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Sexual Orientation Identity and Its Implication in the Disparities in Psychological Health-Related Quality of Life

Purpose: To examine disparities in psychological health-related quality of life (HRQoL) among sexual minority women within racial/ethnic subgroups. Design: A secondary analysis of the 2018 Behavioral Risk Factor Surveillance Survey (BRFSS). Setting: United States. Subjects: Noninstitutionalized, cisgender, adult women in the U.S (unweighted n = 81,947). Measures: Socioeconomics, health behaviors, and healthcare access as risk factors, whereas 1 item measures psychological HRQoL as an outcome. Analysis: Weighted multivariable logistic regressions to estimate the odds of having adversely psychological HRQoL in relation to sexual orientation and other correlates within a racial/ethnic subgroup independently. Results: The prevalence of adverse psychological HRQoL was greater in bisexual and “other” sexual orientation women. Both bisexual (adjusted odds ratio [aOR] = 1.58; 95% confidence interval [CI] = 1.26-2.00) and “other” sexual orientation (Aor = 1.93; 95%CI = 1.26-2.96) had greater adjusted odds of adversely psychological HRQoLcompared to their heterosexual peers in non-Hispanic White women. Bisexual women (aOR = 3.42; 95%CI = 1.98-5.88) had greater adjusted odds of adversely psychological HRQoLcompared to their heterosexual peers in Latinas. No similar pattern was observed in non-Hispanic Black women. Conclusion: Disparities in psychological HRQoL varied by sexual orientation identities within different racial/ethnic subgroups. The magnitude of the association for Latina bisexual women was strong. Implications for bisexual health among people with intersecting identities are discussed.