This cross-sectional study examines differences in lifetime prevalence of skin cancer across racial and ethnic groups by sexual orientation among US adults.
Key Points
Question
Does the association between sexual orientation and lifetime prevalence of skin cancer differ across racial and ethnic groups among US adult females and males?
Findings
In this cross-sectional study of 1 512 400 US adults, lifetime prevalence of skin cancer was higher among Hispanic and non-Hispanic Black sexual minority (SM) males compared with their heterosexual counterparts. Lifetime prevalence of skin cancer was lower among non-Hispanic White SM females but higher among Hispanic and non-Hispanic Black SM females compared with their heterosexual counterparts.
Meaning
In this study, differences in lifetime prevalence of skin cancer among SM adults compared with heterosexual adults varied across race and ethnicity among females and males.
Abstract
Importance
Sexual minority (SM) persons have been found to have differential rates of skin cancer, but limited data exist on differences across racial and ethnic groups and by individual sexual identities.
Objective
To examine differences by sexual orientation in the lifetime prevalence of skin cancer among US adult females and males across racial and ethnic groups and by individual sexual identity.
Design, Setting, and Participants
This cross-sectional study used data from the Behavioral Risk Factor Surveillance System from January 1, 2014, to December 31, 2021, for US adults from the general population. Data were analyzed from December 1, 2023, to March 1, 2024.
Main Outcomes and Measures
Self-reported lifetime prevalence of skin cancer by sexual orientation. Age-adjusted prevalence and adjusted prevalence odds ratios (AORs) compared heterosexual and SM adults in analyses stratified by individual race.
Results
Of 1 512 400 participants studied, 805 161 (53.2%) were heterosexual females; 38 933 (2.6%), SM females; 638 651 (42.2%), heterosexual males; and 29 655 (2.0%), SM males. A total of 6.6% of participants were Hispanic; 3.4%, non-Hispanic Asian, Pacific Islander, or Hawaiian; 7.5%, non-Hispanic Black; 78.2%, non-Hispanic White; and 4.3%, other race and ethnicity. Mean (SE) age was 48.5 (0.03) years (incomplete data for age of respondents ≥80 years). The lifetime prevalence of skin cancer was overall higher among SM males compared with heterosexual males (7.4% vs 6.8%; AOR, 1.16; 95% CI, 1.02-1.33), including specifically among Hispanic males (4.0% vs 1.6%; AOR, 3.81; 95% CI, 1.96-7.41) and non-Hispanic Black males (1.0% vs 0.5%; AOR, 2.18; 95% CI, 1.13-4.19) in analyses stratified by race and ethnicity. Lifetime prevalence rates were lower among SM females compared with heterosexual females among non-Hispanic White females (7.8% vs 8.5%; AOR, 0.86; 95% CI, 0.76-0.97) and were higher among Hispanic (2.1% vs 1.8%; AOR, 2.46; 95% CI, 1.28-4.70) and non-Hispanic Black (1.8% vs 0.5%; AOR, 2.33; 95% CI, 1.01-5.54) females in analyses stratified by race and ethnicity.
Conclusions and Relevance
In this cross-sectional study of US adults, differences in the lifetime prevalence of skin cancer among SM adults compared with heterosexual adults differed across racial and ethnic groups and by individual sexual identity among both females and males. Both Hispanic and non-Hispanic Black and SM females and males had higher rates of skin cancer compared with their heterosexual counterparts. Further research addressing the individual factors contributing to these differences is needed to inform screening guidelines and public health interventions focused on these diverse, heterogeneous populations.
