, Volume 52, Issue 4, pp 1357–1382 | Cite as

A New Piece of the Puzzle: Sexual Orientation, Gender, and Physical Health Status

  • Bridget K. GormanEmail author
  • Justin T. Denney
  • Hilary Dowdy
  • Rose Anne Medeiros


Although research has long documented the relevance of gender for health, studies that simultaneously incorporate the relevance of disparate sexual orientation groups are sparse. We address these shortcomings by applying an intersectional perspective to evaluate how sexual orientation and gender intersect to pattern self-rated health status among U.S. adults. Our project aggregated probability samples from the Behavioral Risk Factor Surveillance System (BRFSS) across seven U.S. states between 2005 and 2010, resulting in an analytic sample of 10,128 sexual minority (gay, lesbian, and bisexual) and 405,145 heterosexual adults. Logistic regression models and corresponding predicted probabilities examined how poor self-rated health differed across sexual orientation–by-gender groups, before and after adjustment for established health risk factors. Results reveal distinct patterns among sexual minorities. Initially, bisexual men and women reported the highest—and gay and lesbian adults reported the lowest—rates of poor self-rated health, with heterosexuals in between. Distinct socioeconomic status profiles accounted for large portions of these differences. Furthermore, in baseline and fully adjusted regression models, only among heterosexuals did women report significantly different health from men. Importantly, the findings highlight elevated rates of poor health experienced by bisexual men and women, which are partially attributable to their heightened economic, behavioral, and social disadvantages relative to other groups.


Self-rated health Sexual orientation Gender Bisexual Gay/Lesbian 



A previous version of this article was presented at the 2012 annual meeting of the Southern Demographic Association. We thank Erin Cech for her helpful comments during the writing of this article. The second author acknowledges support from the Health Disparities Scholar Program, National Institute on Minority Health and Health Disparities, National Institutes of Health. The opinions and conclusions expressed herein are solely those of the authors and should not be construed as representing the opinions or policies of the National Institutes of Health.


