Discrimination, Violence, Mental Health, and Substance Use by Age and Cancer History Among LGBTQ plus Individuals

Background: Young adult (YA) LGBTQ+ cancer survivors face inequities and unmet needs that impact their well-being. However, the impact of age and cancer among LGBTQ+ individuals have not been adequately assessed.Methods: The North Carolina LGBTQ+ Health Needs Assessment survey, conducted at local Pride events, aimed to collect data to describe the well-being of LGBTQ+ people in NC. Chi-squared tests and multivariable logistic regression models controlling for demographic factors were used to assess age and cancer-related differences in discrimination, violence, mental health, and substance use outcomes among LGBTQ+ individuals.Results: A total of N = 3170 LGBTQ+ individuals took part in the survey, n = 89 of which were YA (aged 18-39) cancer survivors and n = 111 of which were middle to older adult (M/OA, age 40+) cancer survivors. In bivariate analyses, YA LGBTQ+ cancer survivors reported significantly more LGBTQ+ violence (43.8%), sexual assault (61.4%), experiencing homelessness (33.7%), post-traumatic stress disorder (32.6%), cocaine use (16.9%), opioid use (15.7%), and having ever accidental overdose (43.8%) in comparison with YAs without a cancer history as well as M/OA with and without a cancer history. In multivariable models, YA LGBTQ+ survivors remained at elevated odds of all outcomes in comparison with M/OA survivors without a cancer history. Outcomes varied by intersecting identities among YA survivors.Conclusions: The overlap of anti-LGBTQ+ stigma and discrimination, being young, and having been diagnosed with cancer positions YA LGBTQ+ cancer survivors to experience a higher burden of serious and life-threatening outcomes.