Number 77 n July 15, 2014

Sexual Orientation and Health Among U.S. Adults: 

National Health Interview Survey, 2013 by Brian W. Ward, Ph.D.; James M. Dahlhamer, Ph.D.; Adena M. Galinsky, Ph.D.; and Sarah S. Joestl, Dr.P.H.,

Division of Health Interview Statistics

Abstract

Objective—To provide national estimates for indicators of health-related

behaviors, health status, health care service utilization, and health care access by

sexual orientation using data from the 2013 National Health Interview Survey

(NHIS).

Methods—NHIS is an annual multipurpose health survey conducted

continuously throughout the year. Analyses were based on data collected in 2013

from 34,557 adults aged 18 and over. Sampling weights were used to produce

national estimates that are representative of the civilian noninstitutionalized U.S.

adult population. Differences in health-related behaviors, health status, health

care service utilization, and health care access by sexual orientation were

examined for adults aged 18–64, and separately for men and women.

Results—Based on the 2013 NHIS data, 96.6% of adults identified as

straight, 1.6% identified as gay or lesbian, and 0.7% identified as bisexual. The

remaining 1.1% of adults identified as ‘‘something else,’’ stated ‘‘I don’t know

the answer,’’ or refused to provide an answer. Significant differences were found

in health-related behaviors, health status, health care service utilization, and

health care access among U.S. adults aged 18–64 who identified as straight, gay

or lesbian, or bisexual.

Conclusion—NHIS sexual orientation data can be used to track progress

toward meeting the Healthy People 2020 goals and objectives related to the

health of lesbian, gay, and bisexual persons. In addition, the data can be used to

examine a wide range of health disparities among adults identifying as straight,

gay or lesbian, or bisexual.

Keywords: sexual minority • sexual identity • health status • health care access

public health. Although differences in

health outcomes by race and ethnicity,

Introduction and

Background

sex, and poverty status are historically

The elimination of health disparities well-documented, this has not been the

has long been a focus in the field of case for other sociodemographic

characteristics. Interest in and

information on disparities by sexual

orientation has been increasing. For

instance, recent studies have examined

the health and health care of lesbian,

gay, and bisexual (LGB) populations

and have found clear disparities among

sexual minority groups (i.e., gay or

lesbian and bisexual) and between

sexual minorities and straight

populations. These disparities appear to

be broad-ranging, with differences

identified for various health conditions

(e.g., asthma, diabetes, cardiovascular

disease, or disability) (1–4), health

behaviors such as smoking and heavy

drinking (1–3,5), and health care access

and service utilization (1,6,7). Across

most of these outcomes, sexual

minorities tend to fare worse than their

nonminority counterparts.

Seeking to address those and other

health disparities, the U.S. Department

of Health and Human Services’ Healthy

People 2020 initiative includes the goal

of improving the health, safety, and

well-being of lesbian, gay, bisexual, and

transgender (LGBT) persons. One

specific objective within this goal is to

increase the number of population-based

data systems using a standard set of

sexual orientation questions to monitor

Healthy People objectives (8). A number

of challenges to the collection of sexual

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Centers for Disease Control and Prevention 

National Center for Health Statistics 
Page 2 National Health Statistics Reports n Number 77 n July 15, 2014

orientation data were identified in a

consensus study report from the Institute

of Medicine on LGBT health. These

include defining and operationalizing the

different facets of sexual orientation

(behavior, attraction, and identity) and

obtaining sufficiently large samples of

these relatively small populations to

permit meaningful analyses (9). To

begin to address these objectives and

challenges, the Centers for Disease

Control and Prevention’s National

Center for Health Statistics developed

questions on the identity component of

sexual orientation (10) and added them

to the 2013 National Health Interview

Survey (NHIS). The ongoing collection

of information on sexual orientation in

NHIS will enable more consistent,

long-term monitoring of the Healthy

People 2020 goal of improving the

health, safety, and well-being of LGB

persons (8).

Because the 2013 data release

marks the first time nationally

representative data on sexual orientation

are available in NHIS, the goals of this

report are to present population

distributions of sexual orientation and

examine prevalence rates of select

health indicators across sexual

orientation groups.

Methods

Data source

Data from the 2013 NHIS were

used to generate the estimates presented

in this report. NHIS is an annual

multipurpose health survey conducted

continuously throughout the year and

serves as a primary source of health

data on the civilian noninstitutionalized

population of the United States (11).

Data are collected by trained

interviewers with the U.S. Census

Bureau using computer-assisted personal

interviewing (CAPI), a data collection

method in which an interviewer meets

with respondents face-to-face to ask

questions and enter the answers into a

laptop computer. When necessary,

interviewers may complete missing

portions of the interview over the

telephone.

The survey has four main modules:

the Household Composition Section,

Family Core, Sample Adult Core, and

Sample Child Core. The Household

Composition Section of the

questionnaire collects some basic

demographic and relationship

information about all persons in the

household. The Family Core

questionnaire, which is administered

separately for each family in the

household, collects information on all

persons in the family. Topics in the

Family Core include sociodemographic

characteristics, basic indicators of health

status, health insurance coverage, and

access to and utilization of health care

services. From each participating family,

one sample child (if there are any

children aged 17 years and under) and

one sample adult aged 18 years and

over are randomly selected, and

information on each is collected with

the Sample Child and Sample Adult

questionnaires, respectively. The Sample

Adult Core interview collects additional

data on health status and conditions,

health behaviors, functioning and

disability, and access to and utilization

of health care services. The sample adult

answers for himself or herself, unless he

or she is mentally or physically unable

to do so; in that case, a knowledgeable

family member serves as a proxy

respondent.

