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.
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We include only state survey-years in which at least some respondents were asked all the questions used to form the variables in our regression models.
In supplementary analyses, we entered the health behaviors variables one at a time and found that accounting for smoking reduced the odds of poor health for bisexual men and women by 11 % (from 2.73 to 2.53) and 8 % (from 2.03 to 1.94), respectively. No other substantial changes were observed in these supplementary analyses.
Each significance test evaluates the pairwise comparison for the average marginal effect (AME) of being a member of Group 2 versus being a member of Group 1 (in this example, heterosexual woman vs. heterosexual man). AME uses all observed data for all covariates in the full model (rather than means on all covariates) to predict average probabilities for a hypothetical population of all heterosexual men (Group 1) and a hypothetical population of all heterosexual women (Group 2). In this probability framework, the AME for Group 2 versus Group 1 is .145 – .157 = –.012; SE = .003; t = –3.06; p = .002.
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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.
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Gorman, B.K., Denney, J.T., Dowdy, H. et al. A New Piece of the Puzzle: Sexual Orientation, Gender, and Physical Health Status. Demography 52, 1357–1382 (2015). https://doi.org/10.1007/s13524-015-0406-1
- Self-rated health
- Sexual orientation