Temporal Trends in Sexual Identity and Sociodemographic Disparities in Stockholm, Sweden, 2010-2021

Abstract

Objectives. To examine temporal trends in sexual identity and sociodemographic disparities in Sweden after gender-neutral marriage legislation in 2009. Methods. We analyzed 3 cross-sectional surveys from the Stockholm Public Health Cohort (2010, 2014, 2021) that included 76 083 participants 16 years or older. Weighted Poisson regression was used to estimate associations between sexual identity and sociodemographic covariates. Survey weights and multiple imputation addressed sampling design and nonresponse. Results. Bisexual identity doubled between 2010 and 2021, from 2.1% (95% confidence interval [CI] = 1.8%, 2.4%) to 4.3% (95% CI = 3.8%, 4.7%) among females and from 1.0% (95% CI = 0.8%, 1.2%) to 1.9% (95% CI = 1.6%, 2.3%) among males. In 2021, 15.1% (95% CI = 12.5%, 17.7%) of Generation Z (1997-2012) females and 6.9% (95% CI = 5.8%, 8.0%) of Millennials (1981-1996) identified as bisexual; the figures for males were 4.2% (95% CI = 2.8%, 5.7%) and 2.4% (95% CI = 1.7%, 3.1%). Bisexual identity was associated with lower income and never-married status, although the strength of the associations decreased over time. Conclusions. The rise in bisexual identity, particularly among younger generations, likely reflects shifting societal and cultural norms. Income and marital disparities persist but have narrowed. Public Health Implications. Public health should support bisexual individuals as part of broader efforts to promote equity amid evolving norms. (Am J Public Health. 2025;115(12): 2062-2071. https://doi.org/10.2105/AJPH.2025.308202).

FIGURE 1—

Percentages of Homosexual and Bisexual Identities Among (a) Females and (b) Males: Stockholm County, Sweden, 2010–2021 Note. CI = confidence interval. The results were based on multiple imputation analyses incorporating calibrated weights to account for the stratified random sampling design and potential unit nonresponse bias.

FIGURE 2—

Percentages of Homosexual and Bisexual Identities by Age Group Among (a) Females and (b) Males: Stockholm County, Sweden, 2010–2021 Note. CI = confidence interval. The results were based on multiple imputation analyses incorporating calibrated weights to account for the stratified random sampling design and potential unit nonresponse bias. ^aThe minimum age was 18 years in the 2010 survey and 16 years in the 2014 and 2021 surveys.

FIGURE 3—

Percentages of (a) Bisexual Identity and (b) Homosexual Identity by Sex and by Generation: Stockholm County, Sweden, 2010–2021 Note. The results were based on multiple imputation analyses incorporating calibrated weights to account for the stratified random sampling design and potential unit nonresponse bias. ^aNo participants from Generation Z were included in the 2010 survey.

FIGURE 4—

Associations Between Bisexual Identity and Sociodemographic Factors in Stockholm County, Sweden, 2010–2021 Note. CI = confidence interval; PR = proportion ratio; SPHC-B = Stockholm Public Health Cohort baseline survey. Models 1 and 2 were multivariable models with bisexual identity as the outcome and different sets of sociodemographic covariates. The results were based on multiple imputation analyses incorporating calibrated weights to account for the stratified random sampling design and potential unit nonresponse bias. Sociodemographic variables were retrieved from Swedish registry data for each survey year (2010, 2014, and 2021) except that income in the 2021 survey was sourced from 2020 registry data. ^aModel 1 included age, sex, and country of birth. ^bModel 2 included age, sex, country of birth, education, income, and marital status. ^cThe age range was 18–29 years in the 2010 survey and 16–29 years in the 2014 and 2021 surveys. ^dConsumer Price Index adjusted income with 2021 as the reference year in units of 100 Swedish kronor per year. ^e“Currently married” includes same- and opposite-sex marriages and registered partnerships; “other” includes widowed, separated, and divorced.