Analyses in this report were based

on data collected from 34,557 sample

adults aged 18 and over. The conditional

sample adult response rate (i.e., the

number of completed Sample Adult

interviews divided by the total number

of eligible sample adults) was 81.7%.

The final sample adult response rate,

calculated by multiplying the conditional

response rate by the final family

response rate, was 61.2% (12).

Sexual orientation questions

Starting in 2013, NHIS included

questions to ascertain the identity

component of the sample adult’s sexual

orientation. The sexual orientation

questions were embedded in the Sample

Adult Core, as part of the Adult

Selected Items section. This section also

contained questions about computer use,

satisfaction with health care,

neighborhood tenure, neighborhood

attachment, financial worries, sleep, HIV

testing, and psychological distress.

Questions on gender identity were not

included in the 2013 NHIS.

The first of the four cascading

sexual orientation questions that were

included in the 2013 NHIS, which is

asked of all sample adults aged 18 and

over, reads, ‘‘Which of the following

best represents how you think of

yourself?’’ It has five response options,

which vary slightly by respondent sex.

For male respondents, they are:

+ Gay,

+ Straight, that is, not gay,

+ Bisexual,

+ Something else, and

+ I don’t know the answer.

For female respondents, the

response options are:

+ Lesbian or gay,

+ Straight, that is, not lesbian or gay,

+ Bisexual,

+ Something else, and

+ I don’t know the answer.

Respondents who answered

‘‘something else’’ or ‘‘I don’t know the

answer’’ were asked one or more

follow-up question(s) to provide

additional information on their sexual

orientation. However, data from these

follow-up questions were not used in

this report, and the questions will not be

included in NHIS starting in 2015 (see

forthcoming methodology report for

more information). Although not an

explicit response option, respondents

could refuse to provide an answer to

any of these questions.

For the initial sexual orientation

question (and the ‘‘something else’’ and

‘‘I don’t know the answer’’ follow-up

questions), flashcards listing the

response options were handed to

respondents in the face-to-face interview

setting. Respondents were asked to

report the number corresponding to their

answer. When the questions were

administered over the telephone, the

interviewer read the response options.

Complete text and details of the NHIS

sexual orientation questions are provided

in the 2013 Sample Adult survey

questionnaire, which can be accessed on
National Health Statistics Reports n Number 77 n July 15, 2014 Page 3

the NHIS website: http://www.cdc.gov/

nchs/nhis.htm. In addition, a detailed

methodological report examining the

NHIS sexual orientation data is

forthcoming.

Health and health-related

variables

Selected health-related indicators

were examined for this report. They

were selected from among those

featured in the ‘‘Early Release of

Selected Estimates’’ report series that is

produced quarterly with preliminary

NHIS data (13). They include measures

of health-related behaviors, health status,

health care service utilization, and health

care access (all measured as or recoded

into dichotomous response categories).

The specific health behaviors examined

were: current cigarette smoking, having

consumed five or more alcoholic drinks

in one day at least once in the past year,

and having met federal guidelines for

aerobic activity (through leisure-time

physical activity). Measures of health

status examined were: having a health

status described as excellent or very

good, having experienced serious

psychological distress in the past 30

days, and being obese (measured only

for persons aged 20 and over). Measures

of health care service utilization

included: having received the influenza

vaccine during the past year, and ever

having been tested for HIV. Finally,

indicators of health care access that

were examined were: having a usual

place to go for medical care, having

failed to obtain needed medical care in

the past year due to cost, currently being

uninsured (i.e., having no health

insurance coverage), currently having

coverage through a public health plan,

and currently having private health

insurance coverage. All of these

variables are part of the Sample Adult

Core, with the exception of having a

health status described as excellent or

very good, being currently uninsured,

currently having public health plan

coverage, and currently having private

health insurance coverage; these are part

of the Family Core. Further details

regarding these health-related indicators

can be found in the Technical Notes

section at the end of this report.

Statistical analyses

First, population distributions of

sexual orientation were calculated

overall and by age and sex (Table 1).

Second, prevalence rates of select health

indicators across sexual orientation

groups were examined, both overall as

well as stratified by sex. Because many

of the health indicators examined here

are correlated with age, and the

distribution of sexual minorities differs

significantly between adults aged 18–64

and 65 and over (see Results),

differences in crude rates are influenced

by the differences in the age

distributions. Although age adjustment

would control for these differences,

age-adjusted rates do not reflect the

actual burden of these health indicators

in the population. Therefore, to provide

population-level estimates of the health

indicators examined and to provide

meaningful tests of differences by

sexual orientation, Tables 2–5 first

present crude rates for the entire adult

population (aged 18 and over), followed

by crude rates for the population aged

18–64. However, all statistical

comparisons of health indicators by

sexual orientation are limited to adults

between the ages of 18 and 64 and are

based on crude rates. Differences

between percentages for point estimates

were evaluated using two-tailed

significance tests at the 0.05 level, with

no adjustments made for multiple

comparisons. Given limited statistical

power resulting from small sample sizes,

some observed differences are large yet

do not reach statistical significance.

Estimates that do not meet a priori

standards of reliability or precision are

noted in the tables. Only estimates with

a relative standard error (RSE) equal to

or less than 30.0% are considered

reliable (see Technical Notes). Estimates

with an RSE greater than 30.0% and

less than or equal to 50.0%, although

reported, are considered unreliable and

denoted in the tables with an asterisk.

