This study examines whether health disparities between same-sex and different-sex cohabitors differ depending on socioeconomic status (SES). Previous research showed that SES mediates health disparities between different-sex and same-sex cohabitors, but less is known about its role as a potential moderator. Using data on cohabitors from the Integrated Public Use Microdata Series (IPUMS) National Health Interview Surveys (2007–2018), this study examines how the SES-health gradient shapes health disparities for same-sex and different-sex cohabitors. Average adjusted predictions from multinomial logistic regression models show that higher income-to-needs ratio is associated with improvements in self-rated health for same-sex cohabiting women relative to different-sex cohabiting women. However, results are mixed for men. As income-to-needs ratio increases, same-sex cohabiting men have higher probabilities of “excellent” or “very good” health than different-sex cohabitors; however, their risk of “poor” health increases significantly with higher income-to-needs ratios. Potential explanations related to minority stress, stress proliferation, gendered meanings of self-rated health, and selection are explored. Overall, disparities between same-sex and different-sex cohabitors differ by gender and SES, suggesting socioeconomic diversity should be considered in the study of sexual minority health.
AnderssonGunnarNoackTuridSeierstadAneWeedon-FekjærHarald. 2006. “The Demographics of Same-sex Marriage in Norway and Sweden.” Demography43:79–98.
2.
BadgettM. V. Lee. 2018. “Left Out? Lesbian, Gay, and Bisexual Poverty in the US.” Population Research and Policy Review37:667–702.
3.
BarrettDonald C.2000. “Masculinity Among Working-Class Gay Males.” Pp. 176–205 in Gay Masculinities, edited by NardiP.Thousand Oaks, CA: Sage.
4.
BarrettDonald C.PollackLance M.2005. “Whose Gay Community? Social Class, Sexual Self-expression, and Gay Community Involvement.” The Sociological Quarterly46:437–56.
5.
BlackDanGatesGarySandersSethTaylorLowell. 2000. “Demographics of the Gay and Lesbian Population in the United States: Evidence from Available Systemic Data Sources.” Demography37(2):139–54.
6.
BlackDanSandersSeth G.TaylorLowell J.2007. “The Economics of Lesbian and Gay Families.” Journal of Economic Perspectives21(2):53–70.
7.
BlewettLynn A.DrewJulia A. RiveraGriffinRisaKingMiriam L.WilliamsKari C.2019. IPUMS Health Surveys: National Health Interview Survey, Version 6.3 [Dataset]. Minneapolis, MN: IPUMS. doi:10.18128/D070.V6.3.
8.
BoehmerUlrikeMiaoXiaopengLinkletterCrystalClarkMelissa A.2012. “Adult Health Behaviors over the Life Course by Sexual Orientation.” American Journal of Public Health102:292–300.
9.
CarrDeborahSpringerKristen W.2010. “Advances in Families and Health Research in the 21st Century.” Journal of Marriage and Family72:743–61.
10.
CherlinAndrew J.2004. “The Deinstitutionalization of American Marriage.” Journal of Marriage and Family66:848–61.
11.
CherlinAndrew J.2013. “Health, Marriage, and Same-sex Partnerships.” Journal of Health and Social Behavior54:64–66.
12.
ConnellR. W.2005. Masculinities. 2nd ed.Oakland, CA: University of California Press.
13.
ConronKerith J.MimiagaMatthew J.LandersStewart J.2010. “A Population-based Study of Sexual Orientation Identity and Gender Differences in Health.” American Journal of Public Health100:1953–60.
14.
CourtenayWill H. 2000. “Constructions of Masculinity and Their Influence on Men’s Well-being: A Theory of Gender and Health.” Social Science and Medicine50:1385–401.
15.
de JongValentijn M. T.EijkemansMarinus J. C.van CalsterBenTimmermanDirkMoonsKarel G. M.SteyerbergEwout W.van SmedenMaarten. 2019. “Sample Size Considerations and Predictive Performance of Multinomial Logistic Prediction Models.” Statistics in Medicine38:1601–19.
16.
DenneyJustin K.GormanBridget K.BarreraCristina B.2013. “Families, Resources, and Adult Health: Where Do Sexual Minorities Fit?” Journal of Health and Social Behavior54:46–63.
17.
DuncanGreg J.DalyMary C.McDonoughPeggyWilliamsDavid R.2002. “Optimal Indicators of Socioeconomic Status in Health Research.” American Journal of Public Health92:1151–57.
18.
EdinKathrynKefalasMaria. 2004. Promises I Can Keep: Why Poor Women Put Motherhood before Marriage. Oakland, CA: University of California Press.
19.
GrollmanEric Anthony. 2014. “Multiple Disadvantaged Statuses and Health: The Role of Multiple Forms of Discrimination.” Journal of Health and Social Behavior55:3–19.
20.
HatzenbuehlerMark L.LinkBruce G.PhelanJo C.2013. “Stigma as a Fundamental Cause of Population Health Inequality.” American Journal of Public Health103:813–21.
21.
HomanPatricia. 2019. “Structural Sexism and Health in the United States: A New Perspective on Health Inequality and the Gender System.” American Sociological Review84:486–516.
22.
IdlerEllen L.BenyaminiYael. 1997. “Self-Rated Health and Mortality: A Review of Twenty-seven Community Studies.” Journal of Health and Social Behavior38:21–37.
23.
Institute of Medicine. 2011. The Health of Lesbian, Gay, Bisexual, and Transgender People. Washington, DC: The National Academies Press.
LauHolningStrohmCharles Q.2011. “The Effects of Legally Recognizing Same-sex Unions on Health and Well-Being.” Law and Inequality: A Journal of Theory and Practice29:107–48.
