2023 CHAS: LGBTQ+ Health | Colorado Health Institute

In 2023, Colorado’s LGBTQ+ population was young, educated, and present in every part of the state. Nearly 400,000 Colorado adults identified as LGBTQ+. That’s 8.9% of the adult population. But this group faces huge disparities in mental health and access to care.

New analysis of Colorado Health Access Survey (CHAS) data on sexual orientation and gender identity among adults in Colorado highlights broad disparities and upends some common misperceptions.

Early analysis of the 2023 CHAS found that more than half of LGBTQ+ adults (54%) reported poor mental health — defined as eight or more days in the past month of stress, depression, or problems with emotions — compared with less than a third (27.8%) of their straight and cisgender peers. Further analysis highlights the reasons they are not getting much-needed mental health treatment and exposes disproportionately unfair treatment by medical professionals.

Understanding the LGBTQ+ Community

Age. More younger Coloradans identified as gay or lesbian, bisexual, transgender, queer, questioning, and other gender and sexual identities. One in five adults under age 30 (20.2%) identified as LGBTQ+ in the 2023 survey. This is twice the proportion of adults ages 30 to 49 (9.7%). Less than 5% of people over age 50 identified as LGBTQ+.

Location. LGBTQ+ Coloradans were just as likely to live in a rural community as a city. Almost one in 10 Coloradans in both urban (8.8%) and rural (9.3%) areas identified as LGBTQ+. The highest concentrations of LGBTQ+ people lived in southwest Colorado, Larimer County, and Denver.

Race and ethnicity. LGBTQ+ adults in Colorado came from every race and ethnicity, but nearly three in four (74.4%) identified white not Hispanic.

Education. LGBTQ+ Coloradans are highly educated. They were more likely than their straight and cisgender neighbors to earn a postgraduate degree (25.4% compared with 19.5%); to graduate from college (28.5% compared with 23.7%); or to complete some college, even if they didn’t finish a degree (27.3% compared with 21.6%).

Income. LGBTQ+ adults were less likely than their straight and cisgender peers (2.6% versus 6.1%) to earn less than the Federal Poverty Level (FPL). In 2023, the FPL was $14,580 for a single person, and $30,000 for a family of four.

Terminology

LGBTQ+: Lesbian, gay, bisexual, transgender, queer, questioning, and other gender and sexual identities.

Straight and cisgender: Heterosexual and identifying with the gender assigned at birth.

Disparities

This brief reveals disparities in health outcomes and access to care, which have roots in generations of discrimination. See CHI’s statement on health disparities for a detailed explanation.

Health Care and Barriers to Care

When it comes to health, LGBTQ+ Coloradans had more barriers to overcome — especially with mental health. One in 10 was uninsured (10.2%), more than double the rate of straight and cisgender adults (4.7%). Many earned too much to qualify for Medicaid, and most were not old enough to qualify for Medicare.

However, more LGBTQ+ people had employer-sponsored insurance (51.5% compared with 46.9%) or purchased individual or other insurance plans on the market (6.4% compared with 4.8%).

General and oral health. LGBTQ+ people in Colorado rated both their general health and their oral slightly lower than their straight and cisgender peers. One in five reported fair or poor general health (20.1% compared with 15.9%). More than one quarter reported fair or poor oral health (27.0% compared with 22.7%).

Mental health: Striking disparities. More than half of Colorado’s LGBTQ+ adults were in poor mental health in 2023.

Since 2015, significantly more LGBTQ+ Coloradans have reported poor mental health than their straight and cisgender neighbors. The pandemic worsened mental health for both groups, but not equally. In 2021, poor mental health among LGBTQ+ adults jumped by more than 22 percentage points (to 58.0%) compared with an 11.5 percentage point increase (to 25.8%) compared with straight and cisgender Coloradans.

While rates improved slightly in 2023, more than half of LGBTQ+ Colorado adults, around 186,000 people, still reported poor mental health compared with just over a quarter of straight and cisgender Colorado adults, about 915,000 people.

Poor access to mental health care. In 2023, 38.2% of LGBTQ+ people could not get mental health treatment when they said they needed it, more than double that of straight and cisgender adults (15.0%).

What contributed to such disparity? Perception of coverage and the cost of care were major barriers. Many more LGBTQ+ Coloradans (89.1%) said their health insurance would not cover the cost of mental health care, compared with their straight and cisgender neighbors (50.1%). The cost of treatment was also more concerning for LGBTQ+ people (86.3% compared with 60.8%).

More than seven in 10 LGBTQ+ people (71.1%) could not get an appointment when they needed one, compared with approximately half of straight and cisgender people (49.6%).

Discrimination in treatment. More than ever before, Colorado needs health professionals with training in the specific needs of the LGBTQ+ community.

After being seen by medical professionals, 13.0% of LGBTQ+ patients felt like they were treated with less respect or received services that were not as good — twice as often as straight and cisgender patients (6.5%).

Similarly, LGBTQ+ patients were more likely to say their provider dismissed their health concerns than straight and cisgender patients (25.9% compared with 14.0%).

Of the LGBTQ+ adults who said they were treated dismissively, three in four (76.0%) reported not receiving a treatment plan or referral (compared with 59.5% of straight and cisgender patients). Providers more often told LGBTQ+ patients that they didn’t know what was wrong (66.4% compared with 43.8%) or that a mental health issue was to blame (41.0% compared with 16.6%).

Food and housing inequities. LGBTQ+ Coloradans’ health was also more affected by social factors such food and housing. Nearly one in five LGBTQ+ adults (19.7%), about 73,000 people, ate less than they should in the past 12 months because they did not have enough money for food (compared with 14.7% of straight and cisgender adults).

One in five LGBTQ+ Coloradans (20.5%) also had trouble their paying rent or mortgage in the past year, compared with a little over one in 10 (13.2%) of their straight and cisgender neighbors.

Takeaways

The 2023 CHAS paints a picture of an LGBTQ+ population that is young and educated. But the community has a mental health crisis and often lacks access to care. When LGBTQ+ Coloradans can get care, they face more disrespect and dismissive treatment from providers. To improve mental health in the state, Colorado needs more culturally competent providers. Insurance providers and employers need to better explain their mental health benefits. And medical providers across the board need training to provide LGBTQ+ patients with the care they deserve.