Lesbian, gay, bisexual, and transgender (LGBT) populations have higher prevalences of health conditions associated with severe COVID-19 illness compared with non-LGBT populations (1)˳ The potential for low vaccine confidence and coverage among LGBT populations is of concern because these persons historically experience challenges accessing, trusting, and receiving health care services (2)˳ Data on COVID-19 vaccination among LGBT persons are limited, in part because of the lack of routine data collection on sexual orientation and gender identity at the national and state levels˳ During August 29-October 30, 2021, data from the National Immunization Survey Adult COVID Module (NIS-ACM) were analyzed to assess COVID-19 vaccination coverage and confidence in COVID-19 vaccines among LGBT adults aged ≥18 years˳ By sexual orientation, gay or lesbian adults reported higher vaccination coverage overall (85˳4%) than did heterosexual adults (76˳3%)˳ By race/ethnicity, adult gay or lesbian non-Hispanic White men (94˳1%) and women (88˳5%), and Hispanic men (82˳5%) reported higher vaccination coverage than that reported by non-Hispanic White heterosexual men (74˳2%) and women (78˳ 6%)˳ Among non-Hispanic Black adults, vaccination coverage was lower among gay or lesbian women (57˳9%) and bisexual women (62˳1%) than among heterosexual women (75˳6%)˳ Vaccination coverage was lowest among non-Hispanic Black LGBT persons across all categories of sexual orientation and gender identity˳ Among gay or lesbian adults and bisexual adults, vaccination coverage was lower among women (80˳5% and 74˳2%, respectively) than among men (88˳9% and 81˳7%, respectively)˳ By gender identity, similar percentages of adults who identified as transgender or nonbinary and those who did not identify as transgender or nonbinary were vaccinated˳ Gay or lesbian adults and bisexual adults were more confident than were heterosexual adults in COVID-19 vaccine safety and protection; transgender or nonbinary adults were more confident in COVID-19 vaccine protection, but not safety, than were adults who did not identify as transgender or nonbinary˳ To prevent serious illness and death, it is important that all persons in the United States, including those in the LGBT community, stay up to date with recommended COVID-19 vaccinations˳
NIS-ACM collects data from adults aged ≥18 years using a random-digit-dialed sample of cellular telephone numbers (3)˳ Data collected during August 29-October 30, 2021 from 153,062 respondents were weighted to represent the noninstitutionalized U˳S˳ adult population and to match the number of adults who received ≥1 dose* of COVID-19 vaccine as reported by jurisdictions to CDC˳† The response rate was 20˳9% in both September and October˳§ Sexual orientation was assessed with the question, “What best describes your sexual orientation? Is it heterosexual or straight; lesbian or gay; bisexual; or something else?” Gender identity was assessed with the question, “Would you consider yourself as transgender or nonbinary?” Adults who answered “don’t know” or “refused” to the sexual orientation (9,586, 6˳3%) or gender identity (10,539, 6˳9%) questions were excluded from the analysis˳
Self-reported data on COVID-19 vaccination coverage by sociodemographic characteristics, and behavioral and social drivers of vaccination were analyzed by sexual orientation and gender identity˳¶ Assessed drivers of vaccination were concerns about COVID-19, and importance of and confidence in COVID-19 vaccines˳ Data were stratified by male or female sex for heterosexual, gay or lesbian, and bisexual respondents˳ Because persons who describe themselves as nonbinary do not identify as male or female, gender identity was not stratified by male or female sex˳ Analyses used t-tests and 95% CIs to detect differences in percentages between groups, using a threshold of α = 0˳05 for statistical significance˳ Analyses were performed using SAS (version 9˳4; SAS Institute) and SUDAAN (version 11˳0˳3; RTI International)˳ This activity was reviewed by CDC and was conducted consistent with applicable federal law and CDC policy˳**
