisner, S. L., et al. (2018). Advancing methods for U.S. transgender health. Current Opinion in Endocrinology, Diabetes and Obesity, 25(3), 169–176.
The Trevor Project. (2024). National survey on LGBTQ+ youth mental health. https://www.thetrevorproject.org
