Sexual Orientation Disparities in Preventable Disease: A Fundamental Cause Perspective

Am J Public Health. 2016 Jun;106(6):1109-15. doi: 10.2105/AJPH.2016.303051. Epub 2016 Mar 17.


Objectives: To determine whether fundamental cause theory (which posits that, in societal conditions of unequal power and resources, members of higher-status groups experience better health than members of lower-status groups because of their disproportionate access to health-protective factors) might be relevant in explaining health disparities related to sexual orientation.

Methods: We used 2001 to 2011 morbidity data from the Stockholm Public Health Cohort, a representative general population-based study in Sweden. A total of 66 604 (92.0%) individuals identified as heterosexual, 848 (1.2%) as homosexual, and 806 (1.1%) as bisexual. To test fundamental cause theory, we classified diseases in terms of preventability potential (low vs high).

Results: There were no sexual orientation differences in morbidity from low-preventable diseases. By contrast, gay or bisexual men (adjusted odds ratio [OR] = 1.48; 95% confidence interval [CI] = 1.13, 1.93) and lesbian or bisexual women (adjusted OR = 1.64; 95% CI = 1.28, 2.10) had a greater risk of high-preventable morbidity than heterosexual men and women, respectively. These differences were sustained in analyses adjusted for covariates.

Conclusions: Our findings support fundamental cause theory and suggest that unequal distribution of health-protective resources, including knowledge, prestige, power, and supportive social connections, might explain sexual orientation health disparities.

MeSH terms

  • Female
  • Health Services / statistics & numerical data*
  • Health Status Disparities*
  • Heterosexuality / psychology
  • Humans
  • Male
  • Risk Factors
  • Sexual Behavior*
  • Sexual and Gender Minorities / psychology
  • Social Support
  • Socioeconomic Factors
  • Sweden