Sexual Orientation and Lifetime Prevalence of Skin Cancer Across Racial and Ethnic Groups

Abstract

ImportanceSexual 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.ObjectiveTo 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 ParticipantsThis 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 MeasuresSelf-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.ResultsOf 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 RelevanceIn 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.