The Intersection of Sexual Orientation and Education Attainment on Self-Rated Health Among Adults over 50

Background and Purpose: Sexual minority identities may bring a higher risk of poor health due to historical and structural oppression, while education attainment has been regarded as a core indicator of socioeconomic position in health research of the older population. Intersectionality suggests that sexual minority older adults may experience unique disparities in self-rated health (SRH) due to their intersecting identities. Limited knowledge exists regarding SRH disparities among older adults based on sexual orientation and education. This study applies an intersectional lens, aiming to examine SRH disparities at the intersection of sexual orientation and education among adults over 50.

Methods: This study examined how sexual orientation was associated with self-rated health by educational attainment among adults over 50. Using data from the 2020 Health and Retirement Study, 166 lesbian, gay, and bisexual (LGB) adults over 50 were matched with heterosexual controls in a 1:3 ratio using propensity score matching. A total of 664 adults over 50 were included in this study. SRH, a variable known to capture both physical and mental well-being, was dichotomized to contrast fair and poor responses with good, very good, and excellent responses. Sexual orientation was categorized as LGB and heterosexual. Educational attainment was coded into two levels: high school (HS) education or less, and more than HS education. Covariates included age, gender, race, employment status, country of birth, poverty, activities of daily living (ADL), and living arrangements. The moderating effect of educational attainment on the association between sexual orientation and SRH was also assessed.

Results: Correlational analysis revealed that there was no significant difference between LGBs (N=166) and heterosexuals (N=498) in educational attainment, while good/very good/excellent SRH was associated with more than HS education (r=0.21, p<.001). Adjusted logistic regression analyses indicated LGB individuals were inclined to rate their health status as good/very good/excellent (Odds ratio (OR)=1.63, 95% Confidence Interval (CI) [0.02-0.97]). However, the association between sexual orientation and SRH depends on educational attainment: LGB individuals with HS education or less were inclined to report good/very good/excellent SRH (OR=2.84, 95% CI [1.39-5.81]), while LGB individuals with more than HS education showed no inclination (OR=1.02, 95% CI [0.55-1.90]).

Conclusions and Implications: Our study underscores the importance of considering the intersection of sexual orientation and education attainment when addressing intersectionality in research aimed at improving the health of LGB older adults. Consistent with existing research findings, LGB older adults and older adults with higher levels of education tend to rate their health as better; however, once the intersection of these two identities was taken into consideration, LGB older adults with higher education attainment did not benefit from their two identities regarding SRH. Identifying intersectional patterns highlights the need for interventions that consider intersectionality to improve the health of specific subgroups within LGB older adults. Future research should investigate the mechanisms behind these associations and explore intersection-sensitive health promotion strategies for LGB older adults.