Does sexual identity modify the association of having health insurance or a usual source of care with all-cause mortality? A cross-sectional study of NHANES data

Sexual minorities present inequities in healthcare access that could lead to a higher mortality risk. We explored whether the association of having either health insurance or a usual source of care with all-cause mortality differs by sexual identity (sexual minorities versus heterosexuals) among U.S. adults aged 20–59. Data were obtained from the National Health and Nutrition Examination Surveys (2007–2016) and linked to the National Death Index (through 2019). The main association was tested for effect modification by sexual identity using Cox proportional hazards models. Sensitivity analyses were performed to test for robustness. Among the 19,388 participants, having health insurance or a usual source of care was not significantly associated with mortality (adjusted hazard ratio [aHR] = 1.07; 95% CI = 0.70, 1.63). This null association did not vary among sexual minorities (aHR = 1.07; 95% CI = 0.69, 1.66) and heterosexuals (aHR = 1.04; 95% CI = 0.29, 3.74). Findings from the sensitivity analyses were consistent with the main findings. In conclusion, having health insurance or a usual source of care may not fully explain mortality disparities among sexual minorities without addressing the broader context of healthcare access, quality, and utilization. Further research should identify additional healthcare drivers of inequities and inform targeted policy and practice interventions for this marginalized group.