  1. Allison, P. D. (2002). Missing data. London, UK: Sage Publications.Google Scholar
  2. Austin, E., & Irwin, J. (2010). Health behaviors and health care utilization of Southern lesbians. Women's Health Issues, 20, 178–184.CrossRefGoogle Scholar
  3. Badgett, M. V. L., Durso, L. E., & Schneebaum, A. (2013). New patterns of poverty in the lesbian, gay, and bisexual community. Los Angeles, CA: The Williams Institute.Google Scholar
  4. Bartus, T. (2005). Estimation of marginal effects using margeff. Stata Journal, 5, 309–329.Google Scholar
  5. Bauer, G. R. (2014). Incorporating intersectionality theory into population health research methodology: Challenges and the potential to advance health equity. Social Science & Medicine, 110, 10–17.CrossRefGoogle Scholar
  6. Berkman, L. F., & Glass, T. (2000). Social integration, social networks, social support, and health. In L. F. Berkman & I. Kawachi (Eds.), Social epidemiology (pp. 137–173). Oxford, UK: Oxford University Press.Google Scholar
  7. Bird, C. E., & Rieker, P. P. (2008). Gender and health: The effects of constrained choices and social policies. New York, NY: Cambridge University Press.CrossRefGoogle Scholar
  8. Black, D., Gates, G., Sanders, S., & Taylor, L. (2000). Demographics of the gay and lesbian population in the United States: Evidence from available systematic data sources. Demography, 37, 139–154.CrossRefGoogle Scholar
  9. Bowleg, L. (2012). The problem with the phrase women and minorities: Intersectionality—An important theoretical framework for public health. American Journal of Public Health, 102, 1267–1273.CrossRefGoogle Scholar
  10. Brennan, D. J., Ross, L., Dobinson, C., Veldhuizen, S., & Steele, L. (2010). Men’s sexual orientation and health in Canada. Canadian Journal of Public Health, 101, 255–258.Google Scholar
  11. Brown, D., Hayward, M. D., Hummer, R. M., & Montez, J. K. (2012). The significance of education for mortality compression in the United States. Demography, 49, 819–840.CrossRefGoogle Scholar
  12. Centers for Disease Control and Prevention (CDC). (2005–2010). The BRFSS data user guide. Retrieved from
  13. Centers for Disease Control and Prevention (CDC). (2012). About BMI for adults. Retreived from
  14. Chang, M. L. (2010). Shortchanged: Why women have less wealth and what can be done about it. Oxford, UK: University Press.CrossRefGoogle Scholar
  15. Cho, S., Crenshaw, K. W., & McCall, L. (2013). Toward a field of intersectionality studies: Theories, applications, and praxis. Signs, 38, 785–810.CrossRefGoogle Scholar
  16. Choo, H. Y., & Ferree, M. M. (2010). Practicing intersectionality in sociological research: A critical analysis of inclusions, interactions, and institutions in the study of inequalities. Sociological Theory, 28, 129–149.CrossRefGoogle Scholar
  17. Cochran, S. D., Mays, V., Bowen, D., Gage, S., Bybee, D., Roberts, S. . . . White, J. (2001). Cancer-related risk indicators and preventive screening behaviors among lesbian and bisexual women. American Journal of Public Health, 91, 591–597.Google Scholar
  18. Cole, E. R. (2009). Intersectionality and research in psychology. American Psychologist, 64, 170–180.CrossRefGoogle Scholar
  19. Collins, P. H. (2000). Black feminist thought: Knowledge, consciousness, and the politics of empowerment. New York, NY: Routledge.Google Scholar
  20. Connell, R. (2012). Gender, health, and theory: Conceptualizing the issue, in local and world perspective. Social Science & Medicine, 74, 1675–1683.CrossRefGoogle Scholar
  21. Conron, K. J., Mimiaga, M., & Landers, S. (2010). A population-based study of sexual orientation identity and gender differences in adult health. American Journal of Public Health, 100, 1953–1960.CrossRefGoogle Scholar
  22. Denney, J. T., Gorman, B. K., & Barrera, C. B. (2013). Families, resources, and adult health: Where do sexual minorities fit? Journal of Health and Social Behavior, 54, 46–63.CrossRefGoogle Scholar
  23. Dilley, J. A., Simmons, K., Boysun, M., Pizacani, B., & Stark, M. (2010). Demonstrating the importance and feasibility of including sexual orientation in public health surveys: Health disparities in the Pacific Northwest. American Journal of Public Health, 100, 460–467.CrossRefGoogle Scholar
  24. Gallup. (2010.) Gay and lesbian rights. Retrived from
  25. Gates, G. J. (2011). Census snapshot: 2010 methodology. Adjustment procedures for same-sex couple data. Los Angeles, CA: The Williams Institute. Retrieved from
  26. Gates, G. J., & Ost, J. (2004). The gay and lesbian atlas. Washington, DC: The Urban Institute Press.Google Scholar