Introduction
Skin cancer is the most common cancer in the US.1 Sexual minority (SM) people, including those who identify as bisexual, gay, lesbian, and other nonheterosexual identities, have differential rates of skin cancer. Compared with heterosexual males, SM males were reported to have higher rates of skin cancer,2,3 including both keratinocyte carcinomas and melanoma2; conversely, SM females, particularly bisexual females,3 were reported to have lower rates of keratinocyte carcinomas.2 These differences are likely at least partially associated with unique UV radiation (UVR) exposure behaviors. For instance, SM males reported high rates of indoor tanning and poor outdoor sun protection behaviors.1,2,4
Sexual minority populations are heterogeneous, and limited data exist on the association between race and ethnicity and individual sexual identities (ie, bisexual, gay or lesbian, and other sexual identities as separate groups) on skin cancer prevalence among SM people. Race and ethnicity have been shown to be associated with skin cancer risk and related behavioral risk factors. While non-Hispanic White (hereafter, White) individuals have the highest incidence of melanoma and keratinocyte carcinomas,5 racial and ethnic minority individuals may experience delayed diagnosis,5 resulting in more advanced disease5,6,7 and an increased mortality risk from skin cancer.5,6 Although skin cancer risk is broadly associated with UVR exposure, studies have found no significant association between UVR exposure and melanoma risk in racial and ethnic minority patients.8 The UVR exposure behaviors of SM people also differ across race and ethnicity. A study of US high school students found lower odds of indoor tanning among SM White females compared with heterosexual White females but higher odds among SM Hispanic and non-Hispanic Black (hereafter, Black) females.9 In this study, we aimed to investigate the association between sexual orientation, including individual sexual identities, and the lifetime prevalence of skin cancer across racial and ethnic groups among US adults.
Methods
This cross-sectional study used data from the Behavioral Risk Factor Surveillance System (BRFSS) from January 1, 2014, to December 31, 2021, for US adults (aged ≥18 years). The BRFSS consists of annual, US population–based telephone surveys. Respondents with missing data on sexual orientation, race and ethnicity, skin cancer history, and/or covariates were excluded. The University of Minnesota institutional review board deemed this study exempt from approval as the study used publicly available, deidentified data. The study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.
Statistical Analysis
Data were analyzed from December 1, 2023, to March 1, 2024. All analyses were sex stratified based on self-reported binary sex. Sexual minority people were defined as those self-identifying as bisexual, lesbian or gay, or something else or other, and heterosexual people as straight, that is, not gay or lesbian. We compared demographic characteristics by sexual orientation using Pearson χ2 tests or adjusted Wald tests. We calculated age-adjusted prevalence and adjusted prevalence odds ratios (AORs) using logistic regression for self-reported lifetime prevalence of skin cancer comparing (1) heterosexual and SM adults in analyses stratified by individual race and ethnicity and, (2) in secondary analyses, by individual sexual identity among White individuals and racial and ethnic minority individuals (combined into a single group to ensure stable statistical estimates). Race and ethnicity categories included Black; Hispanic; non-Hispanic Asian, Pacific Islander, or Hawaiian; White; and other race and ethnicity (Alaska Native, American Indian, multiracial, or other race). Disaggregated analyses were conducted as secondary analyses due to the more limited sample size and power in some subgroups. All statistical analyses were weighted due to the complex sample design and were performed using Stata, version 16.1 (StataCorp LLC) with 2-sided P < .05. No adjustment was made for multiple comparisons.
Results
Among 1 600 480 total respondents, 88 080 (5.6%) had missing data, resulting in a final sample of 1 512 400 respondents (805 161 [53.2%] heterosexual females, 38 933 [2.6%] SM females, 638 651 [42.2%] heterosexual males, and 29 655 [2.0%] SM males). A total of 6.6% of participants were Hispanic; 3.4%, non-Hispanic Asian, Pacific Islander, or Hawaiian; 7.5%, non-Hispanic Black; 78.2%, non-Hispanic White; and 4.3%, other race and ethnicity. Mean (SE) age was 48.5 (0.03) years (incomplete data for age of respondents ≥80 years). Demographic characteristics are available in Table 1.
