###### Abstract  
COVID-19 infection rates and severity are worse in marginalised groups, although, for sexual and gender minorities, there are no data on infections, hospitalisations or deaths, but there may be worse rates. This study uses information from Understanding Society: The UK Household Longitudinal Study (UKHLS) to derive COVID-19 symptoms and positive tests by sexual orientation. Data came from all seven UKHLS COVID-19 survey waves in 2020 and 2021, and sexual orientation in main UKHLS waves 3 and 9. Numbers ranged from 17,800 to 12,000. Covariates in the regression models were gender, age, highest educational qualification, ethnicity, diagnosed medical condition, and key worker status. Compared to heterosexual individuals, more sexual minorities experienced symptoms, and bisexual individuals reported a greater number of symptoms. Gays and lesbians were no more or less likely to have been tested, but a larger proportion of bisexual individuals were tested. Regression models showed that differences mostly disappeared when other characteristics were considered. A small sample size means that principal questions remain, so health inequalities have been largely unnoticed and therefore not addressed. Suitable action should be taken to minimise their future risks. Why sexual and gender minorities have been omitted needs to be explored, and action needs to be taken to ensure this does not happen again. sexual orientation; COVID-19; UKHLS; longitudinal study; health inequalities +
Footnote †: journal:  
Academic Editor: [PERSON]  
Received: 24 June 2021  
Accepted: 16 July 2021  
Published: 26 July 2021  
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**C.O. lockdown [5], which may result in higher rates of COVID-19 infections. There are also higher rates of ill mental health [6], poorer wellbeing [7], and smoking [8] compared to heterosexual men. For lesbians and bisexual women, there are higher rates of obesity [9], asthma [10], and smoking [8]. In trans women, there are higher rates of mental ill health and poor wellbeing [11]. There is also a relatively higher proportion of sex workers [12]. In gay men and trans women, there is also a relatively high proportion of HIV/AIDS infection [13]. Despite these risk factors for increased COVID-19 infections, hospitalisations, and potential deaths, there is a lack of information on these rates amongst the UK LGBT population. There are several datasets that could be used to address this lack of data, but there are many issues that have thus far prevented this from taking place. The UK Office for National Statistics (ONS) has stated that it is \"currently unable to report on deaths registered in England and Wales, including deaths involving COVID-19 by sexuality\" (personal communication, Professor Sir [PERSON], Chief Statistician, ONS, 23 February 2021). Part of the reason for this is that sexual orientation and gender identity are not recorded in death certification, and partly because the UK Census 2011 did not include questions on sexual orientation and gender identity. The ONS COVID infection study does not ask questions relating to gender identify or sexual orientation. The Hospital Episode Statistics database also does not have sexual orientation or gender identity. The NHS Data Standard for Sexual Orientation Monitoring was adopted in 2019, but coverage is still very poor, possibly because \"there is no need to collect data from every patient\" [14]. There is no equivalent for gender identity yet. UK datasets that do include sexual orientation include the ONS Annual Population Survey (APS), Health Survey for England (HSE), the Improving Access to Psychological Therapies (IAPT) cohort study, and the English General Practice Patient Survey (GPPS), but none of these have COVID-19 data. The Biobank cohort study has sexual behaviour data, but not sexual orientation.