Investigating Sex Differences in the Association of Disclosure and Concealment of Sexual Minority Identity with Cardiovascular Health in the CARDIA Cohort at Year 35

Objective: Sexual minority (SM) populations experience worse cardiovascular health than heterosexual populations. One potential pathway is the effects of disclosure (sharing) or concealment (withholding) of SM identity due to anticipated discrimination. However, no studies have investigated the association between disclosure or concealment and cardiovascular health. We assess 1) if higher rates of sexual orientation identity concealment and lower rates of disclosure associate with lower odds of having ideal cardiovascular health and 2) if these findings vary by sex. Methods: We performed a cross-sectional analysis of LGB (lesbian, gay, bisexual) participants who completed disclosure and concealment assessments in the Year 35 examination of the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Concealment and disclosure were calculated as a composite score comprised of the sum of weighted answers across five social contexts; higher scores represent higher concealment or disclosure. Cardiovascular health (CVH) was assessed using components from the American Heart Association’s Life’s Simple 7 (LS7). Adjusted linear or logistic regression models were performed to examine the association of outness and disclosure with total LS7 score and CVH components. Results: The sample included 50 SM men and 51 SM women; mean age of 61 years (SD=3.5). Contrary to our hypothesis, increased concealment and decreased disclosure was associated with higher CVH in select contexts. In females, higher concealment was associated with higher total LS7 score. All SMs with high concealment had target cholesterol versus 30% in SMs with low concealment. Sex did not modify the relationship between binary disclosure/concealment and CVH but sensitivity analysis with continuous disclosure/concealment measures suggested potential modification by sex. Conclusions: Concealment and disclosure were not associated with most CVH indicators in SMs.