Abstract P172: Potential Contribution of Social Factors in Reducing Population Disparities in Cardioprotective Health Behavior Between Bisexual, Gay/Lesbian, and Straight Adults

Abstract

Background: Studies have demonstrated disparities in cardioprotective behavior by sexual orientation. Social factors have been associated with individual outcomes, but their impact on population disparities is unclear. We assessed if hypothetically intervening on social factors may reduce health behavior disparities by sexual orientation. Methods: We analyzed the intake survey data from the 2015-2023 Kaiser Permanente Research Bank. We compared unadjusted and demographics-standardized prevalence of selected health behaviors by sexual orientation (gay/lesbian or bisexual (LGB) vs straight adults (reference)). We then assessed the potential impact of hypothetically intervening on a single social factor (neighborhood safety, discrimination, education, income) on population disparities using a gap-closing estimand approach (i.e., modified inverse propensity weighting with g-computation). Results: We included 166,479 adults (mean age = 59 years), with 4.5% (7,476) gay/lesbian and 3% (4,936) bisexual. A higher proportion of LGB adults had documented current smoking, binge drinking, and low fruit intake compared to straight adults. Also, a higher proportion of bisexual adults had a high fast-food diet and inadequate sleep. Standardized prevalence of smoking, binge drinking, and inadequate sleep (bi only) remained higher in LGB adults. In gap-closing analysis, no change in gay/lesbian-straight disparities were observed. Reduction in bi-straight disparities in smoking (-2.5%, 95%CI: -3.5, -1.7) and sleep (-2.4%, 95%CI: -3.6, -1.1) may occur with higher college education rates. The sleep disparity (-2.4, 95%CI: -4.0, -0.93) may also decrease by reducing discrimination rates. None of the factors reduced the binge drinking disparity. (Table) Conclusion: LGB adults had higher prevalence of smoking, drinking, and inadequate sleep (bi only). Addressing single factors could reduce some LGB health behavior disparities but multi-factor interventions may be necessary to attain equity across orientations.