Sexual Orientation and Influenza Vaccine Uptake in the Southern United States

Research at the national level suggests that gay or lesbian adults are significantly more likely to receive a flu vaccine compared to straight individuals, however, this relationship has not been explored at the regional level. The American South is known for its health disparities, high level of poverty, and social conservatism, which may impact the health outcomes of its residents, especially those who have a minoritized sexual orientation (e.g., lesbian, gay, bisexual, transgender, or queer [LGBTQ]). The aim of this study was to examine the association between flu vaccine uptake and sexual orientation in the American South. Methods: Survey data were obtained from the Centers for Disease Control and Prevention’s (CDC) Behavioral Risk Factor Surveillance System (BRFSS) from states in the American South that administered the optional Sexual Orientation and Gender Identity module between 2014 and 2021. Our primary exposure and outcome of interest were sexual orientation and receipt of an influenza vaccine within the past year, respectively. Two models were employed to assess this relationship adjusting for 1) only demographic variables and 2) demographic and socioeconomic variables. Results: Of 474,961 participants, 391,045 answered the sexual orientation question. Among these, 375,123 identified as straight, 5,545 as gay or lesbian, 7,039 as bisexual, and 3,338 as “something else.” A total of 384,313 participants answered both the sexual orientation and influenza vaccine uptake questions and were included in analyses. The prevalence of flu vaccine uptake was 42.2% among adults who identified as straight, 40.1% among those who identified as gay or lesbian, 37.6% among those who identified as “something else,” and 32.0% among those who identified as bisexual. After adjusting for both demographic and socioeconomic variables, receipt of flu vaccine was 1.16 (95% confidence interval: 1.10–1.21) times higher among those who identified as gay or lesbian, 1.07 (95% CI: 1.02–1.13) times higher among those who identified as bisexual, and 1.13 (95% CI: 1.05–1.21) times higher among those who identified as “something else.” Discussion: In contrast to prior research that has associated an increased level of flu vaccination among gay or lesbian individuals with their overall higher socioeconomic status, our studies indicate that uptake was minimally affected after socioeconomic factors were taken into account. Though the prevalence of vaccination was lower among individuals who were bisexual or belonged to an unspecified sexual minority group, our study indicates that this was explained by differences in demographic and socioeconomic factors. In a broader sense, this suggests that vaccination among bisexual people living in the American South could be more influenced by their younger age and lower socioeconomic status. Considering this variation between sexual orientation groups, there is a need for more research to identify pathways to increase flu vaccination uptake among all sexual orientation groups.