March 27, 2019
Sexual minorities—people who report sexual attraction to or behavior with members of the same sex and people who identify as gay, lesbian, or bisexual—are at a higher risk for a broad range of health problems at different points in their lives. Previous research has shown that sexual minorities are more likely to experience health problems like substance-use disorders and mood or anxiety disorders. In a recent article in Annals of Epidemiology by Methodology Center Investigators Cara Exten Rice and Stephanie Lanza, the authors used time-varying effect modeling (TVEM) to examine whether the occurrence of problems changed as people aged. The authors found that the odds for anxiety and depression among sexual minorities was highest in their early 20s, while odds for poor cardiovascular health were higher in their 40s and 50s.
When asked about the reason for these disparities, Cara emphasized that this was not a causal study but indicated that disparities may result from increased stress due to discrimination and prejudice. “It’s generally believed that sexual minorities experience increased levels of stress throughout their lives as a result of discrimination, microaggressions, stigma, and prejudicial policies,” she said. “Those increased stress levels may then result in poor health in a variety of outcomes, including health behaviors like substance use and chronic diseases like heart disease .”
Stephanie said the results help shed light on understudied health risks. “Discussions about health disparities often focus on the differences between men and women, across racial and ethnic groups, or between people of different socioeconomic backgrounds. However, sexual minority groups suffer substantially disproportionate health burdens across a range of outcomes, including poor mental health and problematic substance-use behaviors.”
For the study, the researchers used data from about 30,999 participants between the ages of 18 and 65 from the National Epidemiologic Survey of Alcohol and Related Conditions-III. Data included information about past-year alcohol, tobacco and drug use disorders, as well whether the participants had a past-year history of depression, anxiety, sexually transmitted infections (STIs) or cardiovascular disease.
“We observed that odds of substance-use disorders remained constant across age for sexual minorities, while in the general population they tend to be concentrated in certain age groups,” Cara said. “We saw that sexual minorities were more likely to have these substance-use disorders even in their 40s and 50s when we see in the general population that drug use and alcohol use start to taper off.”
Cara said the findings could be used to develop programs to help prevent these health problems before they start. “A necessary first step was to understand how health disparities affecting sexual minorities vary across age,” Rice said. “These findings shed light on periods of adulthood during which intervention programs may have the largest public health impact. Additionally, future studies that examine possible drivers of these age-varying disparities, such as daily experiences of discrimination, will inform the development of intervention content to promote health equity.”
Sara A. Vasilenko, Syracuse University, and Jessica N. Fish, University of Maryland, also contributed to this research.