Differences in Discrimination, Violence, Mental Health, and Substance Use Outcomes by Cancer History Among LGBTQ+ Individuals in North Carolina

BACKGROUND Health inequities among lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority populations (LGBTQ+) are driven by anti-LGBTQ+ stigma and discrimination. However, there is limited research on the manifestations of stigma and discrimination among LGBTQ+ cancer survivors. METHODS Data were collected by the North Carolina Department of Health and Human Services via the 2023 North Carolina LGBTQ+ Health Needs Assessment. Differences in outcomes (i.e., discrimination, violence, homelessness, mental health, substance use, and overdose) between LGBTQ+ individuals by cancer history were assessed using Chi-squared tests. Further, multivariable logit models were used to generate predicted probabilities, average marginal effects (AME), and 95% confidence intervals (CI) of the association of cancer with each outcome. RESULTS A total of N = 3170 LGBTQ+ individuals (n = 200 cancer survivors) took part in the survey. In adjusted analyses, cancer history was associated with an 8.1 to 19.1 percentage point increase in the probability of all discrimination, violence, and homelessness outcomes. The largest AME of cancer was with accidental overdose (AME: 22.5; 95% CI, 15.2–29.8), followed by homelessness (AME: 19.1; 95% CI, 11.6–26.6), spouse or family violence (AME: 16.7; 95% CI, 9.3–24.1), LGBTQ+ violence (AME: 15.1; 95% CI, 7.8–22.5), sexual assault (AME: 14.1; 95% CI, 6.0–22.2), as well as nicotine product (AME: 9.0; 95%CI, 1.6–16.5) and cocaine use (AME: 8.9; 95% CI, 3.8–14.1). The most common barriers to mental health services were cost (36.0%) and health insurance (33.5%). LIMITATIONS The needs assessment was a convenience-based study, which limits the generalizability of our findings. CONCLUSIONS LGBTQ+ cancer survivors in North Carolina experience an elevated burden of discrimination, violence, suicide attempt, substance use, and accidental overdose in comparison to LGBTQ+ individuals without a cancer history.