Estimates with an RSE greater than

50.0%, denoted with a dagger in the

tables, are not reported due to

insufficient reliability and precision of

the point estimate.

To account for the multistage,

complex sampling design of NHIS,

estimates and standard errors presented

in this report are based on weighted data

that were analyzed using SAS version

9.3 and SAS-callable SUDAAN version

11.0 software. All estimates presented in

the following section are thus

generalizable to the adult civilian

noninstitutionalized U.S. population.

Results

Sexual orientation

Among all U.S. adults aged 18 and

over, 96.6% identified as straight, 1.6%

identified as gay or lesbian, and 0.7%

identified as bisexual. The remaining

1.1% of adults identified as ‘‘something

else’’ (0.2%), selected ‘‘I don’t know the

answer’’ (0.4%), or refused to provide

an answer (0.6%). After classifying as

missing data and dropping from the

analyses those cases with responses of

‘‘something else,’’ ‘‘I don’t know the

answer,’’ and refused, the percentage of

adults who identify as gay or lesbian

and bisexual remained unchanged, and

the percentage of adults who identify as

straight increased slightly to 97.7%

(Table 1). For the remainder of this

report, estimates are based on a

three-category measure of sexual

orientation: gay or lesbian, straight, and

bisexual.

Table 1 also presents the percent

distribution of sexual orientation by sex

and age group. The examination by

respondent sex showed no significant

differences in the percentage of men and

women who identified as gay or lesbian,

or straight. By contrast, a higher

percentage of women (0.9%) than men

(0.4%) identified as bisexual. The

examination by age revealed that the

percentage of adults who identified as

gay or lesbian was similar for adults

aged 18–44 (1.9%) and adults aged

45–64 (1.8%), with the estimates for

both of these groups being higher than

the estimate for adults aged 65 and over

(0.7%). The percentage of adults who

identified as bisexual also varied with

age. A higher percentage of adults aged
Page 4 National Health Statistics Reports n Number 77 n July 15, 2014

18–44 identified as bisexual (1.1%)

compared with adults aged 45–64

(0.4%) and adults aged 65 and over

(0.2%).

Prevalence of selected

health indicators by sexual

orientation for adults aged

18–64

Health-related behaviors

As shown in Table 2, a higher

percentage of adults aged 18–64 who

identified as gay or lesbian (27.2%) or

bisexual (29.5%) were current cigarette

smokers compared with their

counterparts who identified as straight

(19.6%). Differences in the prevalence

of current cigarette smoking by sexual

orientation were also found among

women aged 18–64: 27.2% of women

who identified as gay or lesbian and

29.4% of women who identified as

bisexual were current cigarette smokers,

compared with 16.9% of women who

identified as straight. No significant

differences were found among men aged

18–64.

For the measure of alcohol

consumption, a higher percentage of

adults aged 18–64 who identified as gay

or lesbian (35.1%) or bisexual (41.5%)

reported having had five or more drinks

in one day at least once in the past year

compared with those who identified as

straight (26.0%). Among men aged

18–64, a higher percentage of those who

identified as bisexual (56.3%) had five

or more drinks in one day at least once

in the past year compared with those

who identified as straight (35.1%).

Among women aged 18–64, a higher

percentage of those who identified as

gay or lesbian (27.7%) or bisexual

(34.9%) had five or more drinks in one

day at least once in the past year

compared with those who identified as

straight (17.2%).

With regard to meeting the federal

physical activity guidelines for aerobic

activity, no significant differences were

found by sexual orientation, neither

among adults overall aged 18–64 nor for

women or men in this age group.

Health status indicators

Percent distributions by sexual

orientation for the health status

indicators are shown in Table 3. No

significant differences were found by

sexual orientation for the percentage of

adults aged 18–64 with excellent or very

good health, neither overall nor among

men. Among women, however, a higher

percentage of those who identified as

straight (63.3%) were in excellent or

very good health compared with women

who identified as gay or lesbian

(54.0%).

A higher percentage of adults aged

18–64 who identified as bisexual

(11.0%) experienced serious

psychological distress in the past 30

days compared with their counterparts

who identified as straight (3.9%).

Among women aged 18–64, a higher

percentage of those who identified as

bisexual (10.8%) experienced serious

psychological distress compared with

those who identified as straight (4.5%).

No significant differences were

found overall in the percentage of adults

aged 20–64 who were obese. Significant

differences were observed in the

sex-stratified comparisons, however. A

higher percentage of men aged 20–64

who identified as straight (30.7%) were

obese than men who identified as gay

(23.2%); among women aged 20–64, a

higher percentage of those who

identified as bisexual (40.4%) were

obese than women who identified as

straight (28.8%).

Health care service utilization

Prevalence estimates for the two

select health care service utilization

indicators by sexual orientation are

presented in Table 4. A higher

percentage of adults aged 18–64 who

identified as gay or lesbian (42.9%)

received an influenza vaccination in the

past year compared with those adults

aged 18–64 who identified as straight

(35.0%). Among men aged 18–64, a

higher percentage of those who

identified as gay (46.1%) received an

influenza vaccination in the past year

compared with those who identified as

straight (30.9%). Among women aged

18–64, no significant differences were

found in the receipt of an influenza

vaccination in the past year.

For HIV testing, among all adults

aged 18–64, a higher percentage of

those who identified as gay or lesbian

(68.7%) have ever been tested for HIV,

followed by those who identified as

bisexual (53.5%), and then by those

who identified as straight (41.7%).

