Sexual Orientation Differences in Alcohol Use Disorder Across the Adult Life Course

  • Jessica N. Fish
    Address correspondence to: Jessica N. Fish, PhD, Department of Family Science, University of Maryland Prevention Research Center, School of Public Health, University of Maryland, 4200 Valley Road, Suite 1142, College Park MD 20742.
    Department of Family Science, University of Maryland Prevention Research Center, School of Public Health, University of Maryland, College Park, Maryland
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  • Cara Exten
    College of Nursing, Pennsylvania State University, University Park, Pennsylvania
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      Sexual orientation‒related disparities in alcohol use disorder are well-established. Yet, the degree to which sexual orientation differences in alcohol use disorder vary across the life course is poorly understood. There is also a limited understanding of how exposure to minority stressors and their relationship with alcohol use disorder vary as a function of age.


      Using nationally representative data collected in 2012–2013, authors used sex-stratified time-varying effect models to estimate age-specific prevalence rates of alcohol use disorder among heterosexual and sexual minority adults aged 18–60 years (N=28,090). Among sexual minority adults (n=1,050), authors also assessed age-specific associations between exposure to lesbian, gay, and bisexual‒related discrimination and alcohol use disorder. Analyses were conducted in 2019.


      Gay and bisexual male participants aged 18–45 years demonstrated the highest prevalence rates of alcohol use disorder (e.g., >45% at age 25 years), whereas lesbian, gay, and bisexual female participants were most likely to meet the criteria for alcohol use disorder between ages 45 and 55 years. Sexual minority adults who experienced discrimination in the past year had greater odds of alcohol use disorder between ages 23 and 34 years and again from ages 42 to 53 years; the association between discrimination and alcohol use disorder was strongest among sexual minority men.


      Sexual orientation–related disparities in alcohol use disorder are dynamic across the life course and point to critical times for screening and intervention. Developmental perspectives of sexual minority health inequities demand focused research attention as findings will help to identify strategies for promoting sexual minority health at distinct points in the life course.
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