Table 1. Demographic Characteristics by Sexual Orientation Among Female and Male US Adults in the Behavioral Risk Factor Surveillance System From 2014 to 2021a.
| Characteristic | Male participants (n = 668 306) | Female participants (n = 844 094) | ||
|---|---|---|---|---|
| Heterosexual (n = 638 651) | Sexual minority (n = 29 655)c | Heterosexual (n = 805 161) | Sexual minority (n = 38 933)c | |
| Age, mean (SE), y | 47.7 (0.1) | 40.7 (0.2) | 50.0 (0.1) | 36.3 (0.2) |
| Sexual orientation | ||||
| Bisexual | NA | 36.0 (0.7) | NA | 58.0 (0.6) |
| Gay or lesbian | NA | 45.7 (0.7) | NA | 23.0 (0.5) |
| Heterosexual | 100 (0.0) | NA | 100 (0.0) | NA |
| Something else | NA | 18.3 (0.6) | NA | 18.9 (0.5) |
| Race and ethnicity | ||||
| Hispanic | 16.2 (0.2) | 20.7 (0.8) | 15.2 (0.1) | 18.6 (0.6) |
| Non-Hispanic Asian, Pacific Islander, or Hawaiian | 5.4 (0.1) | 6.2 (0.5) | 5.2 (0.1) | 4.8 (0.3) |
| Non-Hispanic Black | 10.9 (0.1) | 10.1 (0.4) | 12.4 (0.1) | 12.3 (0.4) |
| Non-Hispanic White | 64.8 (0.2) | 59.0 (0.8) | 64.8 (0.2) | 60.0 (0.6) |
| Otherb | 2.8 (0.04) | 4.0 (0.2) | 2.5 (<0.1) | 4.4 (0.2) |
| Region | ||||
| Northeast | 17.8 (0.1) | 20.4 (05) | 18.0 (0.1) | 18.8 (0.4) |
| Midwest | 22.4 (0.1) | 22.0 (0.5) | 22.1 (0.1) | 23.2 (0.5) |
| South | 35.5 (0.1) | 33.0 (0.6) | 36.3 (0.1) | 33.7 (0.6) |
| West | 24.2 (0.2) | 26.5 (0.8) | 23.5 (0.2) | 24.3 (0.6) |
| Other | 0.1 (<0.1) | 0.1 (<0.1) | 0.05 (<0.1) | <0.1 (<0.1) |
| Employment status | ||||
| Employed | 63.9 (0.2) | 60.3 (0.7) | 49.7 (0.2) | 54.5 (0.6) |
| Unemployed | 16.8 (0.1) | 27.3 (0.7) | 28.8 (0.1) | 37.9 (0.6) |
| Retired | 19.2 (0.1) | 12.5 (0.4) | 21.6 (0.1) | 7.6 (0.3) |
| Educational level | ||||
| Less than high school | 12.8 (0.1) | 12.5 (0.6) | 11.4 (0.1) | 13.5 (0.5) |
| High school or GED | 29.6 (0.1) | 27.0 (0.7) | 26.5 (0.1) | 26.9 (0.5) |
| Some college | 30.0 (0.1) | 32.9 (0.7) | 33.0 (0.1) | 35.5 (0.6) |
| College | 27.6 (0.1) | 27.7 (0.6) | 29.1 (0.1) | 24.1 (0.4) |
| Health insurance status | ||||
| Insured | 77.8 (0.1) | 74.3 (0.6) | 80.6 (0.1) | 72.7 (0.5) |
| Not insured | 22.2 (0.1) | 25.7 (0.6) | 19.4 (0.1) | 27.3 (0.5) |
| Health care utilization | ||||
| No physician visit in past 1 y | 69.5 (0.2) | 70.0 (0.7) | 78.5 (0.1) | 70.3 (0.6) |
| Physician visit in past 1 y | 30.5 (<0.1) | 30.0 (0.7) | 21.5 (0.1) | 29.7 (0.6) |
| Smoking history | ||||
| Never | 54.1 (0.2) | 56.3 (0.7) | 64.6 (0.1) | 59.4 (0.6) |
| Former | 28.8 (0.1) | 22.5 (0.6) | 22.1 (0.1) | 19.7 (0.5) |
| Current | 17.1 (0.1) | 21.3 (0.6) | 13.3 (0.1) | 20.9 (0.5) |
| Alcohol use | ||||
| Nondrinker | 41.0 (0.2) | 40.2 (0.8) | 52.5 (0.2) | 44.5 (0.6) |
| Light drinker | 39.5 (0.2) | 39.3 (0.7) | 39.4 (0.1) | 42.2 (0.6) |
| Moderate drinker | 19.5 (0.1) | 20.5 (0.6) | 8.2 (0.1) | 13.4 (0.4) |
Abbreviations: GED, General Educational Development; NA, not applicable.