Among men aged 18–64, this same

pattern was found, where the highest

percentage of HIV testing was among

those who identified as gay (81.2%),

followed by those who identified as

bisexual (54.3%), and then by those

who identified as straight (36.1%).

Among women aged 18–64, no

significant differences in HIV testing

were found.

Health care access

For the series of indicators

pertaining to health care access

(Table 5), among all adults aged 18–64,

a higher percentage of those who

identified as straight (81.0%) had a

usual place to go for medical care

compared with those who identified as

bisexual (72.5%). Among men aged

18–64, no significant differences in

having a usual place to go for medical

care were found. Among women aged

18–64, by contrast, a higher percentage

of those who identified as straight

(85.5%) had a usual place to go for

medical care than those who identified

as gay or lesbian (75.6%) or bisexual

(71.6%).

A higher percentage of adults aged

18–64 who identified as bisexual

(16.5%) failed to obtain needed medical

care in the past year due to cost

compared with the percentage of adults

aged 18–64 who identified as straight

(8.8%). Among women aged 18–64, a

higher percentage of those who

identified as gay or lesbian (15.2%)

failed to obtain needed medical care in

the past year due to cost compared with

those who identified as straight (9.6%).

No significant differences by sexual

orientation were found among men aged

18–64 for this indicator.

For indicators of health insurance

coverage, no significant differences in

uninsurance rates were found by sexual
National Health Statistics Reports n Number 77 n July 15, 2014 Page 5

orientation when looking at all adults

aged 18–64 or women in this age

bracket. Among men aged 18–64,

however, a higher percentage of those

who identified as straight (21.9%) were

uninsured compared with those who

identified as gay (15.7%).

Among all adults aged 18–64, and

separately for men and women, no

significant differences were found by

sexual orientation for having public

health plan coverage. By contrast, for

private health insurance coverage, a

higher percentage of all adults aged

18–64 who identified as gay or lesbian

(68.9%) had private health insurance

coverage compared with those who

identified as bisexual (57.1%). No

significant differences in private health

insurance coverage were found in the

sex-stratified comparisons, but the

patterns are the same.

Discussion

For the first time in its 57-year

history, the 2013 NHIS included a

measure of sexual orientation, thereby

enabling researchers and data users to

examine how the prevalence of a wide

variety of health-related behaviors,

health status indicators, and measures of

health care service utilization and access

vary across categories of sexual

orientation in a representative sample of

the civilian noninstitutionalized U.S.

adult population. The goal of this report

was to examine a select set of key

health indicators by sexual orientation.

Among U.S. adults aged 18 and

over, 97.7% identified as straight, 1.6%

as gay or lesbian, and 0.7% as bisexual.

These distributions differed by both sex

and age. A higher percentage of women

identified as bisexual, a finding

consistent with other documented

estimates of sexual orientation (14).

With regard to age, a lower percentage

of adults aged 65 and over identified as

gay or lesbian (0.7%) or bisexual (0.2%)

compared with adults aged 18–44 (gay

or lesbian: 1.9%; bisexual: 1.1%) and

adults aged 45–64 (gay or lesbian:

1.8%; bisexual: 0.4%). NHIS estimates

of the percentage of adults who

identified as gay or lesbian are

consistent with those reported in other

surveys, whereas the NHIS estimates of

the percentage of adults who identified

as bisexual are lower. For example,

national estimates of the bisexual

population from the 2008 General Social

Survey were 1.1% (14). Although

beyond the scope of this report,

differences in question wording and

survey design (e.g., mode of

administration, survey content, and

placement of the sexual orientation

survey question), as well as differences

in survey time period, are possible

reasons for these differences. The

impact of survey design features on

prevalence estimates of sexual

orientation based on NHIS data are

discussed in detail in a forthcoming

methodology report.

As described earlier, to provide

information on the actual levels of the

health indicators examined in this report

and to provide meaningful tests of

differences by sexual orientation, all

statistical comparisons of health

indicators by sexual orientation were

limited to adults aged 18–64. Many of

the associations between sexual

orientation and various health outcomes

found in this analysis are similar to

those found in past research. For

example, a higher percentage of women

aged 18–64 who identified as bisexual

had experienced serious psychological

distress compared with those who

identified as straight, which is similar to

findings in previous studies examining

differences in psychological distress by

sexual orientation (1,15). In this report,

a higher percentage of adults aged

18–64 who identified as gay or lesbian,

or bisexual had five or more drinks in

one day in the past year and were

current cigarette smokers compared with

adults aged 18–64 who identified as

straight, which is similar to previous

studies examining alcohol consumption

(5,16,17) and cigarette smoking (18–20)

by sexual orientation. Past studies (6,21)

on health care utilization have found a

number of significant differences among

adults who identify as straight, gay or

lesbian, and bisexual, similar to those

found in this report. For example, based

on NHIS data, a lower percentage of

women aged 18–64 who identified as

gay or lesbian, or bisexual had a usual

place to go for medical care compared

with women aged 18–64 who identified

as straight, whereas a lower percentage

of adults aged 18–64 who identified as

straight failed to obtain needed medical

care due to cost compared with adults

aged 18–64 who identified as bisexual.

In addition, a higher percentage of men

aged 18–64 who identified as gay

received an influenza vaccination in the

past year compared with men aged

18–64 who identified as straight. And

finally, among men aged 18–64, a

higher percentage of those who

identified as gay or bisexual have ever

been tested for HIV compared with

those who identified as straight.