  27. Gorman, B. K., & Read, J. G. (2006). Gender disparities in adult health: An examination of three measures of morbidity. Journal of Health and Social Behavior, 47, 95–110.CrossRefGoogle Scholar
  28. Gorman, B. K., & Sivaganesan, A. (2007). The role of social support and integration for understanding socioeconomic disparities in self-rated health and hypertension. Social Science & Medicine, 65, 958–975.CrossRefGoogle Scholar
  29. Green, K. E., & Feinstein, B. A. (2012). Substance use in lesbian, gay, and bisexual populations: An update on empirical research and implications for treatment. Psychology of Addictive Behaviors, 26, 265–278.CrossRefGoogle Scholar
  30. Hankivsky, O. (2012). Women’s health, men’s health, and gender and health: Implications of intersectionality. Social Science & Medicine, 74, 1712–1720.CrossRefGoogle Scholar
  31. Hankivsky, O., & Cormier, R. (2009). Intersectionality: Moving women’s health research and policy forward. Vancouver, Canada: Women’s Health Research Network.Google Scholar
  32. Harnois, C. E., & Ifatunji, M. (2011). Gendered measures, gendered models: Toward and intersectional analysis of interpersonal racial discrimination. Ethnic and Racial Studies, 34, 1006–1028.CrossRefGoogle Scholar
  33. Herek, G. M. (2006). Legal recognition of same-sex relationships in the United States: A social science perspective. American Psychologist, 61, 607–621.CrossRefGoogle Scholar
  34. Herek, G. M., Chopp, R., & Strohl, D. (2007). Sexual stigma: Putting sexual minority health issues in context. In I. H. Meyer & M. E. Northridge (Eds.), The health of sexual minorities: Public health perspectives on lesbian, gay, bisexual, and transgender populations (pp. 171–208). New York, NY: Springer.CrossRefGoogle Scholar
  35. Idler, E. L., & Benyamini, Y. (1997). Self-rated health and mortality: A review of twenty-seven community studies. Journal of Health and Social Behavior, 38, 21–37.CrossRefGoogle Scholar
  36. Institute of Medicine (IOM). (2011). The health of lesbian, gay, bisexual, and transgender people: Building a foundation for better understanding. Washington, DC: National Institutes of Health.Google Scholar
  37. Jorm, A. F., Korten, A. E., Rodgers, B., Jacomb, P. A., & Christensen, H. (2002). Sexual orientation and mental health: Results from a community survey of young and middle-aged adults. British Journal of Psychiatry, 180, 423–427.CrossRefGoogle Scholar
  38. Jylhä, M. (2009). What is self-rated health and why does it predict mortality? Towards a unified conceptual model. Social Science & Medicine, 69, 307–316.CrossRefGoogle Scholar
  39. Kastanis, A., & Gates, G. J. (2013a). LGBT African-Americans and African-American same-sex couples. Los Angeles, CA: The Williams Institute. Retrieved from
  40. Kastanis, A., & Gates, G. J. (2013b). LGBT Latino/a individuals and Latino/a same-sex couples. Los Angeles, CA: The Williams Institute. Retrieved from
  41. Kastanis, A., & Gates, G. J. (2013c). LGBT Asian and Pacific Islander individuals and same-sex couples. Los Angeles, CA: The Williams Institute. Retrieved from
  42. Korn, E., & Graubard, B. (1999). Analysis of health surveys. New York, NY: John Wiley & Sons, Inc.CrossRefGoogle Scholar
  43. Krieger, N. (2001). Theories for social epidemiology in the 21st century: An ecosocial perspective. International Journal of Epidemiology, 30, 668–677.CrossRefGoogle Scholar
  44. Langkamp, D. L., Lehman, A., & Lemeshow, S. (2010). Techniques for handling missing data in secondary analyses of large surveys. Academic Pediatrics, 10, 205–210.CrossRefGoogle Scholar
  45. Laumann, E. O., Gagnon, J. H., Michael, R. T., & Michaels, S. (1994). The social organization of sexuality: Sexual practices in the United States. Chicago, IL: University of Chicago Press.Google Scholar
  46. Link, B., & Phelan, J. (1995). Social conditions as fundamental causes of disease. Journal of Health and Social Behavior, 35(Extra issue), 80–94.Google Scholar
  47. Liu, H., Reczek, C., & Brown, D. (2013). Same-sex cohabitors and health the role of race-ethnicity, gender, and socioeconomic status. Journal of Health and Social Behavior, 54, 25–45.CrossRefGoogle Scholar
  48. Marmot, M. G. (2004). The status syndrome: How social standing affects our health and longevity. New York, NY: Henry Holt and Company, LLC.Google Scholar
  49. McCabe, S. E., Hughes, T. L., Bostwick, W. B., West, B. T., & Boyd, C. J. (2009). Sexual orientation, substance use behaviors and substance dependence in the United States. Addiction, 104, 1333–1345.CrossRefGoogle Scholar
