Centering Intersectionality in Social Work Research: Insights into Health, Aging, and Sexual and Gender Minority Experiences

Background: Sexual and gender minority (SGM) older adults often occupy multiple socially marginalized positions, which intersect to create unequal lived experiences. Acknowledging these intersections is essential for recognizing how individuals navigate their overlapping identities amidst the manifestations of social power, privilege, and oppression. However, it is noteworthy that existing literature predominantly focuses on SGM-related discrimination and its impact on health outcomes through a narrow lens, primarily concentrating on homophobic bias while neglecting other dimensions of oppression (e.g., racism, ageism, sexism) and individual agency. By utilizing the person-centered approach, this study aims to identify heterogeneous patterns in individuals’ perception of their identities in terms of centrality and as the basis of their discrimination experiences, while also exploring avenues of resistance.

Methods: Utilizing 2015 data from the National Health, Aging, and Sexuality/Gender Study, the first national longitudinal study of SGM older adults in the United States, we conducted a latent class analysis to examine latent population subgroups based on identity centrality and attributions for day-to-day discrimination. Identity centrality was assessed by asking how often respondents thought about themselves as each of the following social identity groups: gender, sexual and gender identity, age, and race and ethnicity. Additionally, respondents attributed perceived day-to-day discrimination to these same social identity groups. We also examined the associations between profile membership, key psychological and social factors, and physical and mental health-related quality of life.

Results: We compared two through seven latent classes to identify the optimal fit. Based on AIC, BIC, and Entropy fit criteria as well as considerations of interpretability, we determined that the four-class model was optimal. Class 1 (High Perceived Intersectionality; 23.5%) exhibited strong identity centrality and discrimination attribution across age, sexual identity, gender, and race/ethnicity. Class 2 (Intersectionality in Privilege; 29.5%) showed high identity centrality for sexual identity, gender, age, and race/ethnicity but minimal discrimination attribution. Class 3 (Gender Identity-Centered Intersectionality; 5.7%) uniquely emphasized centrality for and discrimination attribution to gender identity. Class 4 (Low Perceived Intersectionality; 42%) had uniformly low probabilities for identity centrality and discrimination attribution. Those with High Perceived Intersectionality and Gender Identity-Centered Intersectionality exhibited lower physical and mental HRQOL compared to other classes and were associated with being women, people of color, lower income, more discrimination, and higher critical consciousness. Those with Intersectionality in Privilege and Low Perceived Intersectionality had the highest health-related quality of life and appeared to be associated with non-Hispanic Whites, lower discrimination, lower identity stigma, and lower critical consciousness.

Conclusions and Implications: This study highlights the significance of incorporating an intersectional lens to better understand the distinct needs and strengths within SGM aging communities. Understanding the heterogeneous nature of group membership, particularly the heightened health disparities among those with high perceived intersectionality and gender identity-centered intersectionality can inform tailored interventions that address interlocking social identities within power structures and individual agency in defining one’s identity centrality. Future translational research should prioritize identifying modifiable social and psychological factors and fostering actionable strategies that can mitigate health inequities for multiply marginalized SGM older adults.