As of April 2024, 55 percent of the LGBT population lived in the 50 states and the District of Columbia where private health insurance service providers weren't allowed to deny coverage for transgender-related health care services, such as sex reassignment surgery. However, only 40 percent lived in states where health insurance protections included sexual orientation and gender identity.

LGBT Americans The share of Americans self-identifying as lesbian, gay, bisexual or transgender has grown in recent years. This suggests that insurance protections which cover LGBT-related health care services will also continue to grow in importance. The prevalence of younger Americans self-identifying as LGBT when compared with older generations confirms this. Millennials and Gen Xers are much more likely to personally identify as LGBT than previous generations were. Growing acceptance and tolerance in wider society means that more people are willing to be open about their gender identity and sexual orientation. For instance, support for same-sex marriage in the U.S. underwent a huge shift over the past two decades with the majority of Americans being in favor of it since 2011.

As reported by the most recent Canadian census data, 0.3 percent of the Canadian population aged 15-19 were non-binary. While gender non-binarity concerns a small portion of the population, this proportion is much higher than among Canadians over 35. A similar observation can be made regarding transgender people: while the trans population represents only 0.19 percent of Canadians, 0.44 percent of 15-19 year olds were transgender men or women, compared with 0.13 percent among 50-54 year olds.

The IPUMS Contextual Determinants of Health (CDOH) data series includes measures of disparities, policies, and counts, by state or county, for historically marginalized populations in the United States including Black, Asian, Hispanic/Latina/o/e/x, and LGBTQ+ persons, and women. The IPUMS CDOH data are made available through ICPSR/DSDR for merging with the National Couples' Health and Time Study (NCHAT), United States, 2020-2021 (ICPSR 38417) by approved restricted data researchers. All other researchers can access the IPUMS CDOH data via the IPUMS CDOH website. Unlike other IPUMS products, the CDOH data are organized into multiple categories related to Race and Ethnicity, Sexual and Gender Minority, Gender, and Politics. The CDOH measures were created from a wide variety of data sources (e.g., IPUMS NHGIS, the Census Bureau, the Bureau of Labor Statistics, the Movement Advancement Project, and Myers Abortion Facility Database). Measures are currently available for states or counties from approximately 2015 to 2020. The Sexual and Gender measures in this release include the proportion of a state's population identifying as LGBTQ+ in the U.S. Census Bureau's Household Pulse Survey, Phases 3.2 (07/21/2021-10/11/2021), 3.3 (12/01/2021-02/07/2022), 3.4 (03/02/2022-05/09/2022), and 3.5 (06/01/2022-08/08/2022). To work with the IPUMS CDOH data, researchers will need to first merge the NCHAT data to DS1 (MATCH ID and State FIPS Data). This merged file can then be linked to the IPUMS CDOH datafile (DS2) using the STATEFIPS variable.

In a global survey conducted in 2023, three percent of respondents from 30 countries identified themselves as transgender, non-binary/non-conforming/gender-fluid, or in another way. In Switzerland, around six percent of the respondents stated to identify themselves with one of the listed genders.

As of June 2022, the transgender population was estimated to reach over 1.63 million in the United States. Transgender people aged between 25 and 64 were thought to make up the majority, with an estimated total of 766,500 trans people belonging to this age group. In comparison, there were also 300,100 youth between the ages of 13 and 17 estimated to identify as transgender in that year.

In 2023, 8.5 percent of female respondents in the United States stated they identify as LGBT, while 4.7 percent of male respondents said the same. This is an increase from 2012, when 3.5 percent of female respondents and 3.4 percent of male respondents identified as LGBT.

Socioeconomic characteristics of the population aged 15 and older that is Two-Spirit, lesbian, gay, bisexual, transgender, and queer or who use other terms related to gender or sexual diversity (2SLGBTQ+), by gender, age group and geographic region. Marital status, presence of children under age 12 in the household, education, employment, personal income, Indigenous identity, the visible minority population, immigrant status, language(s) spoken most often at home, place of residence (population centre/rural), self-rated general health, and self-rated mental health. Estimates are obtained from combined cycles of the Canadian Community Health Survey, 2019 to 2021.

