Abstract Body (Do not enter title and authors here): Introduction: Discriminatory policies are associated with worse mental health and substance use outcomes among sexual minority adults. Despite a higher risk of cardiovascular disease (CVD) than heterosexual adults, there is limited evidence on structural determinants of cardiovascular health among sexual minority adults. Therefore, we examined whether changes in sexual orientation-related nondiscrimination laws were associated with 30-year CVD risk among sexual minority and heterosexual adults.
Hypothesis: We hypothesized that changes in sexual orientation-related nondiscrimination laws would be more strongly associated with 30-year CVD risk among sexual minority adults relative to exclusively heterosexual adults.
Methods: We used longitudinal data from Waves III (2001-2002), IV (2008-2009), and V (2016-2018) of the National Longitudinal Study of Adolescent to Adult Health. We assessed changes in four state-level sexual orientation-related nondiscrimination laws (i.e., employment discrimination, same-sex marriage, hate crime statutes, and same-sex adoption) between Waves III and IV. Changes in sexual orientation-related nondiscrimination laws were categorized as unchanged (reference), improved, or worsened. We assessed 30-year CVD risk using the Framingham Risk Score at Wave V. We ran sex-stratified linear regression models adjusted for demographic factors to examine whether the association between change in nondiscrimination laws with 30-year CVD risk was moderated by sexual orientation (i.e., exclusively heterosexual, mostly heterosexual, homosexual/bisexual).
Results: The sample included 3,827 participants with a mean age of 28.7 (±1.75) years, of whom 83.1% identified as exclusively heterosexual, 51% as female, and 15% as Black. Compared to heterosexual participants of the same sex, an improvement in nondiscrimination laws was associated with lower 30-year CVD risk among mostly heterosexual women (B -4.57, 95% CI = -8.06, -1.08) and homosexual/bisexual men (B -10.91, 95% CI = -19.33, -2.49). In contrast, compared to exclusively heterosexual women, a worsening of nondiscrimination laws was associated with higher 30-year CVD risk among homosexual/bisexual women (B 5.26, 95% CI = 0.30, 10.21). No differences were found between mostly heterosexual and exclusively heterosexual men.
Conclusions: Findings suggest that efforts to enhance policies prohibiting sexual orientation-related discrimination may significantly reduce CVD risk among sexual minority adults.