Abstract
Sexual minority (SM) adults (those who are lesbian, gay, or bisexual) consistently report more health problems compared to heterosexuals, and they tend to experience excess social stress. Although numerous studies have established links between social stress and clinical outcomes in SM adults, few studies have examined biological factors that may help explain how social stress leads to health disparities among SM adults. We used data from the Midlife in the United States Study (MIDUS) to examine whether two inflammatory markers that have been commonly associated with social stress—C-reactive protein (CRP) and interleukin-6 (IL-6)—differed by sexual orientation and whether any differences were explained by perceptions of discrimination. Participants self-identified as heterosexual (n = 1956) or lesbian, gay, or bisexual (n = 81). After controlling for age, gender, race, and education, SM individuals had higher CRP and IL-6 than heterosexuals on average and these differences were partially explained by perceptions of discrimination. Implications for inflammatory pathways as mechanisms related to SM health disparities and discrimination are discussed.
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Notes
Smoking was assessed with the question, “Have you ever smoked cigarettes regularly—that is, at least a few cigarettes every day?”, coded as [0] no, [1] yes. Statin medication use was assessed with the question, “Are you taking cholesterol-lowering medication?”, coded as [0] no, [1] yes. Number of chronic conditions was assessed with the question, “Have you ever had any of the following conditions?: heart disease, high blood pressure, circulation problems, blood clots, heart murmur, TIA or stroke, anemia or other blood disease, cholesterol problems, diabetes, asthma, emphysema/COPD, tuberculosis, positive TB skin test, thyroid disease, peptic ulcer disease, cancer, colon polyp, arthritis, glaucoma, cirrhosis or liver disease, alcoholism, depression, blood transfusion, coded as [0] no, [1] yes and summed.
References
Bennett, J. M., Fagundes, C. P., & Kiecolt-Glaser, J. K. (2013). The chronic stress of caregiving accelerates the natural aging of the immune system. In J. A. Bosch, A. C. Phillips, & J. M. Lord (Eds.), Immunosenescence: Psychosocial and behavioral determinants (pp. 35–46). New York, NY: Springer.
Black, P. H. (2003). The inflammatory response is an integral part of the stress response: Implications for atherosclerosis, insulin resistance, type II diabetes and metabolic syndrome X. Brain, Behavior, and Immunity, 17, 350–364.
Bostwick, W. B., Hughes, T. L., & Everett, B. (2015). Health behavior, status, and outcomes among a community-based sample of lesbian and bisexual women. LGBT Health, 2, 121–126. https://doi.org/10.1089/lgbt.2014.0074
Brim, O. G., Ryff, C. D., & Kessler, R. C. (2004). How healthy are we? A national study of well-being at midlife. Chicago, IL: University of Chicago Press.
Chen, Q., Nian, H., Zhu, Y., Talbot, H. K., Griffin, M. R., & Harrell, F. E., Jr. (2016). Too many covariates and too few cases? A comparative study. Statistics in Medicine, 35, 4546–4558. https://doi.org/10.1002/sim.7021
Chiang, J. J., Park, H., Almeida, D. M., Bower, J. E., Cole, S. W., Irwin, M. R., et al. (2019). Psychosocial stress and c-reactive protein from mid-adolescence to young adulthood. Health Psychology, 38, 259–267. https://doi.org/10.1037/hea0000701
Chrisler, J., & Palatino, B. (2016). Ageism can be hazardous to women’s health: Ageism, sexism, and sterotypes of older women in the healthcare system. Journal of Social Issues, 72, 86–104. https://doi.org/10.1111/josi.12157
Crocker, J., Major, B., & Steele, C. (1998). Social stigma. The handbook of social psychology (4th ed., Vol. 1–2, pp. 504–553). New York, NY: McGraw-Hill.
