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

Cancer history was associated with increased probability of all discrimination, violence, and homelessness outcomes among LGBTQ+ individuals.

• 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 sample included N=3170 LGBTQ+ individuals, of whom n=200 were cancer survivors.
• Multivariable logit models were used to generate predicted probabilities, average marginal effects (AME), and 95% confidence intervals.
• Data were collected via the 2023 North Carolina LGBTQ+ Health Needs Assessment by the NC Department of Health and Human Services.

Cancer history was most strongly associated with accidental overdose among all outcomes examined.

• The largest AME of cancer was with accidental overdose (AME: 22.5; 95% CI, 15.2–29.8).
• This represented the highest percentage point increase in probability of any outcome measured.
• The finding was based on adjusted analyses controlling for other factors.

Cancer history was associated with significantly higher probability of homelessness among LGBTQ+ individuals.

• The AME of cancer history on homelessness was 19.1 percentage points (95% CI, 11.6–26.6).
• This was the second largest AME observed across all outcomes.

Cancer history was associated with increased probability of violence outcomes including spouse or family violence, LGBTQ+ violence, and sexual assault.

• 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).

Cancer history was associated with increased probability of nicotine product use and cocaine use among LGBTQ+ individuals.

• Nicotine product use AME: 9.0 (95% CI, 1.6–16.5).
• Cocaine use AME: 8.9 (95% CI, 3.8–14.1).
• These substance use outcomes were among the smaller but still statistically significant AMEs observed.

The most common barriers to mental health services among LGBTQ+ individuals were cost and health insurance.

• Cost was the most common barrier to mental health services, reported by 36.0% of respondents.
• Health insurance was the second most common barrier, reported by 33.5% of respondents.
• These barriers were assessed across the full LGBTQ+ sample of N=3170.

Health inequities among LGBTQ+ populations are driven by anti-LGBTQ+ stigma and discrimination, but limited research exists on these manifestations among LGBTQ+ cancer survivors specifically.

• The study was motivated by a gap in research on stigma and discrimination among LGBTQ+ cancer survivors.
• The 2023 North Carolina LGBTQ+ Health Needs Assessment was used as the data source.
• Chi-squared tests were used to assess unadjusted differences in outcomes by cancer history.

The study was limited by its convenience-based sampling methodology, which restricts generalizability of findings.

• The needs assessment was described as 'a convenience-based study, which limits the generalizability of our findings.'
• The sample comprised N=3170 LGBTQ+ individuals in North Carolina.