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Understanding sexual orientation and health in Canada: Who are we capturing and who are we missing using the Statistics Canada sexual orientation question?

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Abstract

OBJECTIVES: Public health research on inequalities in Canada depends heavily on population data sets such as the Canadian Community Health Survey. While sexual orientation has three dimensions - identity, behaviour and attraction - Statistics Canada and public health agencies assess sexual orientation with a single questionnaire item on identity, defined behaviourally. This study aims to evaluate this item, to allow for clearer interpretation of sexual orientation frequencies and inequalities.

METHODS: Through an online convenience sampling of Canadians ≥14 years of age, participants (n = 311) completed the Statistics Canada question and a second set of sexual orientation questions.

RESULTS: The single-item question had an 85.8% sensitivity in capturing sexual minorities, broadly defined by their sexual identity, lifetime behaviour and attraction. Kappa statistic for agreement between the single item and sexual identity was 0.89; with past year, lifetime behaviour and attraction were 0.39, 0.48 and 0.57 respectively. The item captured 99.3% of those with a sexual minority identity, 84.2% of those with any lifetime same-sex partners, 98.4% with a past-year same-sex partner, and 97.8% who indicated at least equal attraction to same-sex persons.

CONCLUSION: Findings from Statistics Canada surveys can be best interpreted as applying to those who identify as sexual minorities. Analyses using this measure will underidentify those with same-sex partners or attractions who do not identify as a sexual minority, and should be interpreted accordingly. To understand patterns of sexual minority health in Canada, there is a need to incorporate other dimensions of sexual orientation.

Résumé

OBJECTIFS: La recherche en santé publique sur les inégalités au Canada est fortement tributaire des jeux de données démographiques comme l’Enquête sur la santé dans les collectivités canadiennes. L’orientation sexuelle a trois dimensions (l’identité, le comportement et l’attirance), mais Statistique Canada et les organismes de santé publique l’évaluent à l’aide d’un seul élément de questionnaire qui porte sur l’identité, laquelle est définie selon le comportement. Notre étude vise à évaluer cet élément afin de clarifier l’interprétation des taux de fréquence et des inégalités liés à l’orientation sexuelle.

MÉTHODE: Au moyen d’un échantillon de commodité de Canadiens de ≥14 ans obtenu en ligne, les participants (n = 311) ont répondu à la question de Statistique Canada et à un deuxième jeu de questions sur l’orientation sexuelle.

RÉSULTATS: La question à un seul élément avait un taux de sensibilité de 85,8% pour saisir les minorités sexuelles, définies au sens large par leur identité sexuelle, leur comportement au cours de la vie et leur attirance. Le coefficient kappa de concordance entre l’élément unique et l’identité sexuelle était de 0,89; avec le comportement au cours de l’année précédente, le comportement au cours de la vie et l’attirance, il était de 0,39, 0,48 et 0,57, respectivement. L’élément unique a saisi 99,3% des personnes ayant une identité sexuelle minoritaire, 84,2% des personnes ayant déjà eu des partenaires du même sexe durant leur vie, 98,4% des personnes ayant eu des partenaires du même sexe au cours de l’année précédente, et 97,8% des personnes ayant indiqué avoir une attirance supérieure ou égale pour les personnes du même sexe.

CONCLUSION: Les résultats des enquêtes de Statistique Canada peuvent au mieux être interprétés comme s’appliquant aux personnes qui s’identifient comme faisant partie de minorités sexuelles. Les analyses qui reposent sur cet indicateur sous-identifient les personnes ayant eu des partenaires du même sexe ou étant attirées par des personnes du même sexe sans s’identifier comme faisant partie d’une minorité sexuelle, et devraient être interprétées en conséquence. Pour comprendre les tendances de santé des minorités sexuelles au Canada, il faudrait intégrer les autres dimensions de l’orientation sexuelle.

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Authors and Affiliations

  1. Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, 1960 Middlesex Dr, London, ON, N6G 2V4, Canada

    Christoffer Dharma MSc & Greta R. Bauer PhD

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  1. Christoffer Dharma MSc
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  2. Greta R. Bauer PhD
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Correspondence to Christoffer Dharma MSc.

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Conflict of Interest: None to declare.

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Dharma, C., Bauer, G.R. Understanding sexual orientation and health in Canada: Who are we capturing and who are we missing using the Statistics Canada sexual orientation question?. Can J Public Health 108, e21–e26 (2017). https://doi.org/10.17269/CJPH.108.5848

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  • DOI: https://doi.org/10.17269/CJPH.108.5848

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