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. Author manuscript; available in PMC: 2026 May 13.
Published before final editing as: Psychol Sex Orientat Gend Divers. 2026 May 11:10.1037/sgd0000902. doi: 10.1037/sgd0000902

Health Disparities Between Stress-Related Mental Health Conditions and Chronic Physical Health Conditions Among Hispanic and Latinx Sexual and Gender Minority Individuals: Findings from the All of Us Research Program

Caleb Esteban 1,2, Normarie Torres-Blasco 1,2, Mario Bermonti-Pérez 1,2, Lianel Rosario 1,2, Eddiel Hernández-López 1,2
PMCID: PMC13166103  NIHMSID: NIHMS2148530  PMID: 42131369

Abstract

Sexual and gender minority individuals experience significant health disparities, including elevated rates of stress-related mental health conditions and chronic physical health conditions. Among Hispanic and Latinx populations, these disparities are particularly pronounced. They face intersecting minority stressors related to ethnicity, sexual orientation, and gender identity. This study examined the prevalence and association between stress-related mental health conditions and chronic physical health conditions among sexual and gender minorities in both a full sample and a Hispanic/Latinx subsample. Using data from 413,360 participants in the All of Us Research Program, we assessed the likelihood of reporting chronic physical health conditions among sexual and gender minorities with stress-related mental health conditions. Logistic regression analyses were performed, adjusting for age and body mass index, as these are known covariates. Findings indicate that, in the full sample, sexual and gender minorities were more likely to report chronic physical health conditions compared to their cisgender and heterosexual counterparts. Within the Hispanic/Latinx population, sexual minorities groups with stress-related mental health conditions were over twice as likely to report chronic physical health conditions compared to those without such conditions. The association between gender minority status and chronic physical health conditions was stronger than that observed for sexual minority status, underscoring the compounded health risks faced by gender minority individuals. These findings point the urgent need for targeted healthcare interventions. They also highlight important implications for public health policy and clinical practice, particularly the development of culturally responsive strategies to reduce health disparities among sexual and gender minority individuals.

Keywords: Sexual and gender minorities, Hispanic/Latinx, minority stress, chronic physical health conditions, stress-related mental health conditions, health disparities

Introduction

Stress-related mental health conditions refer to psychological disorders or mental health difficulties that arise from chronic or acute stress, such as post-traumatic stress disorder, acute stress disorder, adjustment disorders (Ghasemi et al., 2024; McEwen & Akil, 2020; Van der Kolk, 2014). These conditions are particularly prevalent in socially oppressed populations, such as Hispanics and Latinxs [hereafter referred to as Hispanic/Latinx] (Williams, 2018), which are exposed to cumulative stressors that negatively impact both mental and physical health (Merrick et al., 2018; Tebes et al., 2019). The interplay between chronic psychological distress and physical health outcomes has been documented, with stress serving as a critical risk factor for the development of chronic physical health conditions, including cardiovascular disease, diabetes, and cancer (Stepoe & Kivimäki, 2012). Given these documented disparities and the critical role of chronic stress in shaping both mental and physical health, the present study examines how stress-related mental health conditions and chronic physical health conditions manifest among sexual and gender minority individuals, with particular attention to Hispanic/Latinx populations.

Stress-Related Mental Health Conditions and Chronic Physical Health

Chronic stress dysregulates multiple physiological systems, particularly the hypothalamic-pituitary-adrenal axis, autonomic nervous system, and immune function (Lei et al., 2025), leading to long-term health consequences (Slavich, 2020). Prolonged exposure to stress hormones such as cortisol and catecholamines contributes to systemic inflammation, insulin resistance, and oxidative stress, all increasing vulnerability to chronic illnesses (Yaribeygi et al., 2022). Research has shown that individuals facing persistent psychosocial stressors exhibit higher rates of hypertension, metabolic syndrome, and tumor progression, emphasizing the significant biological toll of chronic psychological distress (Schneiderman et al., 2005). Moreover, chronic stress is linked to immunosuppression, impairing the body’s ability to fight infections and potentially influencing cancer development and progression (Candeias et al., 2024).

Adjustment disorder is considered the most commonly diagnosed stress-related mental health condition, followed by post-traumatic stress disorder and acute stress disorder (Casey et al., 2015; Kazlauskas et al., 2017; O’Donnell et al., 2014). This pattern of prevalence highlights their clinical relevance and supports the rationale for prioritizing these conditions in research on psychological responses to stress. All three disorders share a diagnostic link to identifiable external stressors, making them particularly suitable for studies focused on situational or event-driven mental health outcomes (Davis et al., 2017). In the context of chronic health conditions such as cancer, diabetes, and cardiovascular disease, these stress-related disorders are highly pertinent. The stress related diagnosis often represents a significant psychological stressor that can trigger emotional, cognitive, and behavioral responses. Given the high prevalence of these conditions and their impact on the psychological well-being of individuals with chronic health conditions, studying their association is crucial for the development of effective interventions (Edmondson et al., 2012; Mitchell et al., 2011; Park et al., 2008).