Dickerson, S. S., & Kemeny, M. E. (2004). Acute stressors and cortisol responses: A theoretical integration and synthesis of laboratory research. Psychological Bulletin, 130, 355–391. https://doi.org/10.1037/0033-2909.130.3.355
Doyle, D. M., & Molix, L. (2014). Perceived discrimination as a stressor for close relationships: Identifying psychological and physiological pathways. Journal of Behavioral Medicine, 37, 1134–1144. https://doi.org/10.1007/s10865-014-9563-8
Doyle, D. M., & Molix, L. (2016). Minority stress and inflammatory mediators: Covering moderates associations between perceived discrimination and salivary interleukin-6 in gay men. Journal of Behavioral Medicine, 39, 782–792. https://doi.org/10.1007/s10865-016-9784-0
Duncan, D. T., & Hatzenbuehler, M. L. (2014). Lesbian, gay, bisexual, and transgender hate crimes and suicidality among a population-based sample of sexual-minority adolescents in Boston. American Journal of Public Health, 104, 272–278. https://doi.org/10.2105/ajph.2013.301424
Everett, B., & Mollborn, S. (2013). Differences in hypertension by sexual orientation among U.S. young adults. Journal of Community Health, 38, 588–596. https://doi.org/10.1007/s10900-013-9655-3
Everett, B., Rosario, M., McLaughlin, K. A., & Austin, S. B. (2014). Sexual orientation and gender differences in markers of inflammation and immune functioning. Annals of Behavioral Medicine, 47, 57–70. https://doi.org/10.1007/s12160-013-9567-6
FBI. (2017). Hate crime statistics. Retrieved from U.S. Department of Justice Federal Bureau of Investigation: https://ucr.fbi.gov/hate-crime/2017/resource-pages/about-hate-crime.pdf
Forbes, M. K., Eaton, N. R., & Krueger, R. F. (2017). Sexual quality of life and aging: A prospective study of a nationally representative sample. The Journal of Sex Research, 54, 137–148. https://doi.org/10.1080/00224499.2016.1233315
Fredriksen-Goldsen, K. I., Kim, H.-J., Barkan, S. E., Muraco, A., & Hoy-Ellis, C. P. (2013). Health disparities among lesbian, gay, and bisexual older adults: Results from a population-based study. American Journal of Public Health, 103, 1802–1809. https://doi.org/10.2105/ajph.2012.301110
Fredriksen-Goldsen, K. I., Kim, H. J., Emlet, C. A., Muraco, A., Erosheva, E. A., Hoy-Ellis, C. P., et al. (2011). The aging and health report: Disparities and resilience among lesbian, gay, bisexual, and transgender older adults. Seattle: Institute for Multigenerational Health.
Fredriksen-Goldsen, K. I., Kim, H. J., Shiu, C., Goldsen, J., & Emlet, C. A. (2015). Successful aging among LGBT older adults: Physical and mental health-related quality of life by age group. The Gerontologist, 55, 154–168. https://doi.org/10.1093/geront/gnu081
Fredriksen-Goldsen, K. I., Kim, H.-J., Shui, C., & Bryan, A. E. B. (2017). Chronic health conditions and key health indicators among lesbian, gay, and bisexual older US adults, 2013–2014. American Journal of Public Health, 107, 1332–1338. https://doi.org/10.2105/ajph.2017.303922
Frost, D. M., Lehavot, K., & Meyer, I. H. (2015). Minority stress and physical health among sexual minority individuals. Journal of Behavioral Medicine, 38, 1–8. https://doi.org/10.1007/s10865-013-9523-8
Gates, G. J. (2017). In US, more adults identifying as LGBT (Gallup Poll). Retrieved from http://news.gallup.com/poll/201731/lgbt-identification-rises.aspx
