Gay Acres: Urban and rural differences in health indicators among sexual minority individuals

The Institute of Medicine listed geographic location as a needed facet of LGBT health research, given the majority of LGBT studies come from metropolitan samples. To examine urban/rural differences among sexual minority individuals, we pooled 10 U.S. states’ Behavioral Risk Factor Surveillance System (BRFSS) surveys that collected sexual orientation in 2010 (n=93,414). Weighted multivariable logistic regression, stratified by sex, was used to examine urban/rural differences in several outcomes, including mental distress, current smoking, and symptoms of cardiovascular disease (CVD). Urban/rural status was defined using the BRFSS designation of metropolitan statistical area (MSA); respondents not living in or near an MSA were considered rural. Equal proportions of sexual minority (11.4%) and heterosexual (10.1%) respondents lived in rural areas. Results suggest differences within sexual minority individuals; rural sexual minority women had 44% lower odds of mental distress than urban sexual minority women (p=.088), and rural sexual minority men had twice the odds of current smoking than urban sexual minority men (p=.077).  Significant differences emerged between both rural and urban sexual minorities and their heterosexual counterparts. Sexual minority men in both urban and rural areas were more likely to report mental distress than heterosexual men, and urban sexual minority men and women had higher odds of CVD symptoms than their urban heterosexual peers. Analyses were hampered by a small number of sexual minorities in rural MSAs, but it is clear that urban/rural status is an important consideration for LGBT health research. Future work in this area should explore explanatory mechanisms for differences.