Sexual Orientation, Gender Identity, and Differences of Sex Development Measures in Federal Health Surveys: Implications for Primary Care Research and Practice.

Abstract

Purpose: Federal initiatives have encouraged collection of sexual orientation, gender identity, and differences of sex development data in national health surveys. Researchers use these data sets to identify health disparities faced by marginalized populations and shape primary care practices. We summarized the current state of sexual orientation, gender identity, and differences of sex development measures in federal health surveys to inform primary care researchers, outline gaps in data, and discussed their research implications.

Methods: We examined 10 large federal population-based health surveys and, using content analysis, summarized the composition and continuity of their sexual orientation, gender identity, and differences of sex development measures.

Results: Federal health surveys have longstanding measures of sexual orientation, with 4 having more than 10 years of data. Several surveys introduced gender identity questions over the last 2 years. Only 1 survey measured differences of sex development.

Conclusions: Federal surveys have robust sexual orientation measures, but more surveys including gender identity and differences of sex development (DSD)s are needed. The presence of sexual orientation and gender identity measures in these surveys could help identify primary care disparities among sexual and gender minority populations. Research using sexual orientation data benefits from standardization and continuity that has not yet been achieved for gender identity measures across these surveys. New federal restrictions may hamper further collection of sexual orientation and gender identity data. The absence of differences of sex development data places this population at risk of having their needs go unaddressed in primary care settings.