GLAAD. (2019). Accelerating acceptance 2019 executive summary: A survey of American acceptance and attitudes toward LGBTQ Americans. Retrieved from Gay & Lesbian Alliance Against Defamation: https://www.glaad.org/sites/default/files/Accelerating%20Acceptance%202019.pdf
Glaser, R., & Kiecolt-Glaser, J. K. (2005). Stress-induced immune dysfunction: Implications for health. Nature Reviews Immunology, 5, 243–251. https://doi.org/10.1038/nri1571
Graham-Engeland, J. E., Sin, N. L., Smyth, J. M., Jones, D. R., Knight, E. L., Sliwinski, M. J., et al. (2018). Negative and positive affect as predictors of inflammation: Timing matters. Brain, Behavior, and Immunity, 74, 222–230. https://doi.org/10.1016/j.bbi.2018.09.011
Grossman, A. H., D’Augelli, A. R., & O’Connell, T. S. (2001). Being lesbian, gay, bisexual, and 60 or older in North America. Journal of Gay & Lesbian Social Services, 13, 23–40. https://doi.org/10.1300/J041v13n04_05
Hamer, M., & Steptoe, A. (2007). Association between physical fitness, parasympathetic control, and proinflammatory responses to mental stress. Psychosomatic Medicine, 69, 660–666. https://doi.org/10.1097/PSY.0b013e318148c4c0
Harvard School of Public Health, N. P. R., Robert Wood Johnson Foundation. (2017). Discrimination in America: Experiences and views of LGBTQ Americans. Retrieved from: https://www.npr.org/documents/2017/nov/npr-discrimination-lgbtq-final.pdf
Hatzenbuehler, M. L., McLaughlin, K. A., & Slopen, N. (2013). Sexual orientation disparities in cardiovascular biomarkers among young adults. American Journal of Preventative Medicine, 44, 612–621. https://doi.org/10.1016/j.amepre.2013.01.027
Hayes, A. F. (2013). Introduction to mediation, moderation, and conditional process analysis. New York, NY: Guilford.
Herbenick, D., Reece, M., Schick, V., Sanders, S. A., Dodge, B., & Fortenberry, J. D. (2010). Sexual behavior in the United States: Results from a national probability sample of men and women ages 14–94. The Journal of Sexual Medicine, 7, 255–265. https://doi.org/10.1111/j.1743-6109.2010.02012.x
Herek, G. M., & McLemore, K. A. (2013). Sexual prejudice. Annual Review of Psychology, 64, 309–333. https://doi.org/10.1146/annurev-psych-113011-143826
Hodge, D. R., Peng, B., Cherry, J. C., Hurt, E. M., Fox, S. D., Kelley, J. A., et al. (2005). Interleukin 6 supports the maintenance of p53 tumor suppressor gene promoter methylation. Cancer Research, 65, 4673–4682. https://doi.org/10.1158/0008-5472.Can-04-3589
Irwin, M. R., Wang, M., Campomayor, C. O., Collado-Hidalgo, A., & Cole, S. (2006). Sleep deprivation and activation of morning levels of cellular and genomic markers of inflammation. Archives of Internal Medicine, 166, 1756–1762. https://doi.org/10.1001/archinte.166.16.1756
Jones, C. P. (2000). Levels of racism: A theoretic framework and a gardener’s tale. American Journal of Public Health, 90, 1212–1215. https://doi.org/10.2105/ajph.90.8.1212
Kershaw, K. N., Lewis, T. T., Diez Roux, A. V., Jenny, N. S., Liu, K., Penedo, F. J., et al. (2016). Self-reported experiences of discrimination and inflammation among men and women: The multi-ethnic study of atherosclerosis. Health Psychology, 35, 343–350. https://doi.org/10.1037/hea0000331
Kessler, R. C., Mickelson, K. D., & Williams, D. R. (1999). The prevalence, distribution, and mental health correlates of perceived discrimination in the United States. Journal of Health and Social Behavior, 40, 208–230.
