Embodying pervasive discrimination: a decomposition of sexual orientation inequalities in health in a population-based cross-sectional study in Northern Sweden

Abstract

BackgroundStudies from Sweden and abroad have established health inequalities between heterosexual and non-heterosexual people. Few studies have examined the underpinnings of such sexual orientation inequalities in health. To expand this literature, the present study aimed to employ decomposition analysis to explain health inequalities between people with heterosexual and non-heterosexual orientation in Sweden, a country with an international reputation for heeding the human rights of non-heterosexual people.MethodsParticipants (N = 23,446) came from a population-based cross-sectional survey in the four northernmost counties in Sweden in 2014. Participants completed self-administered questionnaires, covering sexual orientation, mental and general physical health, social conditions and unmet health care needs, and sociodemographic data was retrieved from total population registers. Sexual orientation inequalities in health were decomposed by Blinder-Oaxaca decomposition analysis.ResultsResults showed noticeable mental and general health inequalities between heterosexual and non-heterosexual orientation groups. Health inequalities were partly explained (total explained fraction 64-74%) by inequalities in degrading treatment (24-26% of the explained fraction), but to a considerable degree also by material conditions (38-45%) and unmet care needs (25-43%).ConclusionsPsychosocial experiences may be insufficient to explain and understand health inequalities by sexual orientation in a reputedly ‘gay-friendly’ setting. Less overt forms of structural discrimination may need to be considered to capture the pervasive material discrimination that seems to underpin the embodiment of sexual minority inequalities. This ought to be taken into consideration in research, policy-making and monitoring aiming to work towards equity in health across sexual orientations.

What drives us apart? Decomposing intersectional inequalities in cigarette smoking by education and sexual orientation among U.S. adults

“…For example, despite the progress towards adopting policies prohibiting discrimination based on sexual orientation in 33 states in the U.S. [50], sexual orientation discrimination in the workplace is still pervasive and widespread [51], which might limit, among others, LGBQ adults’ access to promotions and work benefits. A comparable relative material disadvantage among LGBQ people, possibly rooted in structural barriers on the labor market and in working life and expressed in health inequalities, have also been noted in northern European contexts [52].…”

“…Our study has several limitations. Despite the importance of psychosocial factors such as perceived discrimination [52] and victimization [14] in explaining socioeconomic inequalities and sexual orientation inequalities in cigarette smoking, these factors were not included in the models. This is mainly due to the absence of variables that might capture these factors in the data set.…”

Socioeconomic Status and Psychosocial Resources Mediate Racial/Ethnic Differences in Psychological Health Among Gay and Bisexual Men: A Longitudinal Analysis Using Structural Equation Modeling

“…While gay and bisexual males tend to have higher education than their heterosexual peers, they are less likely to own homes, have fewer economic resources, and are at increased risk of economic hardship, or inability to pay their bills and afford food, compared to heterosexual males ( Conron et al, 2018 ). Evidence also indicates that gay and bisexual persons are more likely to experience adverse physical and mental health compared with heterosexual individuals ( Clarke et al, 2019 ; Elliott et al, 2015 ; Gustafsson et al, 2017 ; Logie et al, 2018 ). However, SES remains an understudied determinant of health for gay and bisexual persons ( Ompad et al, 2018 ).…”

Interroger la sexualité d’hommes atteints d’un cancer de la prostate. Retours sur une enquête par entretiens semi-directifs

“…Deuxièmement, les pratiques homosexuelles, même si elles sont de plus en plus acceptées, demeurent potentiellement stigmatisables. Se dire homosexuel reste souvent difficile, d’autant plus que le cancer de la prostate concerne des hommes âgés et les place en relation directe avec une institution médicale qui est loin d’avoir prouvé son ouverture vis-à-vis des minorités sexuelles (Herek et Garnets, 2007 ; Jablonski et al, 2010 ; Sabin et al, 2015 ; Whitehead et al, 2016 ; Gustafsson et al, 2017). Si j’ai bien essayé de contourner ces difficultés en passant par des associations communautaires, j’ai dû me résoudre à abandonner le projet d’explorer l’expérience du cancer de la prostate chez les gays du fait des difficultés auxquelles je faisais face dans le recrutement des enquêtés.…”