Association between health-related quality of life and health behaviors among men who have sex with men in the United States: a nationwide population-based study

Sexual minority men may experience distinct health-related quality of life (HRQoL) patterns and health-related behavioural risks compared with heterosexual men in the United States. This study examined differences in HRQoL and health-related behaviours between sexual minority and heterosexual men and assessed sociodemographic and behavioural correlates of HRQoL among sexual minority men. Data were drawn from the 2021 Behavioral Risk Factor Surveillance System, including 88,319 men, of whom 3,702 self-identified as gay or bisexual. Outcomes were physical-distress days, mental-distress days, and activity-limitation days in the past 30 days. Sexual minority men reported more mental-distress days than heterosexual men (6.82 vs. 3.19) and slightly more activity-limitation days (5.42 vs. 4.92), while physical-distress days were similar (3.65 vs. 3.44). They also reported higher levels of both health-promoting behaviours and risk behaviours, including smoking and binge or heavy drinking. Among sexual minority men, employment status and age showed strong associations with HRQoL. Compared with retired men, those unable to work reported substantially more physical-distress, mental-distress, and activity-limitation days. Leisure-time physical activity was associated with fewer unhealthy days across all outcomes, while current smoking was associated with more mental-distress days. HRQoL among sexual minority men is multidimensional and shaped by socioeconomic and behavioural factors, supporting targeted mental-health, behavioural, and socioeconomic interventions.