Supplementary file 1: Data for serum/plasma laboratory tests with sex-specific reference intervals performed on patients with sexual orientation/gender identity (SOGI) field differences for legal sex/sex assigned at birth (SAAB)/gender identity (GI) in the electronic medical record (EMR) at the University of Iowa Hospitals and Clinics from January 1, 2021 to December 31, 2021. The data elements include: deidentified patient number, age (years) at time of laboratory testing, location type (outpatient, inpatient, or emergency department) at time of specimen collection, legal sex in EMR, SAAB in EMR, GI in EMR, presence of SOGI mismatch (yes/no), change of legal sex in EMR, gender-affirming gonadectomy (yes/no), GI from chart review, gender-affirming hormone and route of administration, values for tests for 17 laboratory tests, and how the values of these 17 laboratory tests were relative to age-matched reference intervals for cisgender men and women. Assays details and reference intervals are summarized in Supplemental file 3. Chart review for SOGI fields previously reported [1]. There are a total of 1,166 unique patients (all 18.0 years or older) and 7,530 laboratory tests.

Supplementary file 2: Data for plasma creatinine performed for patients 18.0 years or older taking gender-affirming estradiol or testosterone at the University of Iowa Hospitals and Clinics from January 1, 2021 to December 31, 2021. The data elements include: deidentified patient number, age (years) at time of laboratory testing, location type at time of specimen collection, legal sex in EMR, SAAB in EMR, GI in EMR, GI from chart review, gender-affirming hormone and route of administration, self-declared race in EMR (African-American or not), plasma creatinine (mg/dL), estimated glomerular filtration rate (eGFR) calculation using female sex and the 2021 CKD-EPI equation without race refit, eGFR using male as sex, and chronic kidney disease (CKD) stage using either female or male as sex. eGFR equation and CKD stages are from references 2 and 3, respectively. There are a total of 620 unique patients and 1,469 plasma creatinine values.

Supplementary file 3: Includes Supplemental Table 1 with details on laboratory assay and Supplemental Table 2 with reference intervals for the laboratory tests analyzed.

Data tabs for Supplemental Files 1 and 2 include one for primary data and another defining abbreviations.

[1] N.G. Hines et al, Patterns of gender identity data within electronic health record databases can be used as a tool for identifying and estimating the prevalence of gender-expansive people, JAMIA Open 6 (2) (2023) ooad042. DOI: 10.1093/jamiaopen/ooad042.

[2] C. Delgado et al., A Unifying Approach for GFR Estimation: Recommendations of the NKF-ASN Task Force on Reassessing the Inclusion of Race in Diagnosing Kidney Disease, Am J Kidney Dis 79 (2) (2022) 268-288 e261. DOI: 10.1053/j.ajkd.2021.08.003.

[3] Kidney Int Suppl (2011) 3 (1) (2013) 5-14.

In 2021, around 14 percent of individuals living in the District of Columbia identified as LGBT. Colorado, Arizona, Nevada, and Oregon also had high rates, exceeding ten percent. Mississippi and North Dakota had the lowest rates of LGBT populations, the only states with less than five percent.

In 2022, around 85.5 percent of transgender people assigned female at birth had considered suicide, compared to 77.2 percent of transgender people assigned male at birth. Approximately 42.7 percent of transgender people assigned female at birth had attempted suicide, compared to 37.2 percent of transgender people assigned male at birth.

As of 2021, approximately 316,258 persons in Mexico self-identifed as transgender or transsexual, while almost 600,000 self-identified as fluid gender, non-binary, or asexual.

Comparisons of the prevalence of muxe relatives in the paternal and maternal lines of muxes and gynephilic participants.

Worldwide, Brazil reported the highest number of transgender people murdered in 2023, reaching 100 victims. Most of the murders that year were reported in Latin America and the Caribbean. It is assumed that only a minority of the cases actually are reported, and the actual number is estimated to be significantly higher.

In 2023, 9.8 percent of Millennials in the United States stated that they identify as LGBT, while in 2012, less than six percent of respondents from the same generation said the same. Members of Generation Z were the most likely to identify as LGBT, at over 20 percent.

A survey conducted in 2024 found that over a third of respondents were thought that society has gone too far in accepting transgender people. On the other hand, a further third believed that society has not gone far enough.