Theoretical Framework: Minority Stress Model and Biopsychosocial Pathways

The Minority Stress Model (Brooks, 1981; Hendricks & Testa, 2012; Meyer, 2003) provides a conceptual framework to understand how external (distal) stressors, such as discrimination, victimization, and structural stigma, and internal (proximal) stress processes, such as concealment and internalized stigma, can lead to chronic psychological distress and physiological dysregulation. For Hispanic/Latinx sexual and gender minority individuals, these minority stress processes operate within broader ethnoracial marginalization, creating intersectional and compounded stress exposure that can intensify inflammatory pathways and increase vulnerability to chronic physical health conditions (Brooks, 1981; Hendricks & Testa, 2012; Meyer, 2003).

This disparity among sexual and gender minorities exacerbates the physical response, which may lead to a chronically activated response (Flentje et al., 2022). The chronically activated response to social adversity leads to inflammatory processes that contribute to the development of metabolic disorders, tumor growth, and the progression of other severe health conditions (Diamond et al., 2021). As a result, Hispanic/Latinx sexual and gender minority individuals are at an increased risk for cardiovascular disease, diabetes, cancer, and others, especially when stress-related mental health conditions are present (Flentje et al., 2025; Ramos-Pibernus et al., 2020).

Hispanic/Latinx and Sexual and Gender Minorities

Individuals who identify as Hispanic/Latinx and as sexual and gender minorities are particularly susceptible to stress-related mental health conditions due to minority stressors such as discrimination, prejudice, and victimization, which conceptualizes how distal and proximal stressors linked to stigmatized identities lead to adverse mental and physical health outcomes (Frost & Meyer, 2023; Roberts et al., 2012; Wilson et al., 2021). These stressors, stemming from the intersections of Hispanic/Latinx-ethnoracism and LGBTQ-negativism, significantly increase the likelihood of developing both stress-related mental health conditions and chronic physical health conditions, such as cancer, cardiovascular diseases, metabolic disorders (Caceres et al., 2023; Flentje et al., 2020; 2025; Schmitz & Tabler, 2021). The elevated risk for these conditions among Hispanic/Latinx sexual and gender minority individuals is closely linked to the unique socioenvironmental adversities they face, such as systemic discrimination, social isolation, and a lack of social support, all of which contribute to a chronic state of stress and inflammation (Candeias et al., 2024; Frost & Meyer, 2023).

Hispanic/Latinx sexual and gender minority individuals face compounded health disparities shaped by intersecting social determinants, including discrimination, limited access to culturally competent care, and socioeconomic disadvantage (Gonzales & Henning-Smith, 2017). Structural barriers such as lack of access to affordable healthcare and higher rates of uninsurance compared to the full sample further exacerbate their physical health vulnerabilities (Kates et al., 2018). When comparing to non-Hispanic Whites, research has consistently shown that Hispanic/Latinx individuals in the United States are more frequently subjected to experience socioenvironmental adversity (Lockwood & Cuevas, 2022; Tebes et al., 2019). These adversities, including exposure to violence and pervasive systemic discrimination, are strongly associated with higher incidences of both stress-related mental health conditions and chronic physical health conditions in this population (Roberts et al., 2012).

Gaps in the Literature

Despite the significant burden of stress-related mental health conditions and chronic physical health conditions among individuals who identify as sexual and gender minorities, particularly within the Hispanic/Latinx population, research on the prevalence and intersection of these conditions remains critically limited (Espinoza et al., 2024). Existing literature has established that chronic stress contributes to adverse health outcomes, yet few studies have systematically examined how stress-related mental health conditions and chronic physical health conditions manifest among individuals who identify as sexual and gender minorities across different ethnic backgrounds, particularly within Hispanic/Latinx communities (Flentje et al., 2022). Understanding these patterns through the lens of the Minority Stress Model is crucial for identifying at-risk populations and developing targeted interventions that address the multilevel stress processes driving both mental and physical health disparities among Hispanic/Latinx sexual and gender minority individuals (Frost & Meyer, 2023; Merrick et al., 2018).

Given social determinants of health faced by Hispanic/Latinx sexual and gender minorities, it is essential to investigate whether the prevalence of stress-related mental health conditions and chronic physical health conditions differs within this group compared to the full sample. The compounded stressors associated with both ethnic and sexual and gender minority identities may increase the risk of both mental and physical health conditions. However, little is known about how sexual orientation and gender minority status independently influence these risks in Hispanic/Latinx populations compared to the broader U.S. population (The Trevor Project, 2023). Furthermore, while studies suggest that chronic stress and adverse experiences contribute to poor physical health outcomes, the extent to which stress-related mental health conditions increases the likelihood of developing chronic physical health conditions remains underexplored (APA, 2012), particularly among individuals who identify as sexual and gender minorities and within Hispanic/Latinx communities (Pinnamaneni et al., 2022).

Current Study

Guided by the Minority Stress Model, this study examines how minority stress processes, embedded in intersecting ethnic and sexual/gender minority identities, are reflected in the prevalence and associations between stress-related mental health conditions and chronic physical health conditions among Hispanic/Latinx sexual and gender minority individuals. By integrating these dimensions, this research will provide critical preliminary insights into the intersection of mental and physical health disparities among Hispanic/Latinx sexual and gender minorities, informing future interventions aimed at reducing health inequities in this marginalized population.

