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Does Sexual Orientation Complicate the Relationship Between Marital Status and Gender With Self-rated Health and Cardiovascular Disease?

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Demography

Abstract

A substantial body of work has demonstrated the importance of marital status for health, yet the vast majority of this work has studied heterosexual marriages and relationships. To understand the role of marital status in shaping health among heterosexual, lesbian, gay, and bisexual men and women, we examine data from a probability-based sample of adults living in 40 U.S. states for selected years between 2011–2015. We test two physical health outcomes—poor-to-fair self-rated health and cardiovascular disease—and present predicted probabilities and pairwise comparisons from logistic regression models before and after adjustment for demographic characteristics, socioeconomic status, health behaviors, and depression. Overall, findings reveal some important similarities and differences in the relationships between marital status and health by sexual orientation and gender. First, the health benefits of marriage extend to sexual minority adults, relative to adults who are either formerly or never married. Among heterosexual adults, adjusted models also highlight the healthy status of never-married adults. Second, the health benefits associated with intimate relationships appear less dependent on legal marriage among sexual minorities than among heterosexual adults. Third, we document a persistent health disadvantage for bisexual adults compared with heterosexual adults, particularly among women who are formerly married, indicating some elevated health vulnerability among selected sexual minority women. Fourth, associations between sexual orientation and health are more similar across marital status groups for men than women. Altogether, these findings add much needed nuance to our understanding of the association between marital status and health in an era of increasing diversity in adult relationships.

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Notes

  1. In 2014, BRFSS began offering an optional module on sexual orientation; prior to this date, all questions on sexual orientation were added independently by states.

  2. In total, 135,919 people declined to answer or responded that they did not know their sexual orientation, and 4,383 identified their sexual orientation as “other.”

  3. Because the BRFSS does not include a full household roster and the phrasing of the question includes the term “unmarried couple” rather than “cohabiting couple,” we do not assume that all respondents who are part of an unmarried couple are also cohabitating.

  4. Although studies examining how relationships relate to health status for sexual minority adults have used household roster information to indirectly identify adults living with a same-sex partner (e.g., Denney et al. 2013), the household roster information available in the BRFSS is more limited. It does identify the number and gender of adults living in the household with the respondent but not the relationship to the respondent. Thus, we rely on self-reported marital status to measure relationship status of respondents.

  5. In analyses not shown, we explored limiting our sample to respondents in states with marriage equality, but implementing this restriction biased our sample to states with more positive LGB climate. It also reduced our sample size substantially, by 43% (including a 38% reduction of lesbian and gay respondents and a 36% reduction in bisexual respondents), limiting our ability to analyze the 12 sexual orientation × marital status × gender groups discussed in this article. For these reasons (and because adults can cross state lines to get married), we do not restrict our sample to the state-years of data when marriage equality had been legally implemented.

  6. We chose June because it is in the middle of the year and allows us to capture marriage equality resulting from the Obergefell U.S. Supreme Court decision.

  7. All dependent and independent variables are used in the multiple imputation by chained equations (MICE) procedure.

  8. We randomly select and extract an imputed data set, performing all predicted probabilities and pairwise comparisons accordingly. For sensitivity, we replicated this process on multiple randomly selected imputed data sets. Results were nearly identical in every case.

  9. The sexual orientation and marital status categories are a single variable, not an interaction.

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Acknowledgments

Alexa Solazzo was partially supported through a grant from the National Cancer Institute (5T32CA009001). We thank the Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2011–2015; the Alaska Department of Health and Social Services, Division of Public Health and the Centers for Disease Control and Prevention; Bryant, S. M. & Tomassilli, J. C. California Behavioral Risk Factor Surveillance System (BRFSS) SAS Dataset Documentation and Technical Report: 1984-2015. Public Health Survey Research Program, California State University, Sacramento, 2015; the Michigan Department of Community Health and Chronic Disease Epidemiology Section of the Michigan Department of Health and Human Services; the Montana Behavioral Risk Factor Surveillance System, 2011–2013 Behavioral Risk Factor Surveillance System Online, Montana Department of Public Health and Human Services, and supported by the Centers for Disease Control and Prevention Cooperative Agreement (DP09-100102CONT11, S011-110102CONT12, S011-110103CONT13); the Rhode Island Behavioral Risk Factor Surveillance System, 2014–2015, Center for Health Data and Analysis, Rhode Island Department of Health, and supported in part by the National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention Cooperative Agreement 5U58DP001988, Office of Public Health Assessment; Utah Behavioral Risk Factor Surveillance System Survey Data. Salt Lake City, UT: Utah Department of Health, 2010; and BRFSS offices in Arizona, Colorado, Delaware, Florida, Idaho, Illinois, Indiana, Iowa, Louisiana, Massachusetts, Maine, New Mexico, North Dakota, Ohio, Oregon, Virginia, Washington, and Wisconsin.

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  1. Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA

    Alexa Solazzo

  2. Department of Sociology, Rice University, 6100 Main Street, Houston, TX, 77251, USA

    Bridget Gorman

  3. Department of Sociology, Washington State University, PO Box 644020, Pullman, WA, 99164, USA

    Justin Denney

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Solazzo, A., Gorman, B. & Denney, J. Does Sexual Orientation Complicate the Relationship Between Marital Status and Gender With Self-rated Health and Cardiovascular Disease?. Demography 57, 599–626 (2020). https://doi.org/10.1007/s13524-020-00857-9

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