Age Trajectories of Health and Well-Being Among LGBTQ+ Older Adults: Racial/Ethnic Differences and the Role of Structural, Psychological, Behavioral, and Social Factors

Background and Purpose

Accumulating evidence has identified risk and protective predictors of health inequities among LGBTQ+ older adults, one of the fastest growing and health-disparate populations. Yet, whether and how these factors shape age-based health trajectories in this population remains unknown. Prior longitudinal studies have used time since baseline rather than age as the analytic metric, limiting insight into how health changes as a function of aging processes in later life. Age-based growth trajectory analysis reveals when decline accelerates, whether subgroups age at different rates, and at what point modifiable factors matter most, questions time-based models cannot answer. To our knowledge, this is the first study to examine age growth trajectories of health and quality of life among LGBTQ+ older adults. Grounded in the Health Equity Promotion Model (HEPM), which accounts for structural, psychological, behavioral, and social pathways, this study examines age trajectories of seven health outcomes, identifies modifiable factors associated with those trajectories, and assesses racial/ethnic differences in trajectory level and slope.

Methods

Data from the National Health, Aging and Sexuality/Gender Study (NHAS), a five-wave longitudinal study of LGBTQ+ adults aged 50 and older (N = 2,450; 2014–2022) is utilized. The sample is 72% White, 7% Black, 8% Hispanic, and 6% Other racial/ethnic identities. Outcomes include four WHOQOL-BREF domains (physical, psychological, social, and environmental), self-rated general health, depressive symptoms (CES-D), and physical limitations. Accelerated longitudinal multilevel growth curve models use age centered at 50 as the time metric. Sequential covariate block models test overall rates as well as racial/ethnic differences in trajectory level and slope; predictor × age interaction models test whether 12 structural, psychological, behavioral, and social factors moderate age trajectories.

Results

All seven outcomes show significant nonlinear age trajectories, overall in a deteriorating direction, with substantial between-person variation in slopes. Predictor × age interaction models reveal that modifiable factors shape trajectories primarily for physical health outcomes. Higher perceived stress is associated with faster accumulation of physical limitations with age and faster environmental QOL decline. Spirituality buffers against age-related deterioration of self-rated health. Physical activity buffers against age-related accumulation of physical limitations; social network size also moderates the trajectory. No predictors significantly moderate trajectories of psychological health QOL, social QOL, or depressive symptoms. Regarding racial/ethnic differences, Black and Other participants report worse physical health QOL, general health, depressive symptoms, and physical limitations at age 50, but trajectories are largely parallel. Disparities are established at entry into older adulthood rather than widening with age.

Conclusions and Implications

Consistent with HEPM, perceived stress emerges as a key driver of accelerated physical health decline, while spirituality offers meaningful protection against self-rated health worsening. The absence of trajectory moderation for mental health outcomes may suggest these patterns are shaped by conditions earlier in the life course. Racial/ethnic health disparities established at age 50 but stable thereafter point to earlier life course conditions as the critical window for addressing structural inequity. Findings support intersectionality-informed, early-intervention approaches targeting stress reduction, spiritual well-being, and structural inequities to promote healthy aging among LGBTQ+ communities.