Data are presented as weighted percentage (SE) of participants unless otherwise indicated. All statistical analyses were performed using the weighted survey sample per Behavioral Risk Factor Surveillance System guidelines. Unweighted sample sizes are provided for reference.
Alaska Native, American Indian, multiracial, or other race.
Those who identified as bisexual, gay, lesbian, and other nonheterosexual identities.
Lifetime prevalence of skin cancer was overall higher among SM males compared with heterosexual males (7.4% vs 6.8%; AOR, 1.16; 95% CI, 1.02-1.33). In analyses stratified by racial and ethnic group, the lifetime prevalence of skin cancer among SM males compared with heterosexual males was higher only among Black (1.0% vs 0.5%; AOR, 2.18; 95% CI, 1.13-4.19) and Hispanic (4.0% vs 1.6%; AOR, 3.81; 95% CI, 1.96-7.41) males (Table 2). In secondary analyses, the lifetime prevalence of skin cancer was higher among gay males compared with heterosexual males among White males (9.9% vs 8.6%; AOR, 1.19; 95% CI, 1.01-1.41) and higher among bisexual males compared with heterosexual males among racial and ethnic minority individuals (4.6% vs 1.4%; AOR, 3.94; 95% CI, 1.61-9.63) (Table 3).
Table 2. Age-Adjusted Prevalence and Prevalence ORs of Lifetime Skin Cancer History by Sexual Orientation Among All Respondents and by Individual Race and Ethnicity.
| Variable | Lifetime prevalent cases of skin cancer, unweighted No. | Age-adjusted prevalence of lifetime history of skin cancer (95% CI)a | Adjusted prevalence OR (95% CI)b | P value | Fully adjusted prevalence OR (95% CI)c | P value |
|---|---|---|---|---|---|---|
| Males | ||||||
| All respondents | ||||||
| Heterosexual (n = 638 651) | 66 144 | 6.8 (6.7-6.9) | 1.0 [Reference] | .03 | 1.0 [Reference] | .02 |
| Sexual minority (n = 29 655) | 2305 | 7.4 (6.7-8.1) | 1.14 (1.01-1.30) | 1.16 (1.02-1.33) | ||
| Hispanic | ||||||
| Heterosexual (n = 42 685) | 612 | 1.6 (1.3-1.9) | 1.0 [Reference] | <.001 | 1.0 [Reference] | <.001 |
| Sexual minority (n = 3125) | 65 | 4.0 (2.1-7.8) | 3.94 (1.90-8.15) | 3.81 (1.96-7.41) | ||
| Non-Hispanic Asian, Pacific Islander, or Hawaiian | ||||||
| Heterosexual (n = 24 009) | 205 | 0.5 (0.3-0.7) | 1.0 [Reference] | .24 | 1.0 [Reference] | .09 |
| Sexual minority (n = 1343) | 20 | 0.7 (0.3-1.7) | 1.72 (0.70-4.19) | 2.01 (0.89-4.56) | ||
| Non-Hispanic Black | ||||||
| Heterosexual (n = 41 202) | 265 | 0.5 (0.4-0.7) | 1.0 [Reference] | .006 | 1.0 [Reference] | .02 |
| Sexual minority (n = 1955) | 23 | 1.0 (0.6-1.5) | 2.40 (1.29-4.47) | 2.18 (1.13-4.19) | ||
