BACKGROUND: The LGB population is diverse with individuals belonging to a variety of racial/ethnic, sociodemographic, religious, geographic, and cultural backgrounds. These intersecting identities can impact how individuals are viewed and/or treated and, in turn, their health and well-being. Intersectionality is a theoretical framework for examining the synergy of multiple identities and how they shape the structural systems that influence health. This study incorporates an intersectional framework to investigate health disparities faced by LGB people, particularly those from marginalized racial/ethnic groups, in New Mexico.
METHODS: Data (2011-2015) from the New Mexico Behavioral Risk Factor Surveillance System were combined to provide a sufficient sample size to analyze the intersection of sexual orientation and race/ethnicity. We conducted exploratory analyses which revealed significant differences in demographic factors and disparities between LGB and straight adults for a variety of chronic health conditions and risk behaviors. We used logistic regression to examine statistical interaction between sexual orientation and race/ethnicity for outcomes with significant disparities for all adults, and separately for males and females. We adjusted models with significant interaction terms for demographic differences in the LGB and straight populations.
RESULTS: LGB adults differed significantly from straight adults by age, education, annual household income, employment, marital status, and geography. Race/ethnicity did not differ significantly by sexual orientation. After adjustment, we found a statistically significant interaction between sexual orientation and race/ethnicity for prediabetes, doctor-diagnosed depression, current asthma, binge drinking, heavy drinking, and obesity. For some outcomes, LGB racial/ethnic minorities had significantly worse health outcomes compared with LGB white adults and straight adults of any racial/ethnic group. LGB American Indian [AOR: 5.86 (2.81-12.24)] and LGB Hispanic [AOR: 2.49(1.54-4.02)] adults had greater odds of prediabetes compared with LGB white adults [AOR: 1.38 (0.87-2.19)], straight American Indian adults [AOR: 1.80 (1.47-2.22)], and straight Hispanic adults [AOR: 1.18(1.03-1.35)]. LGB Hispanic women [AOR: 1.57 (1.05-2.34)] were more likely to engage in heavy drinking compared with straight Hispanic women [AOR: 0.73 (0.65-0.82)]. LGB Black men [AOR: 4.83 (1.28-18.25)] were significantly more likely to be obese compared with straight Black men [AOR: 1.24 (0.81-1.88)] and LGB white men [AOR: 1.31 (0.82-2.10)].
CONCLUSIONS: Identity can be a marker for the stresses individuals experience due to personally mediated stigma as well as social structures and cultural norms that perpetuate it. Examining the intersection of identities in public health disparities research contributes a more nuanced understanding of the context in which people live and how it impacts their health.