Structural stigma and sexual orientation disparities in health: Evidence from the Australian Census

Melbourne Institute Working Paper No. 14/23

Date: November 2023

Author(s):

Karinna Saxby
Yuting Zhang
Zoe Aitken

Abstract

Objectives: To explore the extent to which structural stigma (sociocultural and institutional constraining factors) is associated with sexual orientation disparities in long-term health conditions.

Methods: Structural stigma was measured using the regional percentage of votes against same-sex marriage from Australia’s Marriage Equality Survey and mapped 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, logistic regression analyses were used 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).

Results: In the lowest stigma quartile, individuals in same-sex relationships had 68% higher odds of reporting a long-term health condition (OR 1.68, 95%CI 1.65-1.71) and this increased to 82% in the highest stigma quartile (OR 1.82, 95%CI 1.77-1.88). Trends were more pronounced for mental health conditions and asthma as well as for males and younger populations.

Conclusions: Living in stigmatising environments may have deleterious health effects for LGBTIQ+ Australians. Policy action and enhanced protections for LGBTIQ+ Australians are urgently required.

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