| Non-Hispanic White | ||||||
| Heterosexual (n = 502 113) | 63 440 | 8.6 (8.5-8.8) | 1.0 [Reference] | .13 | 1.0 [Reference] | .23 |
| Sexual minority (n = 21 353) | 2130 | 9.3 (8.5-10.2) | 1.10 (0.97-1.24) | 1.08 (0.95-1.21) | ||
| Otherd | ||||||
| Heterosexual (n = 28 642) | 1622 | 5.4 (4.7-6.1) | 1.0 [Reference] | <.001 | 1.0 [Reference] | .001 |
| Sexual minority (n = 1879) | 67 | 2.5 (1.7-3.8) | 0.46 (0.30-0.70) | 0.45 (0.29-0.71) | ||
| Females | ||||||
| All respondents | ||||||
| Heterosexual (n = 805 161) | 75 861 | 6.6 (6.5-6.7) | 1.0 [Reference] | .37 | 1.0 [Reference] | .46 |
| Sexual minority (n = 38 933) | 2057 | 6.2 (5.5-6.9) | 0.95 (0.84-1.07) | 0.95 (0.84-1.08) | ||
| Hispanic | ||||||
| Heterosexual (n = 50 474) | 742 | 1.8 (1.4-2.2) | 1.0 [Reference] | .01 | 1.0 [Reference] | .01 |
| Sexual minority (n = 4136) | 70 | 2.1 (1.1-3.1) | 2.46 (1.29-4.70) | 2.46 (1.28-4.70) | ||
| Non-Hispanic Asian, Pacific Islander, or Hawaiian | ||||||
| Heterosexual (n = 24 861) | 227 | 0.4 (0.3-0.7) | 1.0 [Reference] | .14 | 1.0 [Reference] | .32 |
| Sexual minority (n = 1372) | 16 | 0.6 (0.3-1.4) | 2.15 (0.78-5.94) | 1.74 (0.58-5.20) | ||
| Non-Hispanic Black | ||||||
| Heterosexual (n = 67 114) | 386 | 0.5 (0.4-0.6) | 1.0 [Reference] | .03 | 1.0 [Reference] | .04 |
| Sexual minority (n = 3091) | 21 | 1.8 (0.8-4.0) | 2.54 (1.07-6.05) | 2.33 (1.01-5.54) | ||
| Non-Hispanic White | ||||||
| Heterosexual (n = 631 341) | 72 927 | 8.5 (8.3-8.7) | 1.0 [Reference] | .01 | 1.0 [Reference] | .02 |
| Sexual minority (n = 27 553) | 1872 | 7.8 (7.0-8.7) | 0.85 (0.75-0.97) | 0.86 (0.76-0.97) | ||
| Otherd | ||||||
| Heterosexual (n = 31 371) | 1579 | 4.7 (4.1-5.4) | 1.0 [Reference] | .60 | 1.0 [Reference] | .64 |
| Sexual minority (n = 2781) | 78 | 4.5 (2.8-7.0) | 1.16 (0.67-1.98) | 1.13 (0.67-1.91) | ||
Abbreviation: OR, odds ratio.
Age-adjusted prevalence standardized against the age distribution among all females and males using the direct method for age standardization.
Adjusted OR using logistic regression analyses controlling for age and survey year. Analyses among all respondents additionally controlled for individual race and ethnicity.
Fully adjusted OR using logistic regression analyses controlling for age, survey year, US census region, employment status, educational level, insurance status, health care utilization, smoking history, and alcohol use. Analyses among all respondents additionally controlled for individual race and ethnicity.
Alaska Native, American Indian, multiracial, or other race.