Survey design and question wording

differences alluded to above may exist

between NHIS and other data sources,

and could very well account for

differences in findings across studies.

The health indicators used in this report

may also be operationalized differently

across surveys or research studies. For

example, much of the past research that

has found poorer reported health among

sexual minorities dichotomized this

measure as reporting fair or poor health

compared with all other health statuses

(1,2,22), whereas the present study

dichotomized this measure as reporting

very good or excellent health compared

with all other health statuses. In

addition, much of what is known about

the health and well-being of sexual

minorities has been gleaned from studies

using state-level or more specialized

samples that (unlike NHIS) do not allow

for generalizations to be made to the

U.S. adult population (a distinct strength

of NHIS). However, even with a sample

of 34,557 adults, the number of adults

who identified as either gay or lesbian,

or bisexual in NHIS is relatively small,

and for certain health indicators, this

small sample size results in unreliable

estimates. Multiple years of NHIS data

may need to be used before reliable

estimates can be generated for select

health indicators by sexual orientation.

The findings presented here provide

an initial examination of health

differences by sexual orientation using

NHIS data and are not intended to be

comprehensive. NHIS includes a wide

range of survey questions on health, and
Page 6	 National Health Statistics Reports n Number 77 n July 15, 2014

the addition of questions on sexual

orientation will facilitate many

opportunities for future researchers to

examine health among sexual minority

populations using a nationally

representative sample of U.S. adults. In

addition, the NHIS sexual orientation

survey questions should help meet

Healthy People 2020 goals and

objectives related to health among

LGBT persons (8).

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National Center for Health Statistics.

2014. Available from: http://

www.cdc.gov/nchs/data/nhis/

earlyrelease/earlyrelease201403.pdf.

14. Gates GJ. How many people are

lesbian, gay, bisexual, and

transgender? Los Angeles, CA: The

Williams Institute of the University

of California, Los Angeles School of

Law. 2011.

15. Rosario M, Reisner SL, Corliss HL,

Wypij D, Frazier AL, Austin SB.

Disparities in depressive distress by

sexual orientation in emerging adults:

The roles of attachment and stress

paradigms. Arch Sex Behav

43(5):901–16. 2014.

16. Gruskin EP, Gordon N. Gay/lesbian

sexual orientation increases risk for

cigarette smoking and heavy drinking

among members of a large Northern

California health plan. BMC Public

Health 6:241. 2006. Available from:

http://www.biomedcentral.com/1471­

2458/6/241.

17. Cochran SD, Grella CE, Mays VM.

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perceived drug availability mediate

sexual orientation differences in

patterns of substance use? Results

from the California Quality of Life

Survey II. J Stud Alcohol Drugs

73(4):675–85. 2012.

18. McElroy JA, Everett KD, Zaniletti I.

An examination of smoking behavior

and opinions about smoke-free

environments in a large sample of

sexual and gender minority

community members. Nicotine Tob

Res 13(6):440–8. 2011.

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differences in tobacco use and

secondhand smoke exposure among

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Nutrition Examination Surveys. Am J

Public Health 103(10):1837–44.

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in the United States. Nicotine Tob

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Gelberg L. Health behaviors, health

status, and access to and use of

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97(11):2048–55. 2007.
National Health Statistics Reports n Number 77 n July 15, 2014 Page 7

Table 1. Sexual orientation among U.S. adults aged 18 and over, by sex and age group: United States, 2013

Gay or lesbian1 Straight2 Bisexual

Sexual orientation

Number in

thousands

Percent3

(standard error)

Number in

thousands

Percent3

(standard error)

Number in

thousands

Percent3

(standard error)

Overall................................ 3,729 1.6 (0.09) 224,163 97.7 (0.11) 1,514 0.7 (0.06)

Sex

Men .................................

Women ...............................

2,000

1,729

1.8 (0.14)

1.5 (0.12)

108,093

116,071

97.8 (0.15)

97.7 (0.15)

481

1,033

0.4 (0.06)

0.9 (0.10)

Age group (years)

18–44 ................................

45–64 ................................

65 and over.............................

2,028

1,422

278

1.9 (0.15)

1.8 (0.16)

0.7 (0.13)

104,947

77,686

41,531

97.1 (0.18)

97.8 (0.17)

99.2 (0.14)

1,153

289

73

1.1 (0.12)

0.4 (0.07)

*0.2 (0.05)

* Estimate has a relative standard error greater than 30% and less than or equal to 50% and should be used with caution as it does not meet standards of reliability or precision. 1Response option provided on the National Health Interview Survey was ‘‘gay’’ for men, and ‘‘gay or lesbian’’ for women. 2Response option provided on the National Health Interview Survey was ‘‘straight, that is, not gay’’ for men, and ‘‘straight, that is, not gay or lesbian’’ for women. 3Percent distributions in this table may not equal exactly 100.0% due to rounding. 

SOURCE: CDC/NCHS, National Health Interview Survey, 2013. 

