Structural Stigma and Disparities in Long-Term Health Conditions Among Australians in Same-Sex Relationships: 2021 Australian Census.

Abstract

<b>Objectives.</b>  To explore the extent to which structural stigma (sociocultural and institutional constraining factors) is associated with sexual orientation disparities in long-term health conditions. <b>Methods.</b>  We measured structural stigma using the regional percentage of votes against same-sex marriage from Australia's 2017 Marriage Equality Survey and mapped this to the 2021 Census survey of 10 093 399 and 136 988 individuals in different-sex and same-sex relationships, respectively. Controlling for individual and area-level confounders, we used logistic regression analyses to examine the association between quartiles of structural stigma and sexual orientation disparities in long-term health conditions (e.g., any, mental health, asthma, cardiovascular). <b>Results.</b>  In the lowest stigma quartile, individuals in same-sex relationships had 56% higher odds of reporting any long-term health condition (odds ratio [OR] = 1.56; 95% confidence interval [CI] = 1.53, 1.59) and this increased to 63% in the highest stigma quartile (OR = 1.63; 95% CI = 1.58, 1.68). Effects were particularly pronounced for cardiovascular, respiratory, and mental health conditions as well as for men, younger populations, and those living in socioeconomically deprived regions. <b>Conclusions.</b>  Living in stigmatizing environments may have deleterious health effects for sexual minorities in Australia. Policy action and enhanced protections for sexual minorities are urgently required. (<i>Am J Public Health</i>. 2024;114(10):1110-1122. https://doi.org/10.2105/AJPH.2024.307759).