Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
Department of Sociology, Rice University, 6100 Main Street, Houston, TX, 77251, USA.
Demography. 2020 Apr;57(2):599-626. doi: 10.1007/s13524-020-00857-9.
A substantial body of work has demonstrated the importance of marital status for health, yet the vast majority of this work has studied heterosexual marriages and relationships. To understand the role of marital status in shaping health among heterosexual, lesbian, gay, and bisexual men and women, we examine data from a probability-based sample of adults living in 40 U.S. states for selected years between 2011-2015. We test two physical health outcomes-poor-to-fair self-rated health and cardiovascular disease-and present predicted probabilities and pairwise comparisons from logistic regression models before and after adjustment for demographic characteristics, socioeconomic status, health behaviors, and depression. Overall, findings reveal some important similarities and differences in the relationships between marital status and health by sexual orientation and gender. First, the health benefits of marriage extend to sexual minority adults, relative to adults who are either formerly or never married. Among heterosexual adults, adjusted models also highlight the healthy status of never-married adults. Second, the health benefits associated with intimate relationships appear less dependent on legal marriage among sexual minorities than among heterosexual adults. Third, we document a persistent health disadvantage for bisexual adults compared with heterosexual adults, particularly among women who are formerly married, indicating some elevated health vulnerability among selected sexual minority women. Fourth, associations between sexual orientation and health are more similar across marital status groups for men than women. Altogether, these findings add much needed nuance to our understanding of the association between marital status and health in an era of increasing diversity in adult relationships.
大量研究表明，婚姻状况对健康很重要，但绝大多数此类研究都集中在异性婚姻和关系上。为了了解婚姻状况在塑造异性恋、同性恋、双性恋和跨性别男性和女性健康方面的作用，我们分析了 2011 年至 2015 年间美国 40 个州基于概率的成年人样本数据。我们测试了两个身体健康结果，即自评健康状况差或一般和心血管疾病，并呈现了逻辑回归模型调整人口统计学特征、社会经济地位、健康行为和抑郁因素前后的预测概率和两两比较。总体而言，研究结果揭示了婚姻状况与性取向和性别之间健康关系的一些重要相似和不同之处。首先，婚姻对性少数成年人的健康有益，相对于离异或从未结婚的成年人。对于异性恋成年人，调整后的模型也突出了从未结婚成年人的健康状况。其次，与异性恋成年人相比，性少数群体中与亲密关系相关的健康益处似乎较少依赖于合法婚姻。第三，我们记录了双性恋成年人与异性恋成年人相比，存在持续的健康劣势，尤其是离异的女性，这表明一些特定的性少数女性存在更高的健康脆弱性。第四，性取向与健康之间的关联在婚姻状况群体中对男性的相似性大于女性。总之，这些发现为我们理解在成年人关系日益多样化的时代，婚姻状况与健康之间的关联提供了急需的细微差别。
