State-Level LGBTQ-Related Policy Trajectories and Health (Care) Outcomes in the United States: A Sequence and Cluster Analysis Approach.

Objectives. To characterize state-level lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) policy trajectories from 2015 to 2022 and examine their population health implications. Methods. Using Movement Advancement Project data, we constructed US state-level LGBTQ policy trajectories and used sequence and cluster analyses to group similar trajectories. We fit multilevel logistic models using 2023 Behavioral Risk Factor Surveillance System data to estimate associations between policy trajectory clusters and individual health and health care outcomes. We obtained predicted outcome probabilities by cluster and LGBTQ identity. Results. Across the 50 US states and Washington, DC, 37 unique policy trajectories formed 5 clusters: "consistently predominantly discriminatory," "consistently fairly discriminatory," "discriminatory with increasing protection," "moderate change to fairly protective," and "fairly protective change to predominantly protective." Most outcomes were worse in consistently discriminatory states than in increasingly protective states, particularly among LGBTQ adults. Inequities occurred between LGBTQ and cisheterosexual adults within clusters and within LGBTQ identity groups across clusters. Conclusions. Cultivating protective LGBTQ policy climates may help mitigate health and health care inequities. (Am J Public Health. Published online ahead of print October 1, 2026:e1-e10. https://doi.org/10.2105/AJPH.2026.308689).