Resilience and distinct lifeways: sexual orientation and gender minority status differences in health, well-being, and social determinants of health in a population-based sample of older adults

During the past two decades, differences in health and living conditions based on sexual orientation and gender minority status (e.g., those who identify as lesbian, gay, bisexual, and transgender) have received increased attention. The majority of these studies have been conducted among adolescents and young adults, and there is a need for more knowledge about the health situation among older generations of sexual and gender minority individuals. This study provides one of the most comprehensive population-based examinations of health disparities among older sexual orientation and gender minority adults outside the United States. This study explores disparities in health, well-being, and social determinants of health by sexual orientation and gender minority status in Sweden using data from 87,456 individuals aged 65 and older from the Swedish National Public Health Survey (2018–2022). We examined self-rated health, physical symptoms, psychological distress, and mental well-being, alongside social and economic health determinants such as discrimination, victimization, isolation, and financial stress. While sexual and gender minority individuals reported higher levels of social and economic stressors, differences in health outcomes were modest. Gay men showed slightly higher psychological distress, and lesbian women reported lower positive well-being compared to heterosexual peers. There were no significant differences between cisgender and gender minority participants on any of our measures of health and well-being. Further, effect modification analyses showed that disparities were influenced by sociodemographic factors, with education level, migration background, and urbanicity acting as moderators. These findings suggest that despite elevated stressors, older sexual and gender minority adults may demonstrate resilience shaped by life experiences. Public health efforts should address structural inequalities while recognizing the strengths and diversity within this population.