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Healthcare Use by Sexual Orientation in the CTS

About the Author

My name is Danna Robles-Garcia, and I'm a student pursuing a master’s degree (MPH) at the University of Michigan School of Public Health. My career goals are to use policy to create more equitable communities. My policy areas of interest include climate action, expanding access to healthcare and education, and advancing human rights and health for marginalized communities.


I’m grateful to have learned so much in this partnership with the California Teachers Study (CTS). Working with this cohort’s data was an eye-opening experience that showed me the challenges and breakthroughs that researchers and data scientists encounter in their daily work. I was able to improve my skills in data organization using SAS and gain experience with data analysis. Moreover, this experience allowed me to delve into a research area I am passionate about: healthcare use among women who identify as LGBTQ+.

My Research Project

Prior research has shown that women who identify as bisexual or lesbian/gay may access healthcare services significantly less often than women who identify as heterosexual. Understanding trends in healthcare use is important because it will help researchers identify whether some populations are interacting with healthcare services differently than others. Therefore, the goal of my project was to describe how CTS participants interacted with healthcare over time and see if there were any differences in healthcare use by sexual orientation.


Using data from the CTS’s 6th study questionnaire, we included participants who had reported their sexuality as either lesbian or gay, bisexual, or heterosexual. Using California hospitalization data, I looked at inpatient, emergency department, and ambulatory surgery visits for these participants. For reference, an inpatient hospital visit means the participant was admitted to the hospital and stayed at least one night. An emergency department visit refers to a visit to a hospital licensed to provide emergency services. Ambulatory surgery is described as an outpatient procedure that does not require the participant to stay overnight.


For this project, I counted the number of inpatient hospital visits from 1995 to 2019 and the number of emergency department visits and ambulatory surgeries for each participant from 2005 to 2019 (emergency visit and ambulatory surgery data are available for the CTS starting in 2005).


To understand how healthcare use varied among this population, I compared the three types of healthcare visits across the three groups from 2005 to 2019. I focused on this timeframe because it is the period for which we have data from all three sources.

For all three groups, inpatient hospital visits were the least common type of healthcare service. Among bisexual participants, emergency department visits were the most common. Among heterosexual and lesbian/gay participants, ambulatory surgery visits were the most common.

Next Steps

This initial overview of healthcare use among CTS participants provides context for further exploration by CTS researchers. This project was a descriptive analysis, meaning I did not conduct any statistical tests. Future research could include a statistical analysis of these data. Future projects could also examine whether other covariates, such as race/ethnicity, location/region where participants lived, socioeconomic position, and healthcare insurance status affect the relationship between sexual orientation and healthcare use. This type of data can provide essential information to inform future healthcare policies that help ensure everyone is able to attain safe and adequate health care.


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