Employment Status and Poor Adult Health Outcomes Among Lesbian, Gay, and Bisexual Individuals

Austin et al. recently reported on poor adult health among lesbian, gay, and bisexual (LGB) individuals as a function of their exposure to adverse childhood experiences.¹ The authors gathered demographic characteristics for the study and control groups, of which significant differences existed for gender, age, income, employment, and marital status. To control for potential confounding in their statistical analysis, the authors adjusted only for gender, age, income, and marital status. Failing to adjust for employment status represents a noteworthy flaw in the authors’ statistical analyses given that differences in employment status between the study and control groups were significant to P < .001.

Employment, or lack thereof, has been scientifically linked to health status in previous studies.^2,3 Positive correlations have been shown between unemployment and an increased risk of death from heart disease and suicide, as well as increased risks of psychological distress, anxiety or depressive disorders, short- and long-term disability, and current health problems.² Employed individuals tend to have a more rapid recovery from illness. By contrast, unemployed individuals are more likely to become ill, particularly those who have never been employed and those who are of a lower socioeconomic status.³

Considering that the specific employment category noted in the present study is “unable to work,” this could suggest that anyone identifying with this characteristic may have an underlying medical condition or reason for being unemployed. Given the nature of the present study and analyses, employment status may represent a confounding variable capable of skewing final results. When we consider that 12.6% of LGB respondents identified as being unable to work compared with only 5.5% of heterosexual respondents, failing to adjust for employment status could have a significant impact on study results, rendering statistical analysis inaccurate and conclusions unreliable. I commend the authors for enhancing our understanding of the association between exposure to adverse childhood experiences and poor health outcomes in adults among the understudied LGB population. Nevertheless, future research would benefit from a more robust study design and strict experimental protocols aimed at a larger and more inclusive sample of LGB respondents; this would promote more thorough control of potential confounders, allowing the authors to produce comprehensive results and more accurate conclusions.