An ecological analysis of colorectal cancer incidence and mortality: Differences by sexual orientation

<p>Abstract</p> <p>Background</p> <p>Some have suggested gays and lesbians may carry a greater burden of colorectal cancer. To date, individual sexual orientation data are not available in cancer surveillance registries. This prevents an assessment of differences in colorectal cancer incidence and mortality by sexual orientation, using individual-level data.</p> <p>Methods</p> <p>We use an ecological approach to examine differences in colorectal cancer incidence and mortality by county-level sexual orientation data. From the Surveillance, Epidemiology and End Results (SEER) Program we obtain population-based surveillance data on colorectal cancer incidence and mortality from 1996 to 2004. We use Census 2000 data on same-sex partnered households, a proxy of sexual orientation, to derive county-level sexual orientation data. Using multiple regression models, we examined the county-level association of sexual minority density with colorectal cancer incidence and mortality.</p> <p>Results</p> <p>After controlling for race and SES, we identify a significant positive association between greater density of sexual minority men and women and colorectal cancer incidence. With respect to colorectal cancer mortality, we identify a positive association with density of sexual minority men, but not women.</p> <p>Conclusions</p> <p>In the absence of surveillance data on sexual minority individuals, ecological analyses provide estimates of associations at the aggregate level, thereby providing crucial information for follow-up studies.</p

Depression and Sexual Orientation During Young Adulthood: Diversity Among Sexual Minority Subgroups and the Role of Gender Nonconformity.

Sexual minority individuals are at an elevated risk for depression compared to their heterosexual counterparts, yet less is known about how depression status varies across sexual minority subgroups (i.e., mostly heterosexuals, bisexuals, and lesbians and gay men). Moreover, studies on the role of young adult gender nonconformity in the relation between sexual orientation and depression are scarce and have yielded mixed findings. The current study examined the disparities between sexual minorities and heterosexuals during young adulthood in concurrent depression near the beginning of young adulthood and prospective depression 6 years later, paying attention to the diversity within sexual minority subgroups and the role of gender nonconformity. Drawn from the National Longitudinal Study of Adolescent Health (N = 9421), we found that after accounting for demographics, sampling weight, and sampling design, self-identified mostly heterosexual and bisexual young adults, but not lesbians and gay men, reported significantly higher concurrent depression compared to heterosexuals; moreover, only mostly heterosexual young adults were more depressed than heterosexuals 6 years later. Furthermore, while young adult gender nonconforming behavior was associated with more concurrent depression regardless of sexual orientation, its negative impact on mental health decreased over time. Surprisingly, previous gender nonconformity predicted decreased prospective depression among lesbians and gay men whereas, among heterosexual individuals, increased gender nonconformity was not associated with prospective depression. Together, the results suggested the importance of investigating diversity and the influence of young adult gender nonconformity in future research on the mental health of sexual minorities.The authors acknowledge support for this research: the University of Arizona Norton School of Family and Consumer Sciences Fitch Nesbitt Endowment and a University of Arizona Graduate Access Fellowship to the second author. This research uses data from Add Health, a program project directed by Kathleen Mullan Harris and designed by J. Richard Udry, Peter S. Bearman, and Kathleen Mullan Harris at the University of North Carolina at Chapel Hill, and funded by grant P01-HD31921 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, with cooperative funding from 23 other federal agencies and foundations. Special acknowledgment is due Ronald R. Rindfuss and Barbara Entwisle for assistance in the original design. Information on how to obtain the Add Health data files is available on the Add Health website (http://​www.​cpc.​unc.​edu/​addhealth). No direct support was received from grant P01-HD31921 for this analysis. The authors thank Noel Card and Susan Stryker for comments on the previous versions of this article and Richard Lippa and Katerina Sinclair for methodological and statistical consult. The authors also thank the anonymous reviewers and the Editor for their helpful comments.This is the accepted manuscript of a paper published in Archives of Sexual Behavior (Li G, Pollitt AM, Russell ST, Archives of Sexual Behavior 2015, doi:10.1007/s10508-015-0515-3). The final version is available at http://dx.doi.org/10.1007/s10508-015-0515-3