Therefore, this study has three specific aims: (1) to examine the prevalence of stress-related mental health conditions and chronic physical health conditions among individuals who identify as sexual and gender minorities in both the full and Hispanic/Latinx samples; (2) to assess the association between sexual and gender minority status with the likelihood of reporting stress-related mental health conditions and chronic physical health conditions, comparing these relationships within the full and the Hispanic/Latinx samples; and (3) to analyze whether the presence of stress-related mental health conditions increases the likelihood of chronic physical health conditions among sexual and gender minorities and whether this association differs between sexual and gender minority groups in the full and Hispanic/Latinx samples.

Methods

Study Design and Data Source

We conducted a cross-sectional secondary data analysis using the All of Us Research Program dataset, the most comprehensive biomedical dataset in the U.S. with the largest sample of Hispanic/Latinx enrollees to date (National Institutes of Health, 2025; Ramirez et al., 2022). This study was approved by the Ponce Health Sciences University’ Institutional Review Board (Protocol #2308162140). We analyzed the data using the All of Us workbench’s R environment.

We used the cohort builder to select participants who provided data on the main variables of the study (i.e., Hispanic and/or Latinx Identity, Sexual and Gender Minority Identity, Stress-Related Mental Health Conditions, Chronic Physical Health Conditions). We extracted the data about Stress-Related Mental Health Conditions from the electronic health records in the conditions tables since not all conditions were present in the self-report measures.

Cohort Selection

All other data was extracted from self-reports in the survey tables. For sex assigned at birth, sexual orientation and gender identity, each variable was recoded as a dichotomous variable [Intersex = Sex Minority, & Female and Male = Non-Sex Minority; Gay, Lesbian, Bisexual, and None of Those = Sexual Minority, & Straight = Non-Sexual Minority; Non-Binary, Transgender, and None of these = Gender Minority, & Man and Woman = Non-Gender Minority] so that they represented not belonging to the specific sexual and gender minorities (i.e., reference value) or identifying as sex, sexual, and gender minorities. Participants who reported their sex assigned at birth as intersex were coded as a sex assigned at birth minority, while all other categories were coded as not a minority (i.e., reference value). However, these data could not be analyzed in the model due to the small number of persons who identified as, or reported being, intersex, since statistical assumptions were not met. In addition, for this analysis, participants who selected ‘woman’ or ‘man’ were operationalized as cisgender women and cisgender men, respectively. However, because non-binary and transgender individuals may also select ‘woman’ or ‘man’, these categories may include some non-binary and/or transgender participants.

Chronic physical health conditions were coded as not having been diagnosed (i.e., reference value) with diabetes, cancer, or heart disease vs having been diagnosed with any of these chronic physical health conditions. Stress-related mental health conditions were coded as not having been diagnosed (i.e., reference value) with post-traumatic stress disorder, acute stress disorder, adjustment disorders vs having been diagnosed with any of these stress-related mental health conditions. Participants who self-identified as Hispanic, Latino, or Spanish in the ethnicity question, independently of race, were coded as H/L, while other ethnicities were coded as non-H/L. Race and ethnicity were treated as distinct constructs in this study, we focused our analyses on ethnicity by comparing participants who self-identified as Hispanic and/or Latinx to those who did not. Individuals identifying as Hispanic/Latinx encompass diverse racial backgrounds; however, within-group analyses by racial subgroups were not conducted due to our primary analytic focus on ethnic disparities. The chronological age at the time of the analyses was calculated using the R code snippets provided by the All of Us Research Program. Body mass index [BMI] was calculated by averaging observations per participant.

Statistical Analysis

Only participants with complete data were included in the analyses. No data imputation procedures were applied. This complete-case approach was used to minimize bias associated with missing data (Little & Rubin, 2019). We calculated prevalence as the percentage of persons that reported meeting the criteria (e.g., heart disease, posttraumatic stress disorder) in the overall All of Us dataset. All other analyses conducted were Logistic regression models, setting hypotheses tests to two-tailed, alpha to .05, odds ratios (OR) with 95% confidence intervals, and adjusting for chronological age at the time of the analyses and BMI, as these are known covariates of chronic physical health conditions and stress related mental health conditions (Afzal et al., 2021; Hautekite et al., 2022). The analysis examining the relationship between gender minority status and chronic physical health conditions in the Hispanic/Latinx sample was not adjusted for BMI due to multicollinearity with other predictors. Bootstrap resampling using 1,000 replications was applied to calculate robust standard errors and confidence intervals when the assumption of no outliers was violated. Exact logistic regression was implemented to examine the relationship between stress-related mental health conditions and chronic physical health conditions in gender minorities due to its small sample size. All other assumptions were met by statistical models.

Sample

A total of 413,360 participants data were included in this study. The mean age of the sample was 56 years (SD = 17). The majority of participants identified as cisgender women (61%) and heterosexual (90%), and 20% self-identified as Hispanic/Latinx (see Table 1).

Table 1.

