Sexual orientation measurement and chronic disease disparities: National Health and Nutrition Examination Survey, 2009-2014

Ann Epidemiol. 2018 Feb;28(2):72-85. doi: 10.1016/j.annepidem.2017.12.001. Epub 2017 Dec 8.


Purpose: To examine chronic disease disparities by sexual orientation measurement among sexual minorities.

Methods: We pooled data from the 2009-2014 National Health and Nutrition Examination Survey to examine differences in chronic disease prevalence between heterosexual and sexual minority people as defined by sexual identity, lifetime sexual behavior, 12-month sexual behavior, and concordance of lifetime sexual behavior and sexual identity.

Results: Self-identified lesbian women reported greater odds of asthma (adjusted odds ratio [aOR], 3.19; 95% confidence intervals [CI], 1.37-7.47) and chronic bronchitis (aOR, 2.64; 95% CI, 1.21-5.72) than self-identified heterosexual women. Self-identified sexual minority women with a history of same-sex sexual behavior reported greater odds of arthritis (aOR, 1.67; 95% CI, 1.02-2.74). Compared with heterosexual men, gay men reported greater odds of chronic bronchitis when sexual orientation was defined by sexual identity (aOR, 4.68; 95% CI, 1.90-11.56) or 12-month sexual behavior (aOR, 3.22; 95% CI, 1.27-8.20), as did bisexual men defined by lifetime sexual behavior (aOR, 2.36; 95% CI, 1.14-4.89). Bisexual men reported greater odds of asthma when measured by lifetime sexual behavior (aOR, 1.90; 95% CI, 1.12-3.19), as did self-identified heterosexual men with a history of same-sex sexual behavior (aOR, 2.21; 95% CI, 1.10-4.46).

Conclusions: How we define sexual orientation influences our understanding of chronic disease prevalence. Capturing subgroups of sexual minority people in health surveillance is essential for identifying groups most at risk and developing targeted interventions to reduce chronic disease disparities.

Keywords: Chronic disease; Health status disparities; Health surveys; Minority health; Sexual minorities.

MeSH terms

  • Adult
  • Bisexuality / statistics & numerical data*
  • Chronic Disease / epidemiology*
  • Female
  • Health Status Disparities*
  • Health Surveys
  • Heterosexuality / statistics & numerical data*
  • Homosexuality, Female / statistics & numerical data*
  • Homosexuality, Male / statistics & numerical data*
  • Humans
  • Male
  • Middle Aged
  • Minority Health
  • Prevalence
  • Sexual Behavior / statistics & numerical data*
  • Surveys and Questionnaires