In 2022, around 80 percent of transgender people in the United States had considered suicide, while around 40 percent had attempted suicide. There has been an upward trend in both the considered and attempted suicide rate since 2000, when 61 percent of transgender people considered committing suicide and 28 percent had attempted it.

There were almost 700 thousand slaves in the US in 1790, which equated to approximately 18 percent of the total population, or roughly one in every six people. By 1860, the final census taken before the American Civil War, there were four million slaves in the South, compared with less than 0.5 million free African Americans in all of the US. Of the 4.4 million African Americans in the US before the war, almost four million of these people were held as slaves; meaning that for all African Americans living in the US in 1860, there was an 89 percent* chance that they lived in slavery. A brief history Trans-Atlantic slavery began in the early sixteenth century, when the Portuguese and Spanish forcefully brought captured African slaves to the New World, in order to work for them. The British Empire introduced slavery to North America on a large scale, and the economy of the British colonies there depended on slave labor, particularly regarding cotton, sugar and tobacco output. In the seventeenth and eighteenth century the number of slaves being brought to the Americas increased exponentially, and at the time of American independence it was legal in all thirteen colonies. Although slavery became increasingly prohibited in the north, the number of slaves remained high during this time as they were simply relocated or sold from the north to the south. It is also important to remember that the children of slaves were also viewed as property, and (apart from some very rare cases) were born into a life of slavery. Abolition and the American Civil War In the years that followed independence, the Northern States began gradually prohibiting slavery, and it was officially abolished there by 1805, and the importation of slave labor was prohibited nationwide from 1808 (although both still existed in practice after this). Business owners in the Southern States however depended on slave labor in order to meet the demand of their rapidly expanding industries, and the issue of slavery continued to polarize American society in the decades to come. This culminated in the election of President Abraham Lincoln in 1860, who promised to prohibit slavery in the newly acquired territories to the west, leading to the American Civil War from 1861 to 1865. Although the Confederacy (south) were victorious in much of the early stages of the war, the strength in numbers of the northern states (including many free, black men), eventually resulted in a victory for the Union (north), and the nationwide abolishment of slavery with the Thirteenth Amendment in 1865. Legacy In total, an estimated twelve to thirteen million Africans were transported to the Americas as slaves, and this does not include the high number who did not survive the journey (which was as high as 23 percent in some years). In the 150 years since the abolishment of slavery in the US, the African-American community have continuously campaigned for equal rights and opportunities that were not afforded to them along with freedom. The most prominent themes have been the Civil Rights Movement, voter suppression, mass incarceration and the relationship between the police and the African-American community has taken the spotlight in recent years.

No country in Europe had a majority of transgender people saying that they had undergone gender affirming or gender reassignment surgery in 2019, with the Netherlands having the greatest share of any country, at 48 percent. On average only a quarter of trans people in the EU had undergone surgery to alter their appearance in line with their gender identity.

In 2022, about 72 percent of male-male couples in the United States were White, compared to 6.4 percent of gay couples who were Black or African American.

Gay marriage in the United States

In the mid-1990s, a majority of the U.S. population believed that same-sex couples should not be recognized by law, although this figure has been on the decline since then. In 2011, more than 50 percent of Americans believed the opposite, saying that homosexual couples should be recognized by law. 2015 saw a spike in support, and on June 26 of that year, the United States Supreme Court legalized same-sex marriage in all 50 states in the case of Obergefell v. Hodges.

Being LGBT in America

The share of Americans who identify as lesbian, gay, bisexual, or transgender (LGBT) has been on the rise since 2012 and it is estimated that there are about one million same-sex couples in the U.S. Additionally, about half of surveyed people in 2019 believe that one is born gay or lesbian – a significant increase from 1977, when only 13 percent of respondents said the same.

In a global survey conducted in 2023, three percent of respondents declared to be homosexual, gay, or lesbian. In Brazil and the Netherlands, for instance, nine percent, instead, identified as bisexual, representing the largest group of bisexual respondents among the 30 surveyed countries. Moreover, two percent of the interviewees in Switzerland said to be pansexual or omnisexual. Pansexuality describes people who feel attracted to other people regardless of their biological sex, gender, or gender identity, whereas omnisexuality refers to people attracted to people of all gender identities and sexual orientations.