Demographics Data and Prevalence of Main Variables

Variable N f
Gender 407,921
 Woman 248,788 (61%)
 Man 155,087 (38%)
 Non binary 2,198 (0.5%)
 Transgender 1,429 (0.4%)
 Additional Options 419 (0.1%)
  Missing data 3,383
Sex Assigned at Birth 407,462
 Female 251,253 (62%)
 Male 155,956 (38%)
 None of these 153 (<0.1%)
 Intersex 100 (<0.1%)
  Missing data 3,842
Sexual Orientation 401,360
 Heterosexual 360,339 (90%)
 Bisexual 16,256 (4.1%)
 Gay 9,889 (2.5%)
 None 9,282 (2.3%)
 Lesbian 5,594 (1.4%)
  Missing data 9,944
SRMHC
Acute Stress Disorder 413,360
 No 404,644 (98%)
 Yes 8,716 (2.1%)
Adjustment Disorder 413,360
 No 390,042 (94%)
 Yes 23,318 (5.6%)
Post-Traumatic Stress Disorder 413,360
 No 399,398 (97%)
 Yes 13,962 (3.4%)
CPHC
Diabetes 71,919
 No 57,356 (80%)
 Yes 14,563 (20%)
  Missing data 341,441
Cancer 71,919
 No 55,084 (77%)
 Yes 16,835 (23%)
  Missing data 341,441
Heart Disease 71,919
 No 26,461 (37%)
 Yes 45,458 (63%)
  Missing data 341,441
Mean BMI 322,256 30 (7)
  Missing data 91,104
Age 322,256 56 (17)
  Missing data 91,104
Ethnicity 322,256
 Not Hispanic or Latinx 254,422 (79%)
 Hispanic and/or Latinx 64,375 (20%)
 None of these 3,459 (1.1%)
  Missing data 91,104
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Note. Absolute and relative frequencies are presented for categorical data, and means and standard deviations, are presented for continuous data. Gender identity categories reflect responses in the All of Us self-report survey. Participants could select man, woman, non-binary, transgender, or none of these describe me. Non-binary and transgender participants may select woman or man without selecting non-binary or transgender. Thus, the categories labeled “woman” and “man” may include non-binary and/or transgender individuals.

Results

Aim 1: Prevalence of Stress-Related Mental Health Conditions and Chronic Physical Health Conditions

Results showed that in the full sample, the prevalence of chronic physical health conditions was 63% for heart disease, 23% for cancer, and 20% for diabetes. Additionally, 9.1% of the total sample reported a stress-related mental health condition, with adjustment disorder being the most common (5.6%), followed by post-traumatic stress disorder (3.4%) and acute stress disorder (2.1%). When examining participants who identified as sexual and gender minority individuals, results showed that 12% of sexual minority individuals in the Hispanic/Latinx population reported having a stress-related mental health condition, compared to 9.8% of their heterosexual counterparts. Similarly, among gender minority individuals in the Hispanic/Latinx population, 12% reported a stress-related mental health condition, compared to 10% of cisgender individuals. These patterns were consistent in the full sample, where 10% of sexual minority and 12% of gender minority individuals reported a stress-related mental health condition, both higher than their heterosexual and cisgender counterparts (see Tables 2 and 3).

Table 2.

Prevalence of Main Variables by Ethnicity

Variable n Hispanic and/or Latinx Not Hispanic or Latinx None of These
Gender 320,970
 Woman 42,606 (66%) 148,367 (59%) 1,932 (56%)
 Man 21,235 (33%) 102,956 (41%) 1,451 (42%)
 Non binary 163 (0.3%) 1,067 (0.4%) 31 (0.9%)
 Transgender 116 (0.2%) 770 (0.3%) < 20a
 Additional Options 39 (<0.1%) 208 (<0.1%) 17 (0.5%)
  Missing data 448 2,098 36
Sex assigned at birth 320,465
 Female 42,845 (67%) 149,282 (59%) 1,968 (57%)
 Male 21,241 (33%) 103,500 (41%) 1,460 (42%)
 Intersex < 20a 54 (<0.1%) < 20a
 None of these < 20a 65 (<0.1%) 13 (0.4%)
  Missing data 491 2,565 31
Sexual orientation 315,708
 Heterosexual 56,627 (91%) 226,915 (91%) 2,876 (86%)
 None of these 1,973 (3.2%) 4,638 (1.9%) 157 (4.7%)
 Bisexual 1,896 (3.0%) 9,214 (3.7%) 175 (5.2%)
 Gay 1,237 (2.0%) 5,940 (2.4%) 80 (2.4%)
 Lesbian 617 (1.0%) 3,317 (1.3%) 46 (1.4%)
  Missing data 2,257 5,442 145
Stress related mental health conditions 322,256
 No 57,907 (90%) 225,868 (89%) 2,962 (86%)
 Yes 6,468 (10%) 28,554 (11%) 497 (14%)
  Missing data 0 0 0
SRMHC
Acute Stress Disorder 322,256
 No 62,951 (98%) 247,645 (97%) 3,365 (97%)
 Yes 1,424 (2.2%) 6,777 (2.7%) 94 (2.7%)
  Missing data 0 0 0
Adjustment Disorder 322,256
 No 60,281 (94%) 236,630 (93%) 3,201 (93%)
 Yes 4,094 (6.4%) 17,792 (7.0%) 258 (7.5%)
  Missing data 0 0 0
Post-Traumatic Stress Disorder 322,256
 No 61,995 (96%) 244,047 (96%) 3,213 (93%)
 Yes 2,380 (3.7%) 10,375 (4.1%) 246 (7.1%)
  Missing data 0 0 0
CPHC
Diabetes 53,391
 No 5,112 (79%) 36,657 (79%) 318 (72%)
 Yes 1,377 (21%) 9,806 (21%) 121 (28%)
  Missing data 57,886 207,959 3,020
Cancer 53,391
 No 5,664 (87%) 34,365 (74%) 350 (80%)
 Yes 825 (13%) 12,098 (26%) 89 (20%)
  Missing data 57,886 207,959 3,020
Heart Disease 53,391
 No 3,002 (46%) 16,039 (35%) 136 (31%)
 Yes 3,487 (54%) 30,424 (65%) 303 (69%)
  Missing data 57,886 207,959 3,020
Mean BMI 322,256 31 (7) 30 (8) 30 (7)
Age 322,256 50 (16) 58 (17) 56 (16)
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Note. Absolute and relative frequencies are presented for categorical data. Mean and standard deviation are presented for continuous data.

