Abstract
BackgroundStudies 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.MethodsParticipants (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.ResultsResults 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%).ConclusionsPsychosocial 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.
Highlights
Studies from Sweden and abroad have established health inequalities between heterosexual and non-heterosexual people
From the point of departure of the more general ecosocial theory [8], minority stress and fundamental cause theories could jointly be framed as an expression of embodiment [9, 10]; the process whereby structural social inequalities through multiple pathways become differentially embodied in health in LGBQ and heterosexual people, thereby creating and upholding sexual orientation health inequalities in the population
People with a LGBQ orientation reported worse mental health and general health complaints compared to the heterosexual group, demonstrating sexual orientation-based inequalities in self-assessed health
Summary
Studies from Sweden and abroad have established health inequalities between heterosexual and non-heterosexual people. From the point of departure of the more general ecosocial theory [8], minority stress and fundamental cause theories could jointly be framed as an expression of embodiment [9, 10]; the process whereby structural social inequalities (e.g., unequal distribution of power and resources based on sexual orientation) through multiple pathways (e.g., discriminatory experiences) become differentially embodied in health in LGBQ and heterosexual people, thereby creating and upholding sexual orientation health inequalities in the population. Sweden in the mid2010s may represent an internationally interesting setting undergoing a transition from a leading to a moderate position in terms of ‘gay-friendliness’ This development would be expected to impact on sexual orientation inequalities
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