Table 2. Selected health-related behavior indicators of U.S. adults, by sexual orientation and sex: United States, 2013

Both sexes Men Women

Selected health-related Gay or Gay or

behavior indicator1 lesbian2 Straight3 Bisexual Gay2 Straight3 Bisexual lesbian2 Straight3 Bisexual

Aged 18 and over (years) Percent (standard error)

Current cigarette smoker ........ 25.8 (2.57) 17.6 (0.31) 28.6 (4.11) 25.8 (3.86) 20.3 (0.46) 28.8 (6.56) 25.7 (3.71) 15.0 (0.40) 28.5 (5.15)

Five or more alcoholic drinks in

1 day at least once in past year . . . 33.0 (2.64) 22.3 (0.36) 39.5 (4.15) 39.4 (3.80) 31.1 (0.55) 51.6 (7.28) 25.8 (3.61) 14.3 (0.37) 33.8 (4.91)

Met federal guidelines for aerobic

physical activity ............. 56.2 (2.82) 49.2 (0.45) 54.8 (4.47) 63.5 (3.59) 53.7 (0.63) 53.3 (7.36) 47.9 (4.18) 45.1 (0.55) 55.5 (5.67) 

Aged 18–64 (years)

Current cigarette smoker ........ 27.2 (2.73) 19.6 (0.36) 29.5 (4.29) 27.2 (4.09) 22.3 (0.52) 29.6 (7.05) 27.2 (3.98) 16.9 (0.46) 29.4 (5.29)

Five or more alcoholic drinks in

1 day at least once in past year . . . 35.1 (2.80) 26.0 (0.41) 41.5 (4.34) 41.8 (4.01) 35.1 (0.62) 56.3 (7.76) 27.7 (3.83) 17.2 (0.45) 34.9 (5.05)

Met federal guidelines for aerobic

physical activity ............. 57.9 (2.92) 52.3 (0.50) 55.5 (4.62) 63.7 (3.82) 56.2 (0.69) 54.7 (7.80) 51.3 (4.33) 48.4 (0.62) 55.8 (5.79) 

1Selected health-related behavior indicators were chosen based on those provided in the report series titled ‘‘Early Release of Selected Estimates Based on Data From the National Health 

Interview Survey’’ (see reference 13). Definitions of certain selected health-related behavior indicators can be found in the Technical Notes section of this report. 2Response option provided on the National Health Interview Survey was ‘‘gay’’ for men, and ‘‘gay or lesbian’’ for women. 3Response option provided on the National Health Interview Survey was ‘‘straight, that is, not gay’’ for men, and ‘‘straight, that is, not gay or lesbian’’ for women. 

SOURCE: CDC/NCHS, National Health Interview Survey, 2013. 
Page 8 National Health Statistics Reports n Number 77 n July 15, 2014

Table 3. Selected health status indicators of U.S. adults, by sexual orientation and sex: United States, 2013

Both sexes Men Women

Selected health Gay or Gay or

status indicator1 lesbian2 Straight3 Bisexual Gay2 Straight3 Bisexual lesbian2 Straight3 Bisexual

Aged 18 and over (years) Percent (standard error)

Health status described as excellent

or very good ............... 60.3 (2.85) 60.6 (0.40) 58.1 (4.25) 66.2 (3.59) 61.6 (0.55) 63.6 (7.13) 53.4 (4.20) 59.8 (0.51) 55.5 (5.40)

Experienced serious psychological

distress in past 30 days ........ 4.9 (1.12) 3.7 (0.15) 10.8 (2.78) *4.5 (1.60) 3.1 (0.19) † 5.3 (1.55) 4.2 (0.21) 10.9 (2.87) 

Obese4 ......... ......... 29.5 (2.61) 29.0 (0.37) 35.3 (4.25) 23.6 (3.03) 29.7 (0.53) 26.3 (6.17) 36.7 (4.17) 28.3 (0.46) 40.9 (5.52) 

Aged 18–64 (years)

Health status described as excellent

or very good ............... 60.5 (2.97) 64.1 (0.44) 58.3 (4.39) 66.0 (3.78) 64.9 (0.61) 62.3 (7.65) 54.0 (4.33) 63.3 (0.56) 56.5 (5.49)

Experienced serious psychological

distress in past 30 days ........ 5.0 (1.22) 3.9 (0.17) 11.0 (2.91) *4.8 (1.72) 3.3 (0.22) † *5.2 (1.71) 4.5 (0.24) 10.8 (2.93) 

Obese4 ......... ......... 28.9 (2.68) 29.7 (0.41) 34.8 (4.45) 23.2 (3.14) 30.7 (0.60) 25.4 (6.58) 35.9 (4.25) 28.8 (0.53) 40.4 (5.68) 

* Estimate has a relative standard error greater than 30% and less than or equal to 50% and should be used with caution as it does not meet standards of reliability or precision.

† Estimates with a relative standard error greater than 50% are replaced with a dagger and not shown. 1Selected health status indicators were chosen based on those provided in the report series titled ‘‘Early Release of Selected Estimates Based on Data From the National Health Interview Survey’’ 

(see reference 13). Definitions of certain selected health status indicators can be found in the Technical Notes section of this report. 2Response option provided on the National Health Interview Survey was ‘‘gay’’ for men, and ‘‘gay or lesbian’’ for women. 3Response option provided on the National Health Interview Survey was ‘‘straight, that is, not gay’’ for men, and ‘‘straight, that is, not gay or lesbian’’ for women. 4Only calculated for adults aged 20 and over. 

SOURCE: CDC/NCHS, National Health Interview Survey, 2013.