  50. McCall, L. (2005). The complexity of intersectionality. Signs, 30, 1771–1800.CrossRefGoogle Scholar
  51. Meyer, I. H. (2007). Prejudice and discrimination as social stressors. In I. H. Meyer & M. E. Northridge (Eds.), The health of sexual minorities: Public health perspectives on lesbian, gay, bisexual, and transgender populations (pp. 242–267). New York, NY: Springer.CrossRefGoogle Scholar
  52. Pampel, F. C., Krueger, P. M., & Denney, J. T. (2010). Socioeconomic disparities in health behaviors. Annual Review of Sociology, 36, 349–370.CrossRefGoogle Scholar
  53. Pascoe, C. J. (2007). Dude, you’re a fag: Masculinity and sexuality in high school. Berkeley, CA: University of California Press.Google Scholar
  54. Powell, B., Bolzendahl, C., Geist, C., & Steelman, L. (2010). Counted out: Same-sex relations and Americans’ definitions of family. New York, NY: Russell Sage Foundation.Google Scholar
  55. Read, J. G., & Gorman, B. (2010). Gender and health inequality. Annual Review of Sociology, 36, 371–386.CrossRefGoogle Scholar
  56. Reczek, C., & Umberson, D. (2012). Gender, health behavior, and intimate relationships: Lesbian, gay, and straight contexts. Social Science & Medicine, 74, 1783–1790.CrossRefGoogle Scholar
  57. Roberts, S. A., Dibble, S., Nussey, B., & Casey, K. (2003). Cardiovascular disease risk in lesbian women. Women's Health Issues, 13, 167–174.CrossRefGoogle Scholar
  58. Ross, C., & Bird, C. (1994). Sex stratification and health lifestyle: Consequences for men’s and women’s perceived health. Journal of Health and Social Behavior, 35, 161–178.CrossRefGoogle Scholar
  59. Singh-Manoux, A., Martikainen, P., Ferrie, J., Zins, M., Marmot, M., & Goldberg, M. (2006). What does self-rated health measure? Results from the British Whitehall II and French Gazel cohort studies. Journal of Epidemiology and Community Health, 60, 364–372.CrossRefGoogle Scholar
  60. Springer, K. W., Hankivsky, O., & Bates, L. M. (2012). Gender and health: Relational, intersectional, and biosocial approaches. Social Science & Medicine, 74, 1661–1666.CrossRefGoogle Scholar
  61. StataCorp. (2011). Stata statistical software: Release 12. College Station, TX: StataCorp LP.Google Scholar
  62. Swim, J. K., & Hyers, L. I. (2009). Sexism. In T. D. Nelson (Ed.), Handbook of prejudice, stereotyping, and discrimination (pp. 407–430). New York, NY: Psychology Press.Google Scholar
  63. Tang, H., Greenwood, G. L., Cowling, D. W., Lloyd, J. C., Roeseler, A. G., & Bal, D. G. (2004). Cigarette smoking among lesbians, gays, and bisexuals: How serious a problem? (United States). Cancer Causes and Control, 15, 797–803.CrossRefGoogle Scholar
  64. Umberson, D., Chen, M. D., House, J. S., Hopkins, K., & Slaten, E. (1996). The effect of social relationships on psychological well-being: Are men and women really so different? American Sociological Review, 61, 837–857.CrossRefGoogle Scholar
  65. U.S. Department of Health and Human Services (U.S. DHHS) and U.S. Department of Agriculture. (2005). Dietary guidelines for Americans, 2005 (6th ed.). Washington, DC: U.S. Government Printing Office.Google Scholar
  66. Veenstra, G. (2011). Race, gender, class, and sexual orientation: Intersecting axes of inequality and self-rated health in Canada. International Journal for Equity in Health, 10(3). doi: 10.1186/1475-9276-10-3
  67. Veenstra, G. (2013). Race, gender, class, sexuality (RGCS) and hypertension. Social Science & Medicine, 89, 16–24.CrossRefGoogle Scholar
  68. Von Hippel, P. T. (2007). Regression with missing Ys: An improved strategy for analyzing multiply imputed data. Sociological Methodology, 37, 83–117.CrossRefGoogle Scholar
  69. Weber, L., & Parra-Medina, D. (2003). Intersectionality and women’s health: Charting a path to eliminating health disparities. Advances in Gender Research, 7, 181–230.CrossRefGoogle Scholar
  70. Williams, D. R., & Sternthal, M. (2010). Understanding racial-ethnic disparities in health: Sociological contributions. Journal of Health and Social Behavior, 51, S15–S27.CrossRefGoogle Scholar
  71. Wu, Z., Penning, M. J., Pollard, M. S., & Hart, R. (2003). “In sickness and in health”: Does cohabitation count? Journal of Family Issues, 24, 811–838.CrossRefGoogle Scholar

Copyright information

© Population Association of America 2015

Authors and Affiliations

  • Bridget K. Gorman
    • 1
    Email author
  • Justin T. Denney
    • 1
  • Hilary Dowdy
    • 1
  • Rose Anne Medeiros
    • 2
  1. 1.Department of SociologyRice UniversityHoustonUSA
  2. 2.StataCorpCollege StationUSA

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