Sexual orientation differences in allostatic load among adults, age 20-59 years, in the 2001-2010 NHANES

Background: Social disadvantage has been linked to markers of physiological dysregulation, or Allostatic Load (AL). In particular, chronic experiences with discrimination are thought to result in cumulative accumulation of physiological “wear and tear” at the individual level among socially marginalized persons. Objectives: We use information available in the 2001-2010 National Health and Nutrition Examination Survey (NHANES) to investigate whether minority sexual orientation is a risk indicator for higher levels of AL. Methods: The NHANES draws a multistage complex sample of the civilian non-institutionalized population. Both sexual orientation measures and markers of AL are available for individuals, age 20-59 years, in the public dataset. Using multivariate regression methods in gender specific analyses, we examined AL score differences among lesbian/gay (n=211), bisexual (n=307), homosexually experienced (n=424) and exclusively heterosexual (n=13,017) persons, while adjusting for possible confounding due to demographic characteristics, health indicators, and, among men, HIV infection status. Results: Gay men evidenced significantly lower AL, but bisexual men had significantly higher levels of AL as compared to exclusively heterosexual men. No appreciable sexual orientation-related differences were observed among women. These results parallel recent findings that bisexual persons, among sexual minorities, experience the greatest degree of sexual orientation-related health disparities. Conclusions: Our findings suggest that bisexuality, particularly among men, is associated with evidence of physiological dysregulation thought to be driven to some extent by the harmful effects of social marginalization. These findings contribute to accumulating evidence that social marginalization has long term consequences for physical health.