26.
LeblancAllen J.FrostDavid M.WightRichard G.2015. “Minority Stress and Stress Proliferation among Same-sex and Other Marginalized Couples.” Journal of Marriage and Family77:40–59.
27.
LinkBruce G.PhelanJo C.1995. “Social Conditions as Fundamental Causes of Disease.” Journal of Health and Social Behavior35:80–94.
28.
LiuHuiReczekCorinneBrownDustin. 2013. “Same-sex Cohabitors and Health: The Role of Race-ethnicity, Gender, and Social Status.” Journal of Health and Social Behavior54:25–45.
29.
LongJ. ScottFreeseJeremy. 2014. Regression Models for Categorical Dependent Variables Using Stata. 3rd ed.College Station, TX: Stata Press.
30.
ManningWendy D.SmockPamela. 2005. “Measuring and Modeling Cohabitation: New Perspectives from Qualitative Data.” Journal of Marriage and Family67:315–27.
31.
ManorOrlyMatthewsSharonPowerChris. 2000. “Dichotomous or Categorical Response? Analyzing Self-rated Health and Lifetime Social Class.” International Journal of Epidemiology29:149–57.
32.
MarmotMichael. 2004. The Status Syndrome. New York: Holt Publishers.
33.
MarmotMichael. 2015. The Health Gap. New York: Bloomsbury Press.
34.
McLoydVonnie C.1998. “Socioeconomic Disadvantage and Child Development.” American Psychologist53:185–204.
35.
MeyerIlan H.2003. “Prejudice, Social Stress, and Mental Health in Lesbian, Gay, and Bisexual Populations: Conceptual Issues and Research Evidence.” Psychological Bulletin129:674–97.
36.
MizeTrenton D.2019. “Best Practices for Estimating, Interpreting, and Presenting Nonlinear Interaction Effects.” Sociological Science6:81–117.
37.
NardiPeter. 2000. “‘Anything for a Sis, Mary’: An Introduction to Gay Masculinities.” Pp. 1–11 in Gay Masculinities, edited by NardiP.Thousand Oaks, CA: Sage.
38.
National Center for Health Statistics. 2015. Changes to Data Editing Procedures and the Impact on Identifying Same-sex Married Couples in the 2004-2007 National Health Interview Surveys. Washington, DC: Division of Health Statistics, National Center for Health Statistics, Centers for Disease Control, U.S. Department of Health and Human Services.
39.
National Center for Health Statistics. 2018. About the National Health Interview Survey. Washington, DC: National Center for Health Statistics, Centers for Disease Control, U.S. Department of Health and Human Services. Retrieved November 1, 2018 (https://www.cdc.gov/nchs/nhis/about_nhis.htm).
40.
PearlinLeonard I.SchiemanScottFazioElena M.MeersmanStephen C.2005. “Stress, Health, and the Life Course: Some Conceptual Perspectives.” Journal of Health and Social Behavior45(2):205–19.
41.
PhelanJo C.LinkBruce G.TehranifarParisa. 2010. “Social Conditions as Fundamental Causes of Health Inequalities: Theory, Evidence, and Policy Implications.” Journal of Health and Social Behavior51:S28–40. doi:10.1177/0022146510383498.
42.
PlattLisa F.WolfJulia K.ScheitleChristopher P.2018. “Patterns of Mental Health Care Utilization among Sexual Orientation Minority Groups.” Journal of Homosexuality65:135–53.
43.
ReczekCorinneElliottSinnikkaUmbersonDebra. 2009. “Commitment without Marriage: Union Formation Among Long-Term Same-sex Couples.” Journal of Family Issues30:738–56.
44.
ReczekCorinneLiuHuiSpikerRussell. 2017. “Self-rated Health at the Intersection of Sexual Identity and Union Status.” Social Science Research63:242–52.
45.
RossCatherine E.MirowskyJohn. 2013. “Theory and Modeling in the Study of Intimate Relationships and Health.” Journal of Health and Social Behavior54:67–71. doi:10.1177/0022146512474431.
46.
SasslerSharonMillerAmanda J.2011. “Class Differences in Cohabitation.” Journal of Family Relations60:163–77.
47.
SmockPamela J.2004. “The Wax and Wane of Marriage: Prospects for Marriage in the 21st Century.” Journal of Marriage and Family66:966–73.
48.
SpringerKristen W.HankivskyOlenaBatesLisa M.2012. “Gender and Health: Relational, Intersectional, and Biosocial Approaches.” Social Science & Medicine74:1661–66.
49.
StataCorp. 2017. Stata 15 User’s Guide. College Station, TX: StataCorp.
50.
UmbersonDebraDonnellyRachelPollittAmanda M.2018. “Marriage, Social Control, and Health Behavior: A Dyadic Analysis of Same-sex and Different-sex Couples.” Journal of Health and Social Behavior59:429–46.
51.
UmbersonDebraThomeerMieke BethReczekCorinneDonnellyRachel. 2016. “Physical Illness in Gay, Lesbian, and Heterosexual Couples: Gendered Dyadic Experiences.” Journal of Health and Social Behavior57:517–31.
WagnerBrandon. 2019. “Health Status and Transitions in Cohabiting Relationships of American Young Adults.” Journal of Marriage and Family81:847–62.
54.
WaiteLinda J.1995. “Does Marriage Matter?” Demography32:483–507.
55.
WestCandaceZimmermanDon H.2009. “Accounting for Doing Gender.” Gender & Society23:112–22.
56.
ZajacovaAnnaHuzurbazarSnehalataToddMegan. 2017. “Gender and the Structure of Self-rated health Across the Life Course.” Social Science & Medicine187:58–66.
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