Bisexuality, Union Status, and Gender Composition of the Couple: Reexamining Marital Advantage in Health

Abstract

It has long been documented that married individuals have better health outcomes than unmarried individuals. However, this marital advantage paradigm has been developed primarily based on heterosexual populations. No studies to date have examined the health effects of marriage among bisexuals, one of the most disadvantaged but understudied sexual minority groups, although a few have shown mixed results for gays and lesbians. Similarly, no research has examined how the gender composition of a couple may shape bisexuals’ health outcomes above and beyond the effects of sexual orientation. We analyzed pooled data from the 2013–2017 National Health Interview Survey (n = 154,485) and found that the health advantage of marriage applied only to heterosexuals and, to a lesser extent, gays and lesbians. Married bisexuals, however, exhibited poorer health than unmarried bisexuals when socioeconomic status and health behaviors were adjusted for. Moreover, bisexuals in same-gender unions were healthier than bisexuals in different-gender unions primarily because of their socioeconomic advantages and healthier behaviors. Together, our findings suggest that bisexuals, particularly those in different-gender unions, face unique challenges in their relationships that may reduce the health advantage associated with marriage.

Birth Cohort Trends in Health Disparities by Sexual Orientation

“…LGB iden ti fi ca tion also varies by region of resi dence and immi gra tion sta tus (Rosenfeld 2007). In addi tion, LGB peo ple are less likely to be mar ried than their het ero sex ual coun ter parts (Hsieh and Liu 2019), and mar ried peo ple have bet ter health than unmar ried peo ple (Liu and Umberson 2008).…”

“…LGB-iden ti fied peo ple have his tor i cally been sub ject to a host of health disparities rel a tive to their straight coun ter parts, includ ing worse men tal and phys i cal health, Birth Cohort Trends in Health Disparities by Sexual Orientation higher rates of sub stance use, and lower rates of health insur ance (Buchmueller and Carpenter 2010;Herek et al 2009). Notably, bisex ual peo ple expe ri ence the most severe health dis ad van tages across sex ual iden tity groups (Gorman et al 2015;Hsieh and Liu 2019). Minority stress the ory, the pri mary the ory used to explain LGB peo ple's dis pro por tion ately poor health, sug gests that spe cific health dis advan tages accu mu late for sex ual minor i ties because inter per sonal (i.e., micro) and insti tu tional (i.e., macro) dis crim i na tion are fun da men tal causes of stress and disad van tage (Hatzenbuehler et al 2013;Herek 1998;Meyer 2003).…”

“…First, bisex ual peo ple are often not seen by some as authen ti cally a sex ual minor ity and are thus ostra cized from not only the straight com mu nity but also the gay and les bian com mu nity. As a result, the recent LGB move ment may not con fer the same health effects to bisex ual peo ple as to gay men and les bian women (Gorman et al 2015;Hsieh and Liu 2019;Thomeer and Reczek 2016). For exam ple, given that most mar ried and cohabiting bisex ual peo ple are in dif fer ent-sex rela tion ships, they may not feel they have been dis crim i nated against in regard to the legal ity of their union and there fore, com pared with gay men and les bi ans, do not ben e fit as much from the pas sage of same-sex mar riage laws.…”

“…Predicted Probability of Poor Health Fig. 4 Marginal predicted probability of reporting poor physical health (i.e., self-rated physical health = poor), by sexual orientation and cohort, and 95% confidence intervals research suggesting that bisex ual peo ple are the most dis ad van taged among LGB pop u la tions (Gorman et al 2015;Hsieh and Liu 2019;Thomeer and Reczek 2016).…”

“…The per cent age of Amer i can adults iden ti fy ing as les bian, gay, or bisex ual (LGB) doubled from 2.7% in 2008 to 5.4% in 2016, with a par tic u larly nota ble increase in bisexual iden ti fi ca tion over this period (Bridges and Moore 2018). Previous stud ies have dem on strated that LGB peo ple report worse men tal and phys i cal health out comes than their straight coun ter parts (Institute of Medicine 2011; Meyer 2003), with bisex ual peo ple reporting the worst such out comes across all groups (Gorman et al 2015;Hsieh and Liu 2019;Thomeer and Reczek 2016). The most pre dom i nant the ory explaining these health dis ad van tages is minor ity stress the ory, which sug gests that LGB peo ple expe ri ence both inter per sonal and insti tu tional dis crim i na tion on the basis of their sexu al ity (e.g., homo pho bia, biphobia) and that this dis crim i na tion con trib utes to worse health (Meyer, 2003).…”