a

The exact number of participants cannot be presented due to All of Us privacy regulations.

Table 3.

Prevalence of Main Variables by Sexual and Gender Minority Status

SRMHC Hispanic and/or Latinx Sample Full Sample
No Yes No Yes
Sexual Orientation
 Heterosexual 50,959 (90%) 5,562 (9.8%) 327,618 (91%) 32,030 (8.9%)
 Sexual Minorities 4,893 (88%) 689 (12%) 35,178 (90%) 4,068 (10%)
Gender Identity
 Cisgender 57,158 (90%) 6,372 (10%) 365,295 (91%) 36,399 (9.1%)
 Gender Minorities 320 (88%) 45 (12%) 3,279 (88%) 429 (12%)
CPHC Hispanic and/or Latinx Sample Full Sample
No Yes No Yes
Sexual Orientation
 Heterosexual 2,168 (38%) 3,501 (62%) 17,763 (29%) 44,224 (71%)
 Sexual Minorities 280 (43%) 376 (57%) 2,754 (36%) 4,989 (64%)
Gender Identity
 Cisgender 2,474 (39%) 3,916 (61%) 20,354 (29%) 49,093 (71%)
 Gender Minorities 28 (42%) 38 (58%) 343 (41%) 499 (59%)
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Chronic physical health conditions were also more prevalent among gender minority, but not for sexual minority individuals. In the Hispanic/Latinx population, 57% of sexual minority individuals reported a chronic physical health condition, compared to 62% of heterosexual individuals. Among gender minority individuals, 58% reported a chronic physical health condition, compared to 61% of cisgender individuals. A similar pattern was observed in the full sample, where 64% of sexual minority and 59% of gender minority individuals reported a chronic physical health condition (see Table 3).

Our results also showed that sexual minority individuals are 1.39 times more likely to report experiencing stress-related mental health conditions in the full sample, when compared with heterosexual individuals (Odds Radio [OR] = 1.39, 95% CI [1.34, 1.44], p < .001), after adjusting for chronological age and BMI. This association is consistent in the Hispanic/Latinx population (OR = 1.36, 95% CI [1.25, 1.46], p < .001), after adjusting for chronological age and BMI. Gender minority individuals are 1.91 times more likely to report stress-related mental health conditions in the full sample, when compared with cisgender individuals (OR = 1.91, 95% CI [1.72, 2.13], p < .001), after adjusting for chronological age and BMI. This effect was smaller and did not reach statistical significance in the Hispanic/Latinx population (OR = 1.37, 95% CI [0.98, 1.79], p = 0.06), after adjusting for chronological age and BMI.

Regarding chronic physical health conditions, sexual orientation minority individuals are 1.24 times more likely to report chronic physical health conditions in the full sample, when compared with heterosexual individuals (OR = 1.24, 95% CI [1.16, 1.32], p < .001), after adjusting for chronological age and BMI. The effect was smaller in the Hispanic/Latinx population (OR = 1.15, 95% CI [0.97, 1.39], p = 0.11), after adjusting for chronological age and BMI. Gender minority individuals are 1.60 times more likely to report chronic physical health conditions in the full sample, when compared with cisgender individuals (OR = 1.60, 95% CI [1.32, 1.94], p < .001), after adjusting for chronological age and BMI. This effect is consistent in the Hispanic/Latinx population in its magnitude, but it did not reach statistical significance (OR = 1.61, 95% CI [0.97, 2.70], p = .07), after adjusting for chronological age.

Aim 2: Association Between Stress-Related Mental Health Conditions and Chronic Physical Health Conditions

When examining the association between stress-related mental health conditions and chronic physical health conditions in sexual minority individuals in full sample, individuals who reported stress-related mental health conditions are 1.62 times more likely to report chronic physical health conditions (OR = 1.62, 95% CI [1.34, 1.97], p < .001), after adjusting for chronological age and BMI. This effect was larger in the Hispanic/Latinx population (OR = 2.58, 95% CI [1.53, 4.73], p < .001), after adjusting for chronological age and BMI. In gender minority individuals in the full sample, individuals who reported stress-related mental health conditions are 2.07 times more likely to report chronic physical health conditions (OR = 2.07, 95% CI [1.24, 3.52], p < .001), after adjusting for chronological age and BMI. This effect was smaller and not statistically significant in the Hispanic/Latinx population (OR = 1.80, 95% CI [0.052, 7.02], p = 0.36), after adjusting for chronological age and BMI (see Tables 4 and 5).

Table 4.

