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Effect of same-sex marriage legalisation on the health of ethnic minority lesbian, gay and bisexual people: a quasi-experimental study
  1. Yihong Bai1,2,
  2. Chungah Kim2,
  3. Antony Chum2
  1. 1Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
  2. 2School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
  1. Correspondence to Dr Antony Chum; antony.chum{at}gmail.com

Abstract

Background The UK legalised same-sex marriage in 2014. We examine whether same-sex marriage legalisation (SSML), an exogenous policy change, affected the health outcomes among ethnic minority lesbian, gay, bisexual and other (LGB+) individuals.

Methods Using the UK Household Longitudinal Survey, we applied the Callaway and Sant’Anna difference-in-differences to compare physical and mental health across (a) ethnic LGB+ individuals (treatment group), (b) ethnic heterosexual individuals (control group 1) and (c) British white LGB+ individual (control group 2). The study cohort (n=7054) comprised individuals aged 16+ years at baseline in 2011, and were employed in the study period (2011–2019). The outcomes included physical component scores from the short-form 12 health survey (physical component score (PCS-12)), long-standing illnesses and psychological distress (General Health Questionnaire (GHQ)).

Results After SSML, the PCS-12 among the ethnic LGB+ individuals improved significantly compared with both ethnic heterosexuals and British white LGB+ individuals (2.081, 95% CI 0.487 to 3.675). While no clear patterns were found for long-standing illnesses, the GHQ in the treatment group had modest decreases relative to ethnic heterosexuals, and relative to British white LGB+ individuals, by year 2 after SSML.

Conclusion SSML in the UK led to improved physical functioning and reduced psychological distress in ethnic minority LGB+ individuals. Our study shows that ethnic LGB+ individuals may derive even greater health benefits than British white LGB+ people, providing evidence that SSML may help address racial health inequalities within LGB+ communities. As countries worldwide consider legalising same-sex marriage, it is imperative for policymakers to consider the health consequences for sexual and ethnic minorities.

  • ethnic groups
  • gender identity
  • health inequalities
  • longitudinal studies
  • mental health

Data availability statement

Data are available on reasonable request.

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Data availability statement

Data are available on reasonable request.

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Footnotes

  • X @antonychum

  • Contributors YB: conceptualisation, formal analysis, investigation, methodology, resources, software, validation, writing—original draft, writing—review and editing. CK: conceptualisation, data curation, formal analysis, investigation, methodology, resources, software, validation, writing—original draft, writing—review and editing. AC: funding acquisition, investigation, methodology, project administration, resources, supervision, validation, writing—original draft, writing—review and editing. AC: corresponding author and guarantor. YB and CK shared the first authorship.

  • Funding The principal investigator (AC) is supported through the Canada Research Chair programme (CRC-2021-00269). The study was partially funded through the Social Sciences and Humanities Research Council (SSHRC) Insight Grant (435-2020-1086) andCanadian Institutes of Health Research (CIHR) project grant (165892).

  • Disclaimer The funder had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript and decision to submit the manuscript for publication.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.