Among 143,476 survey respondents with nonmissing responses to the sexual orientation question, 3,941 (2˳7%) identified as gay or lesbian and 4,395 (3˳1%) as bisexual; of the 142,523 survey respondents with nonmissing responses to the gender identity question, 5,594 (3˳9%) identified as transgender or nonbinary˳ Receipt of ≥1 dose of a COVID-19 vaccine was higher among gay or lesbian adults (85˳4%) than among heterosexual (76˳3%; p<0˳05) or bisexual (76˳3%) adults (Table 1)˳ Among gay or lesbian adults and bisexual adults, a higher percentage of men (88˳9% and 81˳7%, respectively) than women (80˳5% and 74˳2%, respectively) reported receiving ≥1 COVID-19 vaccine dose (Table 2)˳ The percentage of transgender or nonbinary adults who reported receiving ≥1 dose of COVID-19 vaccine (75˳7%) was statistically similar to that among adults who did not identify as transgender or nonbinary (76˳7%)˳
Among non-Hispanic White adults, the percentage who reported receiving ≥1 COVID-19 vaccine dose was higher among gay or lesbian adults (91˳7%) than among heterosexual adults (76˳5%), higher among gay men (94˳1%) and bisexual men (81˳4%) than among heterosexual men (74˳2%), and higher among gay or lesbian women (88˳5%) than among heterosexual women (78˳6%) (all p<0˳05)˳ The percentage of non-Hispanic White bisexual women who reported receiving ≥1 COVID-19 vaccine dose (74˳6%) was lower than that among heterosexual women (p<0˳05)˳ Among Hispanic adults, the percentage who reported receiving ≥1 COVID-19 vaccine dose was higher among gay men (82˳9%) than among heterosexual men (72˳0%; p<0˳05)˳ Among non-Hispanic Black adults, coverage was lower among gay or lesbian women (57˳9%) and bisexual women (62˳1%) than among heterosexual women (75˳6%) (p<0˳05)˳ Receipt of ≥1 COVID-19 vaccine dose was highest among non-Hispanic White gay men (94˳1%) and lowest among non-Hispanic Black gay or lesbian women (57˳9%)˳ There were no statistically significant differences by race/ethnicity among adults who identified as transgender or nonbinary compared with those who did not identify as transgender or nonbinary˳
By urbanicity,†† among adults residing in a Metropolitan Statistical Area (MSA) principal city, ≥1-dose vaccination coverage was higher among gay men (92˳2%) and bisexual men (88˳3%) than among heterosexual men (76˳6%); a lower percentage of persons who identified as transgender or nonbinary (73˳9%) reported receiving ≥1 dose compared with persons who did not identify as transgender or nonbinary (79˳0%) (all p<0˳05)˳ Among adults residing in an MSA nonprincipal city, the percentage of gay men who reported receiving ≥1 dose (87˳9%) was higher than that among heterosexual men (74˳9%); among bisexual women, ≥1-dose coverage (76˳2%) was lower than that among heterosexual women (80˳6%) (all p<0˳05)˳ For adults living in a non-MSA, coverage was higher among gay or lesbian women (84˳2%) and lower among bisexual women (58˳1%) than among heterosexual women (69˳9%) (all p<0˳05)˳
Among both vaccinated and unvaccinated respondents, a higher percentage of gay or lesbian adults and bisexual adults reported they were very or moderately concerned about COVID-19 (56˳8% and 51˳3%, respectively) than were heterosexual adults (48˳1%) (all p<0˳05) (Table 3)˳ Higher percentages of gay and bisexual men reported they were completely confident or very confident in vaccine safety (82˳4% and 76˳3%, respectively) than were heterosexual men (63˳2%), as were bisexual women (68˳1%) compared with heterosexual women (64˳5%) (all p<0˳05)˳ Higher percentages of gay or lesbian adults and bisexual adults reported that they thought COVID-19 vaccine was very or somewhat important to protect oneself (90˳8% and 86˳8%, respectively) compared with heterosexual adults (80˳4%), and higher percentages of adults who identified as transgender or nonbinary reported they thought COVID-19 vaccine was very or somewhat important to protect oneself (83˳2%) compared with those who did not identify as transgender or nonbinary (80˳7%) (all p<0˳05)˳
