# Disparities in multidimensional psychosocial stressors by sexual minority identity among cancer survivors from the All of Us (AoU) Research Program

## TL;DR

Sexual minority cancer survivors report higher stress and less social support, with greater discrimination in states led by Republican governors.

## Contribution

This study identifies disparities in psychosocial stressors among sexual minority cancer survivors and links them to political context.

## Key findings

- SM cancer survivors had 46% higher odds of high/medium perceived stress compared to non-SM survivors.
- SM survivors had 47% higher odds of low neighborhood social cohesion.
- In states with Republican governors, SM survivors had twice the odds of medical discrimination compared to heterosexual survivors.

## Abstract

Sexual minority (SM) individuals may face discrimination and psychosocial stressors that can adversely impact their cancer care and outcomes. Therefore, we tested for disparities in psychosocial stressors by SM status among cancer survivors and explored whether observed disparities differ by governor’s political affiliation.

Perceived stressors and SM status data from 2018–2022 were obtained from adult cancer survivors identified in the All of Us (AoU) data repository. We evaluated associations between self-reported SM status (heterosexual vs gay, lesbian, bisexual, or other SM minorities) and binary indicators of discrimination in medical settings (any vs. none), perceived stress (high/medium vs low), and neighborhood social cohesion (high/medium vs low) using multivariable logistic regression and stratified models adjusting for sociodemographic and clinical covariates.

In our cohort (N=14,806), 6.3% of survivors reported being a SM. In adjusted models, odds of reporting high/medium levels of perceived stress were 46% (95% CI: 25%, 70%) higher, and odds of low neighborhood social cohesion were 47% (95% CI: 27%, 71%) higher among SM compared to non-SM survivors. In stratified analyses (pinteraction 0.01), among survivors living in states with Republican governors, SM had twice the odds of experiencing discrimination in medical settings (OR: 2.31, 95% CI: 1.50, 3.71) compared to heterosexual survivors. We did not find a significant association in discrimination in the medical setting among SM living in states with Democratic governors.

SM cancer survivors face significant disparities in reported psychosocial stressors, which may impact survivorship outcomes. Associations may differ based on broader political context.

Sexual minority cancer survivors report significantly higher levels of perceived stress and lower neighborhood social cohesion compared to heterosexual survivors. Disparities in medical discrimination were most pronounced among those living in states with Republican governors, highlighting the influence of political context on survivorship experiences.