Person‑level health factors partially mediate the association between lesbian, gay, or bisexual (LGB) identity, allostatic load, and cancer mortality in NHANES

Authors

• Justin Xavier Moore, University of KentuckyFollow
• Alisha Patel, University of Kentucky
• Missy Spears, Queer KentuckyFollow
• Tracy Casanova, Augusta University
• Heidi L. Weiss, University of KentuckyFollow
• Marvin E. Langston, Stanford University
• Keith J. Watts, University of KentuckyFollow
• Donte Boyd, The Ohio State University
• Prajakta Adsul, University of New Mexico
• Meredith S. Duncan, University of KentuckyFollow
• Sydney Howard, University of KentuckyFollow

Abstract

Purpose: Individuals identifying as Lesbian, Gay, or Bisexual (LGB) with high allostatic load have more than double the cancer mortality risk of heterosexual individuals with high allostatic load. This study explored how person-level health factors mediate the relationship between individuals identifying as LGB with high allostatic load and subsequent risk of cancer mortality.

Methods: We conducted a retrospective analysis of 12,470 participants in the National Health and Nutrition Examination Survey (2001–2010) linked to the National Death Index through 31 December 2019. Survey-weighted Cox regression assessed associations of individuals identifying as LGB and allostatic load with cancer mortality. Person-level health factors examined as mediators included household income, general health condition, routine health access, location of healthcare providers, prior health condition, mental health professional visits, and the number of health visits within the past year.

Results: Adults reporting as LGB with high allostatic load had a threefold higher cancer mortality risk than heterosexual adults with low allostatic load (adjusted hazard ratio: 2.96, 95% confidence interval: 1.62–5.41). Mediation analysis showed household income (4.9%), seeing a mental health provider within the past year (8.53%), frequent healthcare visits (9.65%), poor self-reported health (9.9%), and worse health now than past year (5.41%) partially influence this relationship.

Conclusion: In a nationally representative sample, person-level health factors significantly mediated the link between adults reporting as LGB, high allostatic load, and cancer mortality. These findings highlight that potential efforts focused on financial support, culturally competent care, and mental health access may reduce cancer health disparities.

Document Type

Article

Publication Date

2026

Notes/Citation Information

© The Author(s) 2026

Digital Object Identifier (DOI)

https://doi.org/10.1007/s10552-026-02145-0

Funding Information

The investigators received funding from the National Institute on Minority Health and Health Disparities Grant K01 MD015304. Dr. Donte Boyd is supported by the National Institute of Mental Health (R21 MH134743).

Repository Citation

Moore, Justin Xavier; Patel, Alisha; Spears, Missy; Casanova, Tracy; Weiss, Heidi L.; Langston, Marvin E.; Watts, Keith J.; Boyd, Donte; Adsul, Prajakta; Duncan, Meredith S.; and Howard, Sydney, "Person‑level health factors partially mediate the association between lesbian, gay, or bisexual (LGB) identity, allostatic load, and cancer mortality in NHANES" (2026). Markey Cancer Center Faculty Publications. 493.
https://uknowledge.uky.edu/markey_facpub/493