Table 3. Age-Adjusted Prevalence and Prevalence ORs of Lifetime Skin Cancer History by Sexual Orientation Stratified by Race and Ethnicity.
| Variable | Lifetime prevalent cases of skin cancer, unweighted No. | Age-adjusted prevalence of lifetime history of skin cancer (95% CI)a | Adjusted prevalence OR (95% CI)b | P value | Fully adjusted prevalence OR (95% CI)c | P value |
|---|---|---|---|---|---|---|
| Males | ||||||
| Non-Hispanic White | ||||||
| Bisexual (n = 7468) | 621 | 9.0 (7.6-10.5) | 1.00 (0.82-1.24) | .97 | 1.01 (0.82-1.24) | .94 |
| Gay (n = 10 738) | 1188 | 9.9 (8.8-11.3) | 1.27 (1.08-1.51) | .005 | 1.19 (1.01-1.41) | .04 |
| Heterosexual (n = 502 113) | 63 440 | 8.6 (8.5-8.8) | 1.0 [Reference] | NA | 1.0 [Reference] | NA |
| Something else (n = 3147) | 321 | 7.8 (6.2-9.9) | 0.80 (0.61-1.06) | .12 | 0.86 (0.66-1.14) | .30 |
| All racial and ethnic minority groupsd | ||||||
| Bisexual (n = 2785) | 54 | 4.6 (2.1-9.9) | 4.10 (1.60-10.57) | .004 | 3.94 (1.61-9.63) | <.001 |
| Gay (n = 3548) | 61 | 2.3 (0.8-6.4) | 1.56 (0.77-3.16) | .22 | 1.46 (0.73-2.92) | .28 |
| Heterosexual (n = 136 536) | 2704 | 1.4 (1.2-1.5) | 1.0 [Reference] | NA | 1.0 [Reference] | NA |
| Something else (n = 1969) | 60 | 1.5 (1.1-2.2) | 1.46 (0.93-2.29) | .10 | 1.47 (0.91-2.35) | .11 |
| Females | ||||||
| Non-Hispanic White | ||||||
| Bisexual (n = 14 765) | 695 | 7.8 (6.6-9.2) | 0.79 (0.66-0.93) | .01 | 0.77 (0.67-0.95) | .01 |
| Heterosexual (n = 631 341) | 72 927 | 8.5 (8.3-8.7) | 1.0 [Reference] | NA | 1.0 [Reference] | NA |
| Lesbian or gay (n = 7876) | 732 | 8.4 (7.1-10.0) | 1.01 (0.83-1.23) | .92 | 0.94 (0.77-1.15) | .54 |
| Something else (n = 4912) | 445 | 7.5 (5.6-10.0) | 0.78 (0.57-1.06) | .11 | 0.86 (0.64-1.16) | .31 |
| All racial and ethnic minority groupsd | ||||||
| Bisexual (n = 6004) | 86 | 1.4 (0.9-2.1) | 1.66 (1.05-2.60) | .03 | 1.51 (1.01-2.36) | .04 |
| Heterosexual (n = 173 820) | 2934 | 1.3 (1.1-1.5) | 1.0 [Reference] | NA | 1.0 [Reference] | NA |
| Lesbian or gay (n = 2542) | 46 | 1.6 (0.8-3.4) | 1.87 (0.82-4.27) | .14 | 1.69 (0.74-3.88) | .22 |
| Something else (n = 2834) | 53 | 3.2 (1.7-5.7) | 2.52 (1.19-5.32) | .02 | 2.70 (1.26-5.78) | .01 |
Abbreviations: NA, not applicable; OR, odds ratio.
Age-adjusted prevalence standardized against the age distribution among all females and males using the direct method for age standardization.
Adjusted OR controlling for age and survey year. Analyses among all racial and ethnic minority groups additionally controlled for individual race and ethnicity.
Fully adjusted OR controlling for age, survey year, region, employment status, educational level, insurance status, health care utilization, smoking history, and alcohol use. Analyses among all racial and ethnic minority groups additionally controlled for individual race and ethnicity.
Hispanic; non-Hispanic Asian, Pacific Islander, or Hawaiian; non-Hispanic Black; and other race and ethnicity (Alaska Native, American Indian, multiracial, or other race).
