Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
International Journal for Equity in Health
Published in: International Journal for Equity in Health 1/2017

Open Access 01-12-2017 | Research

Embodying pervasive discrimination: a decomposition of sexual orientation inequalities in health in a population-based cross-sectional study in Northern Sweden

Authors: Per E Gustafsson, Ida Linander, Paola A Mosquera

Published in: International Journal for Equity in Health | Issue 1/2017

Login to get access

Abstract

Background

Studies from Sweden and abroad have established health inequalities between heterosexual and non-heterosexual people. Few studies have examined the underpinnings of such sexual orientation inequalities in health. To expand this literature, the present study aimed to employ decomposition analysis to explain health inequalities between people with heterosexual and non-heterosexual orientation in Sweden, a country with an international reputation for heeding the human rights of non-heterosexual people.

Methods

Participants (N = 23,446) came from a population-based cross-sectional survey in the four northernmost counties in Sweden in 2014. Participants completed self-administered questionnaires, covering sexual orientation, mental and general physical health, social conditions and unmet health care needs, and sociodemographic data was retrieved from total population registers. Sexual orientation inequalities in health were decomposed by Blinder-Oaxaca decomposition analysis.

Results

Results showed noticeable mental and general health inequalities between heterosexual and non-heterosexual orientation groups. Health inequalities were partly explained (total explained fraction 64-74%) by inequalities in degrading treatment (24-26% of the explained fraction), but to a considerable degree also by material conditions (38-45%) and unmet care needs (25-43%).

