Division of Epidemiology, School of Public Health, University of California Berkeley, Berkeley, California.
Division of Epidemiology, School of Public Health, University of California Berkeley, Berkeley, California.
Am J Prev Med. 2018 Sep;55(3):281-289. doi: 10.1016/j.amepre.2018.04.037.
It is well established that socially marginalized groups experience worse health than dominant groups. However, many questions remain about the health of members of multiple marginalized groups, such as black sexual minority women. The purpose of this study was to examine the relationship between health-related quality of life (HRQOL), race, and sexual orientation identity among a general population sample of black and white women and to assess additive interaction between sexual orientation identity and race.
This study used cross-sectional 2014 and 2015 Behavioral Risk Factor Surveillance System data from 154,995 women residing in 20 U.S. states. G-computation was used to estimate age-adjusted prevalence differences for nine dichotomized measures of HRQOL. The HRQOL of black sexual minority women was compared with the HRQOL of black heterosexual women, white sexual minority women, and white heterosexual women. Analyses were conducted in 2017.
Age-adjusted prevalence differences for all measures suggested worse HRQOL among black sexual minority women, compared with most of the other groups (e.g., frequent poor mental health comparing black lesbian and heterosexual women: 0.083, 95% CI= -0.017, 0.183); HRQOL among black bisexual women was often similar to or worse than white bisexual women. Most prevalence differences comparing black sexual minority women with white heterosexual women suggested additive interaction that led to stronger or weaker associations than expected. Although many point estimates suggested meaningful differences, many 95% CIs for prevalence differences, and when assessing for interaction, included 0.
Having two marginalized identities compared with one is often associated with worse HRQOL. In addition, race and sexual orientation identity may interact in their relationship to HRQOL, such that black sexual minority women have worse or better HRQOL than expected.
社会边缘化群体的健康状况比主导群体差，这一点已得到充分证实。然而，关于多个边缘化群体成员的健康状况，例如黑人性少数女性，仍有许多问题尚未得到解答。本研究旨在检验黑人和白人女性总体样本中健康相关生活质量（HRQOL）、种族和性取向认同之间的关系，并评估性取向认同与种族之间的附加交互作用。
本研究使用了来自美国 20 个州的 154995 名女性的 2014 年和 2015 年行为风险因素监测系统的横断面数据。使用 G 计算来估计九个二分 HRQOL 测量指标的年龄调整后患病率差异。比较了黑人女同性恋者与黑人异性恋女性、白人女同性恋者和白人异性恋女性的 HRQOL。分析于 2017 年进行。
所有措施的年龄调整后患病率差异表明，与大多数其他群体相比，黑人女同性恋者的 HRQOL 较差（例如，黑人女同性恋者和异性恋女性相比，经常出现较差的心理健康：0.083，95%CI=-0.017，0.183）；黑人双性恋女性的 HRQOL 通常与或差于白人双性恋女性。比较黑人女同性恋者与白人异性恋女性的大多数患病率差异表明存在附加交互作用，导致关联比预期更强或更弱。虽然许多点估计表明存在有意义的差异，但许多患病率差异的 95%CI 以及在评估交互作用时，包括 0。
与一个边缘化身份相比，拥有两个边缘化身份通常与较差的 HRQOL 相关。此外，种族和性取向认同可能在其与 HRQOL 的关系中相互作用，例如，黑人女同性恋者的 HRQOL 比预期的好或差。
