Assessing underlying health risks for severe COVID-19 infection among sexual and gender minority populations in Hawai'i.

The psychosocial impact of COVID-19 on sexual and gender minority (SGM) populations has been widely studied, but risk for severe infection remains less clear, especially in Hawai'i. National studies are not generalizable to Hawai'i's unique racial demographics. This Hawai'i cross-sectional study examined associations between SGM status stratified by race and underlying health conditions and SGM status in Hawai'i, stratified by race, that may increase risk for severe COVID-19. Data from the 2015-2019 Behavioral Risk Factor Surveillance System (BRFSS) of non-institutionalized adults aged 18 years and older in Hawai'i was analyzed using descriptive and regression methods. Sexual and/or gender minority adults accounted for 5.2% and 0.6% of the population, respectively. Compared to Native Hawaiian heterosexual adults, Native Hawaiian sexual minority adults had higher age-adjusted odds of asthma (current - AOR 1.8, CI: 1.33, 2.44 and ever - AOR 1.59, CI: 1.21, 2.09), cancer (AOR 2.07, CI: 1.25, 3.42), and diabetes (AOR 1.58, CI: 1.11, 2.26). Compared to White cisgender adults, Native Hawaiian transgender adults had significantly higher odds of asthma - current (AOR 4.13, CI: 1.44, 11.92), asthma - ever (AOR 4.02, CI: 1.68, 9.66), cancer (AOR 6.67, CI: 1.98, 22.5), diabetes (AOR 4.59, CI: 1.67, 12.62), obesity (AOR 3.76, CI: 1.64, 8.59), a stroke (AOR 3.19, CI: 1.12, 9.06) and cigarette smoking (AOR 3.38, CI: 1.43, 8.02). These chronic health conditions increase vulnerability to severe COVID-19 outcomes. Findings highlight the need for increased chronic disease prevention and management in Hawai'i's SGM communities. Further research is necessary to understand COVID-19's long-term impact and informing equitable public health strategies.