Examination of Sexual and Gender Minorities [SGM] on SRHMC and CPHC Adjusted for Age and BMI among the Full and Hispanic/Latinx Samples

SGM Full Sample Hispanic and/or Latinx Sample
OR 95% CI P n OR 95% CI p n
Effect on SRMHC
 Sexual Orientation 1.39 [1.34, 1.44]a < .001 314,296 1.36 [1.25, 1.46]a < .001 62,103
 Gender Identity 1.91 [1.72, 2.13]a < .001 319,527 1.37 [0.98, 1.79]a .06 63,895
Effect on CPHC
 Sexual Orientation 1.24 [1.16, 1.32] < .001 53,419 1.15 [0.97, 1.39]a .11 6,325
 Gender Identity 1.60 [1.32, 1.94] < .001 53,887 1.61b [0.97, 2.70]b .07b 6,456b
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Note.

a

Bootstrap resampling using 1,000 replications.

b

Not adjusted for BMI because it presented multicollinearity with other predictors.

Table 5.

Examination of SRMHC on CPHC Adjusted for Age and BMI for Each Sexual and Gender Minorities [SGM] Group Among the Full and Hispanic/Latinx Samples Applying Bootstrap Resampling

SGM Ful Sample Hispanic and/or Latinx Sample
OR 95% CI P n OR 95% CI p n
SRMHC
Sexual Orientation 1.62 [1.34, 1.97] < .001 5,243 2.58 [1.53, 4.73] < .001 656
Gender Identity 2.07 [1.24, 3.52] < .001 524 1.80a [.052, 7.02]a .36a 66
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Note.

a

Exact logistic regression.

Aim 3: Stress-Related Mental Health Conditions Increasing the Likelihood of Chronic Physical Health Conditions

Additionally, comorbidities between stress-related mental health conditions and chronic physical health conditions were more prevalent among sexual and gender minority groups. In the Hispanic/Latinx population, 18% of sexual minority individuals with a stress-related mental health condition also reported a chronic physical health condition, compared to only 7.9% of heterosexual individuals. Among gender minority individuals, 29% of those with a stress-related mental health condition also reported a chronic physical health condition, compared to 14% of cisgender individuals. These disparities were also present in the full sample, where 12% of sexual minority and 17% of gender minority individuals with a stress-related mental health condition reported a chronic physical health condition, both higher than their heterosexual and cisgender counterparts (see Table 6).

Table 6.

Prevalence of Comorbidities between SRMHC and CPHC among Sexual and Gender Minorities

SRMHC
CPHC Hispanic and/or Latinx Sample Full Sample
No Yes No Yes
Sexual Orientation
 Heterosexual 258 (92%) 22 (7.9%) 2,552 (93%) 202 (7.3%)
 Sexual Minorities 307 (82%) 69 (18%) 4,386 (88%) 603 (12%)
Gender Identity
 Cisgender 24 (86%) 4 (14%) 314 (92%) 29 (8.5%)
 Gender Minorities 27 (71%) 11 (29%) 414 (83%) 85 (17%)
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Discussion

This study aimed to examine the prevalence and association between stress-related mental health conditions and chronic physical health conditions among sexual and gender minority individuals, with a particular focus on Hispanic/Latinx populations. Our findings highlight significant health disparities, as both sexual and gender minority groups were more likely to report stress-related mental health conditions and chronic physical health conditions compared to their heterosexual and cisgender counterparts. Notably, there are higher comorbidities between stress-related mental health conditions and chronic physical health conditions. Among sexual minority individuals in the Hispanic/Latinx population, where individuals with stress-related mental health conditions were more than twice as likely to report chronic physical health conditions compared to those without these conditions.

Despite the smaller sample size for gender minority individuals, particularly within the Hispanic and Latinx populations, our study’s representation of this group remains consistent with existing research, which often faces similar constraints in data availability. Additionally, our sample of gender minority individuals is more extensive than many previous studies examining this population, allowing for meaningful insights despite its limitations. Meanwhile, this sample of gender minority individuals is substantially larger than what is typically observed in similar studies, strengthening the statistical power of our findings and allowing for a more robust analysis of health disparities (Robertson et al., 2021). When comparing our results to the full sample, the disparities observed in sexual and gender minority populations are evident, reinforcing the need to examine further how the intersection of sexual orientation, gender identity, and ethnicity contributes to long-term health risks.

A key finding of this study is that minority status, whether based on sexual orientation or gender identity, is associated with an increased likelihood of reporting stress-related mental health conditions and chronic physical health conditions. Consistent with the Minority Stress Model, our findings suggest that exposure to chronic stressors, including discrimination, social marginalization, and barriers to healthcare, contributes to physiological dysregulation, leading to adverse health outcomes (Brooks, 1981; Flentje et al., 2025; Frost & Meyer, 2023; Hendricks & Testa, 2012; Meyer, 2003). These results are consistent with broader literature suggesting that prolonged exposure to stress may contribute to physiological processes, such as inflammation and metabolic dysregulation, that are associated with increased risk for chronic physical health conditions, including cardiovascular disease, diabetes, and cancer (Flentje et al., 2020; 2022; 2025; Schneiderman et al., 2005). Additionally, we found that gender minority status is more strongly associated with chronic physical health conditions than sexual minority status, highlighting the heightened vulnerability of transgender and non-binary individuals (Hafeez et al., 2017).