Table 4. Selected health care service utilization indicators of U.S. adults, by sexual orientation and sex: United States, 2013

Both sexes Men Women

Selected health care Gay or Gay or

service utilization indicator1 lesbian2 Straight3 Bisexual Gay2 Straight3 Bisexual lesbian2 Straight3 Bisexual

Aged 18 and over (years) Percent (standard error)

Received influenza vaccine during

past year ................. 45.8 (2.78) 41.1 (0.40) 34.7 (4.22) 48.4 (3.88) 36.9 (0.54) 40.2 (7.00) 42.9 (4.20) 44.9 (0.53) 32.2 (5.24)

Ever been tested for HIV ........ 66.6 (2.79) 36.7 (0.41) 53.9 (4.45) 79.5 (3.26) 33.0 (0.55) 56.7 (7.40) 51.6 (4.21) 40.2 (0.54) 52.6 (5.67)

Aged 18–64 (years)

Received influenza vaccine during

past year ................. 42.9 (2.89) 35.0 (0.41) 32.7 (4.33) 46.1 (4.14) 30.9 (0.57) 36.6 (7.32) 39.1 (4.23) 38.9 (0.58) 31.0 (5.31) 

Ever been tested for HIV ........ 68.7 (2.90) 41.7 (0.47) 53.5 (4.61) 81.2 (3.34) 36.1 (0.62) 54.3 (7.89) 54.1 (4.42) 47.0 (0.63) 53.2 (5.81) 

1Selected health care service utilization indicators were chosen based on those provided in the report series titled ‘‘Early Release of Selected Estimates Based on Data From the National Health 

Interview Survey’’ (see reference 13). Definitions of certain selected health care service utilization indicators can be found in the Technical Notes section of this report. 2Response option provided on the National Health Interview Survey was ‘‘gay’’ for men, and ‘‘gay or lesbian’’ for women. 3Response option provided on the National Health Interview Survey was ‘‘straight, that is, not gay’’ for men, and ‘‘straight, that is, not gay or lesbian’’ for women. 

SOURCE: CDC/NCHS, National Health Interview Survey, 2013. 
National Health Statistics Reports n Number 77 n July 15, 2014 Page 9

Table 5. Selected health care access indicators of U.S. adults, by sexual orientation and sex: United States, 2013

Both sexes Men Women

Selected health care Gay or Gay or

access indicator1 lesbian2 Straight3 Bisexual Gay2 Straight3 Bisexual lesbian2 Straight3 Bisexual

Aged 18 and over (years) Percent (standard error)

Has a usual place to go for medical

care .................... 80.0 (2.29) 83.9 (0.30) 73.6 (3.96) 82.2 (3.18) 79.7 (0.47) 76.0 (5.72) 77.5 (3.49) 87.8 (0.34) 72.5 (5.14)

Failed to obtain needed medical care

in past year due to cost ........ 11.7 (1.61) 7.6 (0.20) 16.2 (3.01) 9.4 (2.01) 6.9 (0.28) *16.1 (5.23) 14.3 (2.49) 8.2 (0.27) 16.2 (3.74)

Currently uninsured ........... 16.0 (1.89) 16.5 (0.32) 22.5 (3.62) 14.6 (2.33) 18.3 (0.46) *19.0 (5.89) 17.6 (2.98) 14.9 (0.37) 24.1 (4.54)

Currently with public health plan

coverage ................. 20.7 (2.17) 31.1 (0.39) 23.1 (3.69) 19.7 (2.86) 28.0 (0.51) 22.2 (6.57) 21.8 (3.35) 33.9 (0.51) 23.5 (4.49)

Currently with private health

insurance coverage .......... 69.1 (2.55) 62.3 (0.42) 56.7 (4.40) 70.3 (3.24) 62.7 (0.57) 63.4 (7.47) 67.8 (3.76) 61.9 (0.54) 53.7 (5.50) 

Aged 18–64 (years)

Has a usual place to go for medical

care .................... 78.6 (2.45) 81.0 (0.35) 72.5 (4.13) 81.2 (3.38) 76.4 (0.55) 74.5 (6.21) 75.6 (3.76) 85.5 (0.41) 71.6 (5.27)

Failed to obtain needed medical care

in past year due to cost ........ 11.9 (1.68) 8.8 (0.24) 16.5 (3.14) 9.1 (2.02) 8.1 (0.33) *16.0 (5.61) 15.2 (2.67) 9.6 (0.33) 16.7 (3.85)

Currently uninsured ........... 17.3 (2.03) 20.1 (0.37) 23.7 (3.79) 15.7 (2.50) 21.9 (0.54) *20.8 (6.41) 19.1 (3.21) 18.4 (0.45) 24.9 (4.67)

Currently with public health plan

coverage ................. 14.8 (1.99) 16.3 (0.33) 19.2 (3.67) 14.0 (2.68) 14.2 (0.42) *14.9 (6.75) 15.8 (3.02) 18.3 (0.47) 21.1 (4.43)

Currently with private health

insurance coverage .......... 68.9 (2.68) 65.1 (0.46) 57.1 (4.56) 70.8 (3.36) 65.2 (0.63) 64.3 (8.02) 66.7 (3.98) 64.9 (0.60) 54.0 (5.61) 

* Estimate has a relative standard error greater than 30% and less than or equal to 50% and should be used with caution as it does not meet standards of reliability or precision. 1Selected health care access indicators were chosen based on those provided in the report series titled ‘‘Early Release of Selected Estimates Based on Data From the National Health Interview 

Survey’’ (see reference 13). Definitions of certain selected health care access indicators can be found in the Technical Notes section of this report. 2Response option provided on the National Health Interview Survey was ‘‘gay’’ for men, and ‘‘gay or lesbian’’ for women. 3Response option provided on the National Health Interview Survey was ‘‘straight, that is, not gay’’ for men, and ‘‘straight, that is, not gay or lesbian’’ for women. 

