Life course predictors of allostatic load among sexual and gender minority (SGM) midlife & older adults

Sexual and gender minority (SGM) midlife and older adults face elevated rates of chronic health conditions, frequent mental distress, and disability compared to their heterosexual peers. Chronic stress, a key predictor of allostatic load (AL), the cumulative wear and tear on physiological systems exacerbates these disparities. Structural stigma manifests at multiple levels (e.g., institutional heterosexism, interpersonal discrimination, self-stigma), increasing the risks for poorer mental, physical, social, and environmental health. Using data from Aging with Pride: National Health, Aging, and Sexuality/Gender Study (NHAS), this study examined predictors of AL among 284 SGM adults aged 50-97. Guided by the Health Equity Promotion Model, hierarchical Poisson regressions explored the relationships between socioeconomic status, lifetime discrimination, adult abuse, marital relationships, identity processes, and AL. Predictors of AL include lower current assets, adult physical abuse, ever being in an opposite-sex marriage, and older age at first SGM identity disclosure. Childhood SES, lifetime discrimination, and identity stigma were not significantly associated with AL. These findings underscore the critical role of life course experiences, particularly socioeconomic security and adult abuse in influencing chronic stress. Opposite-sex marriage, typically presumed beneficial, may adversely impact health within intersectional contexts. Disclosing one's SGM identity later in life was associated with elevated AL, suggesting physiological costs of long-term identity concealment. Interventions targeting socioeconomic stressors, adult physical abuse, and barriers to identity disclosure are instrumental in reducing stress and improving health outcomes in this community. Longitudinal research is needed to further explore these relationships, especially the effects of long-term identity concealment.