Although the association between gender minority status and chronic physical health conditions did not reach statistical significance within the Hispanic and Latinx population, this finding warrants careful interpretation. One plausible explanation is underreporting due to reduced engagement with healthcare services among gender minority individuals. Prior research has shown that transgender and gender non-binary individuals often delay or avoid seeking care due to experiences of stigma, discrimination, and a lack of culturally competent providers (Hafeez et al., 2017; Ramos-Pibernus et al., 2016). This medical mistrust may result in the underdiagnosis or underdocumentation of chronic physical health conditions in this population, thus contributing to the null statistical finding.

At the same time, it is also possible that some gender minority individuals within Hispanic and Latinx communities have developed resilience-based strategies (e.g., adaptive coping mechanisms) that may buffer the physiological effects of chronic stress. These strengths-based processes may play a protective role in mitigating the onset or progression of physical health conditions, even in the face of significant adversity. However, given the structural barriers to healthcare access that this population continues to face, we interpret the finding with caution and advocate for further research to disentangle the roles of underreporting and resilience in shaping health outcomes (Ramos-Pibernus et al., 2020; White-Hughto, 2015).

Furthermore, our study provides new preliminary insights into how the intersection of ethnicity, sexual orientation, and gender identity influences health outcomes. While sexual minority individuals in the full sample were significantly more likely to report chronic physical health conditions when compared to heterosexual individuals, this effect was smaller and not statistically significant among gender minority individuals within the Hispanic/Latinx population. This suggests that additional factors may be influencing health outcomes among Hispanic/Latinx gender minority individuals, warranting further investigation (Cabral & Cuevas, 2020). Specifically, the elevated risk of comorbidities between these conditions’ points to a critical public health concern, as individuals facing chronic stressors (e.g., discrimination, social marginalization, and barriers to healthcare) are more likely to experience negative physiological outcomes like inflammation, metabolic dysfunction, and increased risk for diseases like cardiovascular disease, diabetes, and cancer (Flentje et al., 2020).

These findings are critical for advancing our understanding of the unique health challenges faced by individuals who identify as sexual and gender minority individuals, particularly within the Hispanic/Latinx population (Gonzales & Connelly, 2025). This study highlights the urgent need for integrative and preventive healthcare approaches that address both mental and physical health disparities. The elevated risk of chronic physical health conditions among individuals with stress-related mental health conditions underscores the importance of early intervention, culturally competent healthcare, and policies that mitigate minority stressors such as discrimination and inadequate access to care (Hatzenbuehler et al., 2024). Addressing these disparities is essential to reducing long-term health burdens and improving the overall psychological and social well-being and quality of life of sexual and gender minority individuals, ensuring equitable healthcare outcomes for these historically marginalized populations (Lu et al., 2025).

Strengths and Limitations

This study has several strengths. It represents one of the largest research projects to date examining the intersection of sexual orientation, gender identity, and ethnicity in relation to stress-related mental health conditions and chronic physical health conditions. Additionally, our use of a nationally representative dataset enhances the generalizability of our findings, providing a more comprehensive understanding of health disparities among individuals who identify as sexual and gender minorities.

Despite these contributions, this study has some limitations. While our overall sample size was substantial, the smaller representation of gender minority individuals within the Hispanic/Latinx population limited the inference of certain findings. However, even with this limitation, the gender minority sample in this study remains larger than that of many previous studies examining this population. Additionally, the cross-sectional nature of the database and this study prevents us from making causal inferences about the relationship between stress-related mental health conditions and chronic physical health conditions. Although our analytic approach focused on sexual and gender minority status broadly, we did not disaggregate by sex assigned at birth (e.g., female, male, intersex), sexual orientation (e.g., lesbian, gay, plurisexual, asexual), or gender identity (e.g., transgender, gender non-binary), which may mask important differences in physical and mental health outcomes. An important measurement limitation of this study involves the gender identity response options in the All of Us Research Program dataset. Although the survey includes distinct response options for woman, man, non-binary, and transgender, non-binary and transgender participants may select woman or man without selecting non-binary and transgender options. As a result, the categories labeled as cisgender woman and man in this study may include some non-binary and transgender individuals. Furthermore, although we aimed to examine disparities between intersex (sex assigned at birth minority) and endosex participants, the small number of intersex individuals in the dataset prevented us from including this variable in the final models without violating statistical assumptions.

Additionally, this study cannot determine whether the stress-related mental health conditions reported by participants were directly related to their sexual, gender, or ethnic minority identities. The All of Us dataset does not include measures specifying the sources or contexts of participants’ stress-related diagnoses. Therefore, while our interpretations draw on established minority stress frameworks, we cannot infer that these mental health conditions are a consequence of minority stress experiences.

Future Studies

Future research should expand on these findings by investigating additional stress-related mental health conditions and chronic physical health conditions to provide a more comprehensive understanding of the long-term health impacts faced by individuals who identify as sexual and gender minorities. While this study focused on post-traumatic stress disorder, acute stress disorder, and adjustment disorders, future studies should explore other stress-related mental health conditions, such as generalized anxiety disorder, major depressive disorder, and complex trauma, which may further contribute to chronic disease risk. Similarly, research should examine a broader range of chronic physical health conditions, including autoimmune disorders, neurological conditions, and respiratory diseases, to assess the full scope of health disparities affecting these populations.