SOURCE: CDC/NCHS, National Health Interview Survey, 2013.
Page 10 National Health Statistics Reports n Number 77 n July 15, 2014

Technical Notes

Sexual orientation survey

question

Shown below is the main sexual

orientation question asked of male and

female sample adults in the 2013

National Health Interview Survey

(NHIS). The variable name in the 2013

NHIS data file appears in parentheses at

the end of each question.

Which of the following best

represents how you think of yourself?

(ASISIM)

+ Gay

+ Straight, that is, not gay

+ Bisexual

+ Something else

+ I don’t know the answer

Which of the following best

represents how you think of yourself?

(ASISIF)

+ Lesbian or gay

+ Straight, that is, not lesbian or gay

+ Bisexual

+ Something else

+ I don’t know the answer

Terms related to selected

health indicators

Current cigarette smoker—A person

who had smoked more than 100

cigarettes in his or her lifetime and now

smokes every day or some days.

Five or more alcoholic drinks in 1

day at least once in the past year—A

person who had at least 12 drinks of

any type of alcoholic beverage in his or

her lifetime, and has had five or more

drinks of any alcoholic beverage on at

least one day in the past year.

Met federal guidelines for aerobic

physical activity—This refers to meeting

the 2008 federal Physical Activity

Guidelines for Americans, which are

being used for the Healthy People 2020

objectives. Meeting the guidelines for

aerobic activity means that adults

perform at least 150 minutes a week of

moderate-intensity aerobic physical

activity, or 75 minutes a week of

vigorous-intensity aerobic physical

activity, or an equivalent combination of

moderate- and vigorous-intensity aerobic

activity. The 2008 guidelines state that

aerobic activity should be performed in

episodes of at least 10 minutes and

preferably should be spread throughout

the week. Only leisure-time physical

activity is used in the determination of

whether or not these guidelines have

been met.

Experienced serious psychological

distress in past 30 days—Six

psychological distress questions are

included in the Sample Adult Core

component of NHIS. These questions

ask how often during the past 30 days a

respondent experienced certain

symptoms of psychological distress:

feeling so sad that nothing could cheer

you up, nervous, restless or fidgety,

hopeless, worthless, that everything was

an effort. The response codes (0–4) of

the six items for each person were

summed to yield a scale with a 0–24

range. A value of 13 or more for this

scale is used here to define serious

psychological distress.

Obese—Obesity is defined as a

body mass index (BMI) of 30 kg/m2 or

more. This measure is based on

self-reported height and weight. In

NHIS, the questions ask for weight and

height without shoes.

Received influenza vaccination in

past year—Separate survey questions

asking respondents about receipt of flu

shots and receipt of nasal spray flu

vaccinations were included in the

calculation of flu vaccination estimates.

Ever been tested for HIV—For this

indicator, individuals who received HIV

testing solely as a result of blood

donation were considered not to have

been tested for HIV.

Having a usual place to go for

medical care—For this question, the

sample adult was asked if they have one

or more places to go when they are sick

or need advice about their health. The

response options were: yes; there is no

place; and there is more than one place.

Adults who stated that their usual place

to go for medical care was a hospital

emergency room were categorized as

not having a usual place to go for

medical care.

Currently uninsured—An adult was

coded as currently uninsured if he or

she did not have any private health

insurance, Medicare, Medicaid,

Children’s Health Insurance Program

(CHIP), state-sponsored or other

government-sponsored health plan, or

military plan at the time of the

interview. A person was also defined as

uninsured if he or she had only Indian

Health Service coverage, or had only a

private plan that paid for one type of

service, such as accidents or dental care.

Currently with public health plan

coverage—An adult was coded as

currently with public health plan

coverage if he or she had Medicare,

Medicaid, CHIP, state-sponsored or

other government-sponsored health plan,

or a military plan.

Currently with private health

insurance coverage—An adult was

coded as currently having private health

insurance coverage if he or she had any

comprehensive private insurance plan,

including health maintenance and

preferred provider organizations. These

plans include those obtained through an

employer, purchased directly, or

purchased through local or community

programs, but excludes those plans that

pay for only one type of service such as

accidents or dental care.

Two-tailed significance tests

and relative standard error

The statistic for all two-tailed tests

of significance was calculated as:

|Xa – Xb

|

Z = , 2

√SEa

2 + SEb

where Xa and Xb are the two estimates

being compared, and SEa and SEb are

the standard errors of those estimates.

The relative standard error (RSE)

for each estimate was calculated as:

SE

RSE = * (100) X

where X is the estimate, and SE is the

standard error of that estimate.

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National Health Statistics Reports n Number 77 n July 15, 2014

Acknowledgments

The authors would like to thank Anjel Vahratian, Marcie Cynamon, Stephen Blumberg, Jennifer Madans, Jeannine Schiller, and Lindsey Black

for their valuable assistance and feedback on this report.

Suggested citation

Ward BW, Dahlhamer JM, Galinsky AM, Joestl

SS. Sexual orientation and health among U.S.

adults: National Health Interview Survey, 2013.

National health statistics reports; no 77.

Hyattsville, MD: National Center for Health

Statistics. 2014.

Copyright information

All material appearing in this report is in the

public domain and may be reproduced or

copied without permission; citation as to

source, however, is appreciated.

National Center for Health Statistics

Charles J. Rothwell, M.S., M.B.A., Director

Jennifer H. Madans, Ph.D., Associate Director

for Science

Division of Health Interview Statistics

Jane F. Gentleman, Ph.D., Director

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