UCSF

BACKGROUND: Intersectionality, xenophobia, and health behavior theories suggest that sexual and gender minority (SGM) status, race/ethnicity, and nativity jointly shape healthcare access, yet these dimensions are often examined separately. This study identifies intersectional differences within foreign-born groups that may have previously been obscured. METHODS: Using six waves (2015-2020) of restricted California Health Interview Survey data, we estimated multinomial logistic models of insurance coverage and usual source of care among foreign-born adults, comparing by sexual orientation and gender identity, adjusting for predisposing, enabling, and need factors. To capture racialized differences, we stratified models by ethnoracial identity, for Black, Indigenous, Person of Color (BIPOC) vs. non-BIPOC. RESULTS: Insurance patterns varied by sexual orientation. Compared with heterosexuals, gay/lesbian foreign-born adults had lower probability of being uninsured; respondents reporting sexual orientation as "none" had higher Medicaid/other and lower employer/private coverage. For usual source of care, gay/lesbian adults were less likely to lack a source, whereas bisexual, "none," and "other" groups had higher probabilities of no usual source and lower physician-based care. Transgender identity showed no consistent differences. Hispanic and Black foreign-born adults were more likely to use community/other sites and less likely to use physician care. In BIPOC-stratified models, bisexual/"none"/"other" groups had higher probability of lacking a usual source of care. Among non-BIPOC adults, gay/lesbian adults had lower probabilities of lacking insurance or usual source of care. CONCLUSIONS: Heterogeneity exists within foreign-born SGM populations, with policy-relevant disparities concentrated among BIPOC subgroups. Findings highlight the need for targeted, culturally responsive coverage and care interventions.