Kiecolt-Glaser, J. K. (2010). Stress, food, and inflammation: Psychoneuroimmunology and nutrition at the cutting edge. Psychosomatic Medicine, 72, 365–369. https://doi.org/10.1097/PSY.0b013e3181dbf489
Kiecolt-Glaser, J. K., Derry, H. M., & Fagundes, C. P. (2015). Inflammation: Depression fans the flames and feasts on the heat. The American Journal of Psychiatry, 172, 1075–1091. https://doi.org/10.1176/appi.ajp.2015.15020152
Kiecolt-Glaser, J. K., Gouin, J. P., & Hantsoo, L. (2010). Close relationships, inflammation, and health. Neuroscience and Biobehavioral Reviews, 35, 33–38. https://doi.org/10.1016/j.neubiorev.2009.09.003
Lewis, T. T., Aiello, A. E., Leurgans, S., Kelly, J., & Barnes, L. L. (2010). Self-reported experiences of everyday discrimination are associated with elevated C-reactive protein levels in older African-American adults. Brain, Behavior, and Immunity, 24, 438–443. https://doi.org/10.1016/j.bbi.2009.11.011
Libby, P., & Ridker, P. M. (2004). Inflammation and atherosclerosis: Role of c-reactive protein in risk assessment. The American Journal of Medicine, 116, 9–16. https://doi.org/10.1016/j.amjmed.2004.02.006
Lick, D. J., Durso, L. E., & Johnson, K. L. (2013). Minority stress and physical health among sexual minorities. Perspectives on Psychological Science, 8, 521–548. https://doi.org/10.1177/1745691613497965
Love, G. D., Seeman, T. E., Weinstein, M., & Ryff, C. D. (2010). Bioindicators in the MIDUS national study: Protocol, measures, sample, and comparative context. Journal of Aging and Health, 22, 1059–1080. https://doi.org/10.1177/0898264310374355
Lukaszewicz, M., Mroczko, B., & Szmitkowski, M. (2007). Clinical significance of interleukin-6 (IL-6) as a prognostic factor of cancer disease. Polskie Archiwum Medycyny Wewnetrznej, 117, 247–251.
Maggio, M., Guralnik, J. M., Longo, D. L., & Ferrucci, L. (2006). Interleukin-6 in aging and chronic disease: A magnificent pathway. The Journals of Gerontology: Series A, Biological Sciences and Medical Sciences, 61, 575–584. https://doi.org/10.1093/gerona/61.6.575
Marsland, A. L., Walsh, C., Lockwood, K., & John-Henderson, N. A. (2017). The effects of acute psychological stress on circulating and stimulated inflammatory markers: A systematic review and meta-analysis. Brain, Behavior, and Immunity, 64, 208–219. https://doi.org/10.1016/j.bbi.2017.01.011
Mays, V. M., Juster, R. P., Williamson, T. J., Seeman, T. E., & Cochran, S. D. (2018). Chronic physiologic effects of stress among lesbian, gay, and bisexual adults: Results from the National Health and Nutrition Examination Survey. Psychosomatic Medicine, 80, 551–563. https://doi.org/10.1097/PSY.0000000000000600
McEwen, B. S., & Gianaros, P. J. (2010). Central role of the brain in stress and adaptation: Links to socioeconomic status, health, and disease. Annals of the New York Academy of Sciences, 1186, 190–222. https://doi.org/10.1111/j.1749-6632.2009.05331.x
Meyer, I. H. (1995). Minority stress and mental health in gay men. Journal of Health and Social Behavior, 36, 38–56.
Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129, 674–697. https://doi.org/10.1037/0033-2909.129.5.674
Miller, G., Chen, E., & Cole, S. W. (2009). Health psychology: Developing biologically plausible models linking the social world and physical health. Annual Review of Psychology, 60, 501–524. https://doi.org/10.1146/annurev.psych.60.110707.163551
Nakashima, J., Tachibana, M., Horiguchi, Y., Oya, M., Ohigashi, T., Asakura, H., et al. (2000). Serum interleukin-6 as a prognostic factor in patients with prostate cancer. Clinical Cancer Research, 6, 2702–2706.