Among females, lifetime prevalence of skin cancer overall did not differ by sexual orientation (Table 2). In analyses stratified by race and ethnicity, the lifetime prevalence of skin cancer among SM females compared with heterosexual females was higher among Black (1.8% vs 0.5%; AOR, 2.33; 95% CI, 1.01-5.54) and Hispanic (2.1% vs 1.8%; AOR, 2.46; 95% CI, 1.28-4.70) females and was lower among White females (7.8% vs 8.5%; AOR, 0.86; 95% CI, 0.76-0.97). In secondary analyses, the lifetime prevalence of skin cancer was lower among bisexual females compared with heterosexual females among White females (7.8% vs 8.5%; AOR, 0.77; 95% CI, 0.67-0.95) and higher among both bisexual females (1.4% vs 1.3%; AOR, 1.51; 95% CI, 1.01-2.36) and females identifying as something else or other (3.2% vs 1.3%; AOR, 2.70; 95% CI, 1.26-5.78) compared with heterosexual females among racial and ethnic minority individuals (Table 3).
Discussion
In this cross-sectional study, sexual orientation was associated with differential lifetime prevalence of skin cancer, but these relative differences varied across race and ethnicity and sexual orientation. We found higher relative skin cancer prevalence among White gay males and both Black and Hispanic SM females and males, particularly those identifying as bisexual, compared with their heterosexual counterparts. We found lower relative skin cancer lifetime prevalence among White SM females, particularly among those identifying as bisexual. These findings suggest heterogeneity of skin cancer prevalence among SM people across race and ethnicity and individual sexual identity. While the effect size of some associations was modest, these findings may have important implications for population-based research and public health efforts aimed at early detection and prevention of skin cancer among US adults.1
Several factors may explain these findings. First, distinct UVR risk behaviors across identities among SM people could be associated with skin cancer prevalence in these diverse populations. Prior studies reported that Black and Hispanic SM females and males and White SM males have high rates of indoor tanning,9 which correlates with differences in skin cancer prevalence identified in our study. More broadly, Black people have a lower perceived risk of skin cancer10 and are less likely to use sunscreen or protective clothing11 compared with White persons, although data on individuals with multiple minority identities (ie, SM and racial and ethnic minority identities) are lacking. Black and Hispanic SM people12 and bisexual individuals13 in particular experience increased minority stress and discrimination, which may result in poorer health behaviors and lower educational attainment, which is associated with lower perceived risk and less knowledge of skin cancer.10 Bisexual and gay males, compared with heterosexual males, have higher rates of indoor tanning,2 potentially related to body dissatisfaction2 and community influence,3 correlating with increased skin cancer risk. Limited health care access, coverage, and financial limitations among bisexual women may influence their awareness and/or behaviors related to skin cancer risk factors.14 Finally, observed differences could be related to detection bias as prior studies found that SM males are more likely than heterosexual males to obtain skin cancer screening.4,15
Limitations
Study limitations include sampling and nonresponse bias as some US states or territories were excluded due to lack of data collection on sexual orientation (eTable 1 in Supplement 1). Furthermore, skin cancer outcomes were self-reported without medical record review or histopathologic confirmation.
Conclusions
This cross-sectional study of US adults demonstrated that differences in the lifetime prevalence of skin cancer among SM adults compared with heterosexual adults varied by race and ethnicity and individual sexual identity. Future research and public health interventions should consider race and ethnicity and individual sexual identity when addressing skin cancer and related risk behaviors, with a particular emphasis on Black and Hispanic SM females and males and White gay males.5 Such efforts may help inform screening guidelines and primary prevention efforts aimed at reducing rates of skin cancer among all people.1
eTable. US States or Territories by Collection of Optional Sexual Orientation Data, BRFSS 2014-2021
Data Sharing Statement
References
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
eTable. US States or Territories by Collection of Optional Sexual Orientation Data, BRFSS 2014-2021
Data Sharing Statement