Conclusions

Psychosocial experiences may be insufficient to explain and understand health inequalities by sexual orientation in a reputedly ‘gay-friendly’ setting. Less overt forms of structural discrimination may need to be considered to capture the pervasive material discrimination that seems to underpin the embodiment of sexual minority inequalities. This ought to be taken into consideration in research, policy-making and monitoring aiming to work towards equity in health across sexual orientations.
Literature
1.
Semlyen J, King M, Varney J, Hagger-Johnson G. Sexual orientation and symptoms of common mental disorder or low wellbeing: combined meta-analysis of 12 UK population health surveys. BMC Psychiatry. 2016;16:67.CrossRefPubMedPubMedCentral
2.
Branstrom R, Hatzenbuehler ML, Pachankis JE. Sexual orientation disparities in physical health: age and gender effects in a population-based study. Soc Psychiatry Psychiatr Epidemiol. 2016;51:289–301.CrossRefPubMed
3.
Branstrom R, van der Star A. More knowledge and research concerning the health of lesbian, gay, bisexual and transgender individuals is needed. Eur J Public Health. 2016;26:208–9.CrossRefPubMed
4.
Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychol Bull. 2003;129:674–97.CrossRefPubMedPubMedCentral
5.
van der Star A, Branstrom R. Acceptance of sexual minorities, discrimination, social capital and health and well-being: a cross-European study among members of same-sex and opposite-sex couples. BMC Public Health. 2015;15:812.CrossRefPubMedPubMedCentral
6.
Phelan JC, Link BG, Tehranifar P. Social conditions as fundamental causes of health inequalities: theory, evidence, and policy implications. J Health Soc Behav. 2010;51:S28–40.CrossRefPubMed
7.
Branstrom R, Hatzenbuehler ML, Pachankis JE, Link BG. Sexual orientation disparities in preventable disease: a fundamental cause perspective. Am J Public Health. 2016;106:1109–15.CrossRefPubMed
8.
Krieger N. Theories for social epidemiology in the 21st century: an ecosocial perspective. Int J Epidemiol. 2001;30:668–77.CrossRefPubMed
9.
Krieger N. Epidemiology and the people's health: theory and context. Oxford: Oxford University Press; 2011.CrossRef
10.
Krieger N. Embodying inequality: a review of concepts, measures, and methods for studying health consequences of discrimination. Int J Health Serv. 1999;29:295–352.CrossRefPubMed
11.
12.
Takács J. Homophobia and Genderphobia in the European Union: Policy Contexts and Empirical Evidence. Stockholm: Swedish Institute for European Policy Studies; 2015.
13.
European Commission. Special Eurobarometer 437. Discrimination in the EU in 2015. Brussels: European Union; 2016.
14.
ILGA-Europe. Annual Review of the Human Rights Situation of Lesbian, Gay, Bisexual, Trans and Intersex People in Europe. Brussels: ILGA-Europe; 2016.
15.
Axelsson J, Moden B, Rosvall M, Lindstrom M. Sexual orientation and self-rated health: the role of social capital, offence, threat of violence, and violence. Scand J Public Health. 2013;41:508–15.CrossRefPubMed
16.
Hatzenbuehler ML, Phelan JC, Link BG. Stigma as a Fundamental Cause of Population Health Inequalities. American Journal of Public Health. 2013;103:813–21.CrossRefPubMedPubMedCentral
17.
Blosnich JR, Farmer GW, Lee JGL, Silenzio VMB, Bowen DJ. Health Inequalities Among Sexual Minority Adults Evidence from Ten US States, 2010. Am J Prev Med. 2014;46:337–49.CrossRefPubMedPubMedCentral
18.
Oaxaca R. Male–female wage; differentials in urban labor markets. Int Econ Rev. 1973;14:693–709.CrossRef
19.
Emamian MH, Zeraati H, Majdzadeh R, Shariati M, Hashemi H, Fotouhi A. The gap of visual impairment between economic groups in Shahroud, Iran: a blinder-oaxaca decomposition. Am J Epidemiol. 2011;173:1463–7.CrossRefPubMed
20.
Goldberg DP, Gater R, Sartorius N, Ustun TB, Piccinelli M, Gureje O, Rutter C. The validity of two versions of the GHQ in the WHO study of mental illness in general health care. Psychol Med. 1997;27:191–7.CrossRefPubMed
21.
Lundin A, Hallgren M, Theobald H, Hellgren C, Torgen M. Validity of the 12-item version of the General Health Questionnaire in detecting depression in the general population. Public Health. 2016;136:66–74.CrossRefPubMed
22.
Statistics Sweden: Swedish socioeconomic classification. Reports on statistical co-ordination 1982:4. Stockholm; 1984.
23.
Erikson R, Goldthorpe JH, Portocarero L. Intergenerational class mobility and the convergence thesis: England, France and Sweden. Br J Sociol. 2010;61:185–219.CrossRefPubMed
24.
Owen O’Donnell O, Eddy Van Doorslaer E, Adam Wagstaff A, Magnus Lindelow M. Explaining Differences between Groups: Oaxaca Decomposition. In: Analyzing Health Equity Using Household Survey Data: A Guide to Techniques and Their Implementation. Washington, D.C: The World Bank; 2008.
25.
Jann B. The Blinder-Oaxaca decomposition for linear regression models. Stata Journal. 2008;8:453–79.
26.
O'Donnell OA, Wagstaff A: Analyzing health equity using household survey data: a guide to techniques and their implementation. Washington, D.C.: The World Bank; 2008.
27.
Herek GM, Garnets LD. Sexual orientation and mental health. Annu Rev Clin Psychol. 2007;3:353–75.CrossRefPubMed
28.
Fergusson DM, Horwood LJ, Ridder EM, Beautrais AL. Sexual orientation and mental health in a birth cohort of young adults. Psychol Med. 2005;35:971–81.CrossRefPubMed
29.
Cochran SD. Emerging issues in research on lesbians' and gay men's mental health: does sexual orientation really matter? Am Psychol. 2001;56:931–47.CrossRefPubMed
30.
Jorm AF, Korten AE, Rodgers B, Jacomb PA, Christensen H. Sexual orientation and mental health: results from a community survey of young and middle-aged adults. Br J Psychiatry. 2002;180:423–7.CrossRefPubMed
31.
Fredriksen-Goldsen KI, Kim HJ, Barkan SE, Muraco A, Hoy-Ellis CP. Health disparities among lesbian, gay, and bisexual older adults: results from a population-based study. Am J Public Health. 2013;103:1802–9.CrossRefPubMedPubMedCentral
32.
Sandfort TG, Bakker F, Schellevis FG, Vanwesenbeeck I. Sexual orientation and mental and physical health status: findings from a Dutch population survey. Am J Public Health. 2006;96:1119–25.CrossRefPubMedPubMedCentral
33.
34.
Raphael D. Challenges to promoting health in the modern welfare state: The case of the Nordic nations. Scand J Public Health. 2014;42:7–17.CrossRefPubMed
35.
Barnes DM, Hatzenbuehler ML, Hamilton AD, Keyes KM. Sexual orientation disparities in mental health: the moderating role of educational attainment. Soc Psychiatry Psychiatr Epidemiol. 2014;49:1447–54.CrossRefPubMedPubMedCentral
Metadata
Title
Embodying pervasive discrimination: a decomposition of sexual orientation inequalities in health in a population-based cross-sectional study in Northern Sweden
Authors
Per E Gustafsson
Ida Linander
Paola A Mosquera
Publication date
01-12-2017
Publisher
BioMed Central
Published in
International Journal for Equity in Health / Issue 1/2017
Electronic ISSN: 1475-9276
DOI
https://doi.org/10.1186/s12939-017-0522-1

Other articles of this Issue 1/2017

International Journal for Equity in Health 1/2017 Go to the issue

Research

Examining changes in maternal and child health inequalities in Ethiopia

Research

Up close and real: living and learning in a remote community builds students’ cultural capabilities and understanding of health disparities

Review

The role of health system governance in strengthening the rural health insurance system in China

Research

Factors influencing risky sexual behaviour among Mozambican miners: a socio-epidemiological contribution for HIV prevention framework in Mozambique

Research

Extending access to essential services against constraints: the three-tier health service delivery system in rural China (1949–1980)

Research

The rise and fall of dental therapy in Canada: a policy analysis and assessment of equity of access to oral health care for Inuit and First Nations communities