Self-Rated Health and Inflammation: Associations among Partnered Sexual Minority and Heterosexual Adults

Objective: Self-rated health (SRH), as measured by a single item, is a well-established and remarkably robust predictor of morbidity and mortality, yet few studies have examined its biological correlates across diverse sexual orientation identities. Methods: Using data from the population-representative National Couples Health and Time study (NCHAT) and it's biospecimen sub-study (NCHAT-BIO), this study explored the relationship between LGBQ+ identity, SRH, and systemic inflammation. Among 3477 partnered (married or cohabiting) cisgender adults, 42.6% identified as LGBQ+ and a subset of 654 (42.9% LGBQ+) provided dried blood spot samples analyzed for IL-6 and C-reactive protein (CRP). Results: In the full NCHAT sample, LGBQ+ respondents reported significantly poorer SRH than their heterosexual peers (LGBQ+ vs. Heterosexual: t = 3.3574, df = 3466, p-value < 0.001). In the NCHAT-BIO subsample, poorer self-rated health was significantly related to both higher IL-6 (beta = -0.22, SE = 0.041, p < 0.0001) and higher CRP (beta = -0.40, SE = 0.055, p < 0.0001), supporting the hypothesis that subjective health assessments may capture interoceptive awareness of inflammatory status. Importantly, the strength of the association between SRH and inflammation did not differ across groups based on sexual orientation and gender (Interaction p-value for IL-6: 0.54, for CRP: 0.45). The associations between SRH and inflammatory markers were attenuated after inclusion of key health and behavioral covariates, suggesting potential mediating factors warranting future investigation. Conclusions: These findings replicate prior research on SRH and inflammation and extend them to LGBQ+ plus adults, underscoring the importance of inclusive health measurement. Given SRH's robust predictive power for future morbidity and mortality, integrating assessments of sexual orientation and biological markers offers critical insight for understanding and addressing health disparities.