Disparities in substance use behaviors and disorders among adult sexual minorities by age, gender, and sexual identity

Abstract

Background: Sexual minorities (SMs) experience elevated rates of substance use behaviors and disorders relative to heterosexuals; minority stress is theorized to contribute to these disparities. As SMs are not a homogenous group, analyses that aggregate SMs across sexual identity, age, or gender obscure important variation among this population. To date, age- and gender-specific disparities have not been rigorously examined using a large national sample.

Methods: Using data on 67,354 adults (ages 18-49) from the 2015 and 2016 National Survey of Drug Use and Health we examined age- and gender-specific disparities in smoking, heavy episodic drinking, marijuana use, illicit drug use, and alcohol/substance use disorder. Age groups were ages 18-25, 26-34, and 35-49. Using logistic regression, we estimated age- and gender-specific odds ratios for gay/lesbian and bisexual individuals, relative to heterosexuals; analyses adjusted for demographic characteristics.

Results: Bisexual women had significantly elevated odds of all outcomes at all ages, relative to heterosexual women. Gay/lesbian individuals had significantly elevated odds for nearly all outcomes compared to same-gender heterosexuals at ages 18-25, but not consistently at older ages. For bisexual men, significant disparities compared to heterosexual men were only observed at ages 35-49 for marijuana use and alcohol/substance use disorder.

Conclusions: We found notable within-group differences regarding SM disparities. While disparities were most pronounced in young adulthood for gay/lesbian individuals and mid-adulthood for bisexual men, bisexual women uniquely experienced disparities across all ages. Minority stress experiences may vary with respect to gender, age/cohort, and sexual identity, resulting in differential risk for substance use.

Keywords: Disparities; LGB; Sexual minorities; Substance use; Substance use disorders.

Figure 1.. Adjusted odds ratios estimates of sexual minority disparities in substance use outcomes among 2015–2016 NSDUH participants ages 18–49, relative to same-age and same-gender heterosexual peers (n=67,354).

Note: Reference group is same-age and same-gender heterosexuals (ref OR=1.0, denoted by horizontal axis). Adjusted regression models included: race/ethnicity, education level, urbanicity, employment status, household income, health insurance status, overall self-reported health, marital status, household size, and number of respondent’s children under 18 years old living in household. Odds ratio estimates are weighted to account for NSDUH survey design.