Compounding Health Inequalities by Sexual Orientation Identity and Socioeconomic Status

Background

Many sexual minority groups have low socioeconomic status (SES). Both low SES and sexual minority status predict compromised health, but little is known about whether they have compounding health implications. Higher SES reduce health disparities for sexual minority individuals, providing buffering from negative health implications. Partnership, which can buffer the health disparities experienced by LGBQ populations, may play a role in the interaction between SES and sexual minority status. We examined disparities in self-rated and mental health by the intersection of sexual orientation identity and socioeconomic status, attending to heterogeneities across genders, gay/lesbian and bisexual identities, and marriage and cohabitation.

Methods

We pooled repeated cross-sectional data from the nationally representative 2018-2022 Swedish National Public Health Surveys (N = 222,800 to 318,515). The focal physical health outcomes were self-rated health, the Kessler-6 psychological distress scale, and the Warwick-Edinburgh Mental Well-Being scale.

Results

In multivariate models interacting SES with sexual orientation, lacking a university degree and having lower income consistently predicted disproportionately compromised mental health outcomes for bisexual and gay/lesbian compared to heterosexual respondents, beyond the additive associations of SES and sexual orientation with mental health (p<.05). For self-rated health, this pattern held for low income (p<.05) but not education. Additional models found a triple disadvantage for low-SES sexual minorities who were also unpartnered (p.<05).

Conclusions

Among lesbian/gay and bisexual populations, having low SES presents a disproportionately strong risk for mental and self-rated health. This risk intensifies for those who are also unpartnered. Because large proportions of Swedish sexual minorities fit this profile, there is a need for policy supports for this vulnerable population.

Key messages

• Low education and income make gay/lesbian and bisexual Swedish adults’ mental and sometimes self-rated health particularly vulnerable. Also being unpartnered creates a triple disadvantage for health.

• These risks are compounding, not additive. Especially since many Swedish sexual minorities have low socioeconomic status and are unpartnered, policy supports are needed for this vulnerable population.