Disparities in multidimensional psychosocial stressors by sexual identity among cancer survivors from the All of Us Research Program

OBJECTIVES: To examine disparities in psychosocial stressors by sexual identity among cancer survivors and whether these differ by state governmental leaning. METHODS: Cross-sectional data (2018-2022) from 14,806 cancer survivors in the All of Us repository were analyzed. Sexual identity (heterosexual vs. sexual minority) was examined in relation to discrimination in medical settings (DMS), perceived stress (PS), and neighborhood social cohesion (NSC) using multivariable logistic regression models adjusted for sociodemographic and clinical covariates, stratified by state governmental leaning. RESULTS: 6.3% of survivors identified as sexual minority (SM). Compared with heterosexual survivors, SM individuals had higher odds of medium/high perceived stress (aOR = 1.46, 95% CI 1.26-1.72) and low neighborhood social cohesion (aOR = 1.47, 95% CI 1.27-1.71). In Republican-leaning states, they had over twice the odds of medical discrimination (aOR = 2.31; 95% CI = 1.50-3.71), with no association in Democratic-leaning states. CONCLUSIONS: Sexual minority cancer survivors experience greater psychosocial stressors regardless of their state's governmental leaning, which may impact their cancer survivorship. Those in Republican-leaning states are more likely to have DMS experiences, potentially affecting their access to care and overall health. Future research should explore the long-term effects of policy environments and their influence on discrimination and psychosocial stress among SM cancer survivors.