Intersectional health disparities among U.S. midlife and older adults focusing on sexual orientation and race and ethnicity: Evidence from a population-based study.

Older adults with sexual minority and racial/ethnic minority statuses are posited to face heightened health disadvantages due to multiple marginalizations. Yet, there remains a dearth of empirical evidence. We examined health disparities among Hispanic, Black, Asian, and additional sexual minorities of color aged 50 and older in the U.S. Using the 2013-2023 National Health Interview Survey data stratified by gender, we estimated joint disparities with adjusted risk differences (RDs) in 25 health indicators between sexual minorities of color and non-Hispanic White heterosexuals and tested for synergistic effects, that is, whether excess intersectional disparities contribute to health risks beyond the sum of disparities from single marginalizations. Among men, joint disparities driven by synergistic effects were observed in asthma (RD: 6.1 percentage points [pp], 95 % CI: 0.0-12.2) for Hispanic sexual minorities; cognitive (12.7 pp, 3.0-22.4) and vision impairment (3.4 pp, 3.7-23.1) for Black sexual minorities; and poor general health (21.9 pp, 8.1-35.7), feelings of anxiety (28.8 pp, 12.8-44.9) and depression (24.5 pp, 8.4-40.5), limited physical functioning (15.1 pp, 3.2-26.9), and physical inactivity (19.4 pp, 1.1-37.7) for additional sexual minorities of color. Among women, joint disparities in flu non-vaccination (10.0 pp, 1.9-18.1) for Black sexual minorities and cardiovascular disease (15.5 pp, 5.5-25.6) and former smoking (21.2 pp, 5.4-37.0) for additional sexual minorities of color were driven by synergistic effects. Inverse disparities were observed among Asian and Hispanic sexual minority women. The synergistic multiple disadvantage hypothesis was partially supported. Public health policy should prioritize initiatives to support intersectional health research that identifies modifiable mechanisms.