February 6, 2024

Socioeconomic status — frequently measured as a combination of education, income and occupation — has a huge impact on health outcomes. Despite this fact, there is little research specifically examining how socioeconomic status (SES) varies according to people’s gender expression.

A recent study published in the Journal of Epidemiology and Community Health examined associations between socially assigned gender expression, sexual orientation and SES. Among both men and women, gender nonconforming individuals — whether they identified as heterosexual or part of a sexual minority — were more likely to have low SES compared to gender conforming heterosexuals.

Dr. Stephanie Hernandez

Dr. Stephanie Hernandez

“Education, for example, is a crucial indicator of SES,” said Stephanie Hernandez, PhD, a former postdoctoral trainee at the UNC-Chapel Hill Carolina Population Center who is now an assistant professor of epidemiology at Drexel University’s Dornsife School of Public Health and an adjunct assistant professor in the Department of Maternal and Child Health at the Gillings School of Global Public Health. “Education is important because it is related to employment and income, which in turn can influence health. In our study, about one in four gender nonconforming women graduated from college (had a bachelor’s degree or higher) compared to around one in two gender conforming heterosexual women.”

Dr. Carolyn Halpern

Dr. Carolyn Halpern

Hernandez worked with Carolyn Halpern, PhD, professor and chair in Gillings’ Department of Maternal and Child Health, and Kerith J. Conran, ScD, Blachford-Cooper Distinguished Scholar and research director at the UCLA Williams Institute.

The researchers used data from 12,300 participants in the National Longitudinal Study of Adolescent to Adult Health to find associations between sexual orientation and gender expression and seven measures of socioeconomic status. They also considered covariates such as race, ethnicity and urban versus rural location.

Their analysis found that low SES was more common among sexual and gender minorities, which matches findings from earlier research.

The new study adds to this body of evidence by being one of the first to examine gender expression and sexual orientation jointly in relation to SES in the United States while controlling for parental and household characteristics in adolescence and early adulthood that are related to adult SES.

Furthermore, this study paints a more complete picture of SES by using seven measures: education, employment and income, which are common, and additional indicators such as household debt, trouble paying bills, and experiencing foreclosure, eviction or repossession, thereby providing a more complete assessment of SES and how it varies by sexual orientation and gender expression.

“SES differences highlighted in this study have significant implications for understanding health disparities among gender nonconforming sexual minorities,” Hernandez said. “Low SES has been linked to restricted access to health care, higher stress levels and reduced opportunities for maintaining a healthy lifestyle. These factors can contribute to health disparities, potentially placing gender nonconforming and/or sexual minorities with low SES — especially women — at higher risk for poor physical and mental health.”

“Understanding SES differences is crucial for developing targeted interventions and policies aimed at reducing health disparities in this population,” she added. “Addressing SES differences moving forward will require collaboration among policymakers, health care providers, researchers, educators, employers and advocacy groups.”

Contact the UNC Gillings School of Global Public Health communications team at sphcomm@unc.edu.

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