National Institute on Minority Health and Health Disparities (NIMHD). (2016). Sexual and gender minorities formally designated as a health disparity population for research purposes [Press release]. Retrieved from https://www.nimhd.nih.gov/about/directorscorner/message.html
O’Connor, M. F., Bower, J. E., Cho, H. J., Creswell, J. D., Dimitrov, S., Hamby, M. E., et al. (2009). To assess, to control, to exclude: Effects of biobehavioral factors on circulating inflammatory markers. Brain, Behavior, and Immunity, 23, 887–897. https://doi.org/10.1016/j.bbi.2009.04.005
Pearson, T. A., Mensah, G. A., Alexander, R. W., et al. (2003). Markers of inflammation and cardiovascular disease application to clinical and public health practice: A statement for healthcare professionals from the centers for disease control and prevention and the American Heart Association. Circulation, 107, 499–511. https://doi.org/10.1161/01.cir.0000052939.59093.45
Pradhan, A. D., Manson, J. E., Rifai, N., Buring, J. E., & Ridker, P. M. (2001). C-reactive protein, interleukin-6, and risk of developing type 2 diabetes mellitus. JAMA, 286, 327–334. https://doi.org/10.1001/jama.286.3.327
Puckett, J. A., Horne, S. G., Herbitter, C., Maroney, M. R., & Levitt, H. M. (2017). Differences across contexts: Minority stress and interpersonal relationships for lesbian, gay, and bisexual women. Psychology of Women Quarterly, 41, 8–19. https://doi.org/10.1177/0361684316655964
Raifman, J., Moscoe, E., Austin, S. B., & McConnell, M. (2017). Difference-in-differences analysis of the association between state same-sex marriage policies and adolescent suicide attempts. JAMA Pediatrics, 171, 350–356. https://doi.org/10.1001/jamapediatrics.2016.4529
Ridker, P. M. (2003). Clinical application of c-reactive protein for cardiovascular disease detection and prevention. Circulation, 107, 363–369. https://doi.org/10.1161/01.CIR.0000053730.47739.3C
Riggle, E. D., Rostosky, S. S., & Danner, F. (2009). LGB identity and eudaimonic well-being in midlife. Journal of Homosexuality, 56, 786–798. https://doi.org/10.1080/00918360903054277
Segerstrom, S. C., & Miller, G. (2004). Psychological stress and the human immune system: A meta-analytic study of 30 years of inquiry. Psychological Bulletin, 130, 601–630. https://doi.org/10.1037/0033-2909.130.4.601
Sin, N. L., Graham-Engeland, J. E., & Almeida, D. M. (2015). Daily positive events and inflammation: Findings from the National Study of Daily Experiences. Brain, Behavior, and Immunity, 43, 130–138. https://doi.org/10.1016/j.bbi.2014.07.015
Smyth, J., Zawadzki, M., & Gerin, W. (2013). Stress and disease: A structural and functional analysis. Social and Personality Psychology Compass, 7, 217–227. https://doi.org/10.1111/spc3.12020
Steptoe, A., Hamer, M., & Chida, Y. (2007). The effects of acute psychological stress on circulating inflammatory factors in humans: A review and meta-analysis. Brain, Behavior, and Immunity, 21, 901–912. https://doi.org/10.1016/j.bbi.2007.03.011
Stoner, L., Lucero, A. A., Palmer, B. R., Jones, L. M., Young, J. M., & Faulkner, J. (2013). Inflammatory biomarkers for predicting cardiovascular disease. Clinical Biochemistry, 46, 1353–1371. https://doi.org/10.1016/j.clinbiochem.2013.05.070
Swank, E., Frost, D. M., & Fahs, B. (2012). Rural location and exposure to minority stress among sexual minorities in the United States. Psychology & Sexuality, 3, 226–243. https://doi.org/10.1080/19419899.2012.700026
Tankard, M. E., & Paluck, E. L. (2017). The effect of a supreme court decision regarding gay marriage on social norms and personal attitudes. Psychological Science, 28, 1334–1344. https://doi.org/10.1177/0956797617709594
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Britney M. Wardecker was partially supported by National Institute on Aging Grant T32 AG049676 to The Pennsylvania State University at the time of this research. Since 1995 the MIDUS study has been funded by the John D. and Catherine T. MacArthur Foundation Research Network and by the National Institute on Aging Grants P01-AG020166 and U19-AG051426.
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Britney M. Wardecker, Jennifer E. Graham-Engeland and David M. Almeida declare that they have no conflict of interest. Each of the authors has contributed in a significant way to this manuscript and each has approved this version.
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Wardecker, B.M., Graham-Engeland, J.E. & Almeida, D.M. Perceived discrimination predicts elevated biological markers of inflammation among sexual minority adults. J Behav Med 44, 53–65 (2021). https://doi.org/10.1007/s10865-020-00180-z
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DOI: https://doi.org/10.1007/s10865-020-00180-z