Research Spotlight: Sexual Orientation and Gender Identity Data Completeness at US Federally Qualified Health Centers, 2020 and 2021

Alex Keuroghlian, MD, MPH, from the Department of Psychiatry at Massachusetts General Hospital and colleagues recently published an article in the American Journal of Public Health, Sexual Orientation and Gender Identity Data Completeness at US Federally Qualified Health Centers, 2020 and 2021.

What was the question you set out to answer with this study?

Collecting patient sexual orientation and gender identity (SOGI) data is essential for improving healthcare access, quality and outcomes. Because of this, the US Health Resources and Services Administration (HRSA) mandated the reporting of SOGI data by all federally qualified health centers (FQHCs) starting in 2016.

However, the first national analysis of SOGI data collection at FQHCs reported low completeness in 2016, with missing sexual orientation data for 77.1% of patients and missing gender identity data for 62.8% of patients.

For this study, we sought to assess the performance of US federally qualified health centers (FQHCs) after six years of required sexual orientation and gender identity (SOGI) data reporting and update estimated proportions of sexual and gender minorities cared for at FQHCs.

What Methods or Approach Did You Use?

We conducted secondary analyses of data reported to the 2020 and 2021 Uniform Data System from 1,297 FQHCs caring for nearly 30,000,000 patients annually.

We used multivariable logistic regression to explore FQHC-level and patient-level factors associated with SOGI data completeness.

What Did You Find?

Through our analyses, we found that over the six years, required reporting by 1,297 U.S. health centers of sexual orientation and gender identity data improved significantly across almost 30 million patients.

We found that far less SOGI data was missing, including 29.1% for sexual orientation and 24.0% of gender identity data of patients. Among patients with reported SOGI data, 3.5% identified as sexual minorities and 1.5% identified as gender minorities.

We also found that southern FQHCs and those caring for more low-income and Black patients were more likely to have above-average SOGI data completeness. Larger FQHCs were more likely to have below-average SOGI data completeness.

What are the Next Steps?

Through this, we have learned that there have been substantial increases in SOGI data completeness at FQHCs over six years, which reflects the success of reporting mandates.

However, future research is needed to identify other patient-level and FQHC-level factors contributing to residual levels of SOGI data missingness. This could include investigating why larger FQHCs have poorer data completeness, or what the rate of youth reporting on SOGI data is, since they were not included in the mandate.

About the Massachusetts General Hospital

Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The Mass General Research Institute conducts the largest hospital-based research program in the nation, with annual research operations of more than $1 billion and comprises more than 9,500 researchers working across more than 30 institutes, centers and departments. In July 2022, Mass General was named #8 in the U.S. News & World Report list of "America’s Best Hospitals." MGH is a founding member of the Mass General Brigham healthcare system.