Associations of Social Determinants of Health with Overall Health and Quality of Life Among Sexual and Gender Minority People in New York State.

Purpose: This study examined associations between social determinants of health (SDOH) and overall health and quality of life (QOL) among sexual and gender minority (SGM) people in New York State. Methods: SGM individuals (N = 2342) completed a community needs assessment survey in 2021. Among an analytic sample (N = 2279), hierarchical regression models examined the relative strength of the association between primary SDOH barriers (i.e., food insecurity, unstable housing, economic insecurity) and overall health and QOL relative to secondary SDOH barriers (i.e., medical mistrust, social isolation, SGM health-related structural barriers) and psychosocial barriers to engaging in care (i.e., depressive symptoms, lack of SGM community connectedness). Path models explored significant secondary barriers to care as potential explanatory mechanisms between primary SDOH barriers and outcomes. Results: In hierarchical regression models, depressive symptoms were most strongly associated with overall health, whereas primary SDOH barriers were associated with poor QOL over other factors considered. In path models, a statistically significant path for depressive symptoms was found for both overall health and QOL. Social isolation and SGM health related structural barriers were also significant paths between primary SDOH barriers and both outcomes. Conclusion: This study demonstrates the complex relationships that exist between SDOH-related barriers and critical health outcomes for SGM people. Entities seeking to improve these outcomes should focus attention on advancing structural competency to assess and address a broader than traditionally considered range of barriers that are likely present at elevated levels for SGM populations.