LGBTQ+ Healthcare Disparaties and Respiratory Care Research

This is the first part in a two-part Pride Month series on recent LGBTQ+ research, healthcare disparities, and respiratory care.

With Pride Month in full swing, organizations have an opportunity to reflect and improve upon an important reality: LGBTQ+ individuals continue to experience significant health disparities, including with respiratory health.

Studies have identified elevated rates of asthma among sexual minority populations, while emerging evidence suggests LGBTQ+ individuals may also experience barriers to chronic obstructive pulmonary disease (COPD) diagnosis, treatment, and long-term disease management. At the same time, these populations remain significantly underrepresented in respiratory health research, leaving important questions unanswered about how best to meet their needs.

Research into these disparities “is crucial for building an evidence base that can allow doctors, policymakers, and sexual and gender minority people to work together to design better healthcare systems and to improve the health and well-being of everyone in our communities,” said Alex Keuroghlian, a Harvard Medical School Associate Professor of Psychiatry at Massachusetts General Hospital, in a statement about his recent LGBTQ research.

Understanding Respiratory Health Disparities

As recent Respiratory Care journal evidence suggests, LGBTQ+ people face a disproportionate burden of respiratory disease.

For instance, lesbian/gay adults who were daily smokers had the highest predicted probability of asthma (86%), compared with 78% among bisexual daily smokers and 68% among heterosexual daily smokers, according to research published in “Between and Within Sexual Identity-Group Differences in Asthma Prevalence in the United States.” (Daily smokers consistently demonstrated the highest likelihood of asthma.)

The study also found significant differences in weight. Obese bisexual adults had a 73% predicted probability of asthma, while obese lesbian/gay adults had a 72% probability, and obese heterosexual adults had a 69% probability.

The authors concluded that there “is evidence of considerable disparities by sexual identity group with sexual and gender minority individuals being disproportionately burdened with asthma relative to heterosexual adults across cigarette smoking and obesity.”

These findings align with broader public health research suggesting that LGBTQ+ populations often experience higher rates of smoking, increased rates of depression and anxiety, and more barriers to healthcare access—all factors that may contribute to poorer respiratory outcomes.

The Research Gap in COPD Care

While asthma disparities are becoming more visible, evidence regarding COPD disparities remains limited.

A 2024 scoping review published in Respiratory Care examined health inequities affecting people with COPD and found a striking lack of research focused on LGBTQ+ populations. The authors noted that since the National Institutes of Health formally recognized sexual and gender minorities as a health disparity population in 2016, “only one study within our sample examined LGBTQ+ patients with COPD.”

The review concluded that race, income, and education were the most frequently studied COPD inequities, while LGBTQ+ identity, sex and gender, and geography remained among the least investigated factors.

This lack of research creates challenges for clinicians attempting to provide evidence-based care. As the review authors concluded, future research into inequities “is pertinent for quality individual patient care.”

For respiratory therapists, that also means recognizing that many LGBTQ+ patients may encounter a healthcare system that has historically lacked data about their experiences and needs.