Building on the limitations noted earlier, future studies should also separate analyses by sex assigned at birth and sexual orientation and gender identity categories. This will allow for a more nuanced understanding of how specific identities (e.g., intersex, plurisexual, non-binary) experience differential exposures to stress and health. Special attention should be given to increasing the representation of intersex individuals in large-scale datasets to enable meaningful analysis of this historically underrepresented group.

Although the All of Us dataset distinguishes between ethnicity and race, enabling the identification of both White and non-White Hispanic/Latinx individuals, our analysis used the Hispanic/Latinx category as defined in the dataset. This broad categorization may still limit visibility of important within-group differences. Future research grounded in intersectionality should structure ethnicity and race questions in ways that capture the compounding effects of ethnoracism among Hispanic/Latinx LGBTQ+ individuals, thereby avoiding the assumption of a “raceless Latinidad” (Adames et al., 2021).

In addition, future studies should aim to develop targeted intervention models that address the intersection of stress-related mental health conditions and chronic physical health conditions among sexual and gender minorities. These models should incorporate a biopsychosocial framework that accounts for biological, psychological, social, and structural determinants of health. By considering factors such as systemic discrimination, healthcare access, minority stress, and physiological dysregulation, these interventions can more effectively mitigate the negative health outcomes associated with chronic stress. Longitudinal studies are also needed to better understand the causal pathways between stress-related mental health conditions and chronic physical health conditions, as well as the role of protective factors such as resilience, social support, and affirming healthcare practices. By integrating these dimensions, future research can contribute to the development of comprehensive, equity-driven health policies and interventions that improve the well-being and quality of life of individuals who identify as sexual and gender minorities, particularly within Hispanic/Latinx communities.

Conclusion

Our findings provide preliminary critical insights into the intersection of sexual orientation, gender identity, and ethnicity in shaping health disparities. Given the disproportionate burden of both stress-related mental health conditions and chronic physical health conditions among individuals who identify as sexual and gender minorities, particularly within the Hispanic/Latinx population, targeted healthcare interventions are urgently needed. Public health efforts should focus on increasing access to culturally competent mental health services, addressing systemic discrimination in healthcare settings, and implementing preventive measures to mitigate the physiological consequences of chronic stress. By addressing these disparities, we can move toward more equitable health outcomes for sexual and gender minority individuals, especially for Hispanic/Latinx communities.

Public Significance Statement.

This study highlights the significant health disparities faced by sexual and gender minorities, particularly within Hispanic and Latinx communities. Findings show that individuals with stress-related mental health conditions are at higher risk of developing chronic physical health conditions, emphasizing the need for targeted healthcare interventions. Addressing these disparities through culturally competent care and minority stress-informed policies is essential to improving health outcomes in these marginalized populations.

Acknowledgments

We sincerely thank the participants of the All of Us Research Program for their invaluable contributions, without whom this research would not have been possible. We also acknowledge the National Institutes of Health’s All of Us Research Program for providing access to the participant data used in this study. Additionally, we extend our gratitude to the Hispanic Alliance for Clinical and Translational Research (Alliance) and the Hispanics in Research Capability (HiREC) for supporting this work through the 2023 Alliance/HiREC Small Grant Award. Lastly, we appreciate the Ponce Research Institute (PRI) and the Office of Research and Development (ORD) at Ponce Health Sciences University (PHSU) for their assistance in grant management.

Funding

The project described was supported by the 2023 Alliance/HiREC Small Grant Award of the Hispanic Alliance for Clinical and Translational Research (Alliance) who is supported by the National Institute of General Medical Sciences (NIGMS) National Institutes of Health under the Award Number U54GM133807 in collaboration with the Hispanic for Research Capability (HiREC) who is supported by the National Institute on Minority Health and Health Disparities (NIMHD) under the Award Number S21MD001830. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Footnotes

Note on Terminology

The term Latinx is used throughout this manuscript to align with the inclusive terminology adopted in U.S.-based academic and public health contexts. Although the All of Us dataset identifies participants using the category Latino/Hispanic, the term Latinx was selected to reflect gender diversity within this population and to avoid gendered binary constructions (Latino/Latina). The alternative term Latine is increasingly used in Spanish-speaking countries; however, we recognize that its usage remains debated, as some individuals view it as inclusive (gender-neutral), while others consider it exclusive when used primarily to make nonbinary identities visible within a binary linguistic structure (Pew Research Center, 2024).

Ethics approval and consent to participate

This study was approved as exempt by the Institutional Review Board (IRB) of the Ponce Health Sciences University (#2308162140). All methods were carried out in accordance with relevant guidelines and regulations.

Consent for publication

This study used de-identified participant data from the All of Us Research Program. All participants provided broad consent for the use of their data in research, and this study complies with the All of Us data use policies and ethical guidelines.

Competing interests

The authors declare that they have no competing interests.

Availability of data and materials

The datasets used and/or analyzed during the current study are available through the Researcher Workbench at https://researchallofus.org. Requests for additional information about the findings presented in this study may be directed to the corresponding author.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The datasets used and/or analyzed during the current study are available through the Researcher Workbench at https://researchallofus.org. Requests for additional information about the findings presented in this study may be directed to the corresponding author.

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