Consequences of Stigma for Sexual Orientation Disparities in Health-Related Quality of Life: A Prospective Study

Background: Long-term consequences of stigma against sexual minorities for health-related quality of life (HRQL) are unknown. Methods: We used data from 6,194 females and males in the Growing Up Today Study, a prospective cohort of U.S. youth, to examine predictors of sexual orientation disparities in HRQL. In 2013, participants (ages 18-31 years) reported sexual orientation (Completely Heterosexual [CH], Mostly Heterosexual [MH], Bisexual [B], and Lesbian/Gay [LG])). Unlike other studies, we used EQ-5D-5L, a preference-based measure recommended in cost-effectiveness analysis, to assess HRQL (range: 0 [death] to 1 [perfect health]). Participants previously reported past-year bullying victimization (range: 1 [never] to 5 [several times/week]) and self-perceived social standing (range: 1 [top] to 10 [bottom]) in adolescence. Longitudinal, multivariable linear regression models were used to assess the effect of bullying and social standing in adolescence on sexual orientation HRQL score disparities in young adulthood, controlling for gender and age. Results: Compared to CHs, sexual minorities reported more bullying and lower social standing in adolescence and lower HRQL in young adulthood: MH HRQL score=0.880; B 0.845; LG 0.870 vs. CH 0.916 (all p-values<0.05). When bullying and social standing were added to the multivariable models, orientation-group effect estimates were attenuated ~10%, suggesting adolescent bullying and lower social standing partly explained HRQL disparities in young adulthood. Conclusions: Sexual minorities have lower HRQL compared to CHs, which is in part due to past bullying victimization and lower social standing. Importantly, our findings can be used in cost-effectiveness analyses of interventions to reduce stigma against sexual minorities.