Heart attack and stroke occurrence at the intersection of race and sexual orientation: a nationally representative study of adults in the United States.

BACKGROUND: Strokes and myocardial infarctions (MIs) are among the most costly and quality of life diminishing conditions. Marginalized and minoritized people including Black, Indigenous, and other People of Color, experience higher MI and stroke odds than White comparisons. This may also be true for lesbian, gay, bisexual people (LGB) who have higher levels of MI and stroke risk factors than heterosexual comparisons. However, extremely limited evidence describes either MI/stroke occurrence among US adults with these intersecting identities. METHODS: Self-reported race/ethnicity, sexual orientation, and MI and stroke diagnoses were obtained from the 2019-2021 Behavioral Risk Factor Surveillance System. Interaction analyses within survey-weighted age-adjusted logistic regression modeling were used to calculate the relative excess risk due to interaction (RERI). RESULTS: Being female of another race (not White or Black) and LGB had an additive association with MI occurrence; the combined influences of being female, another race, and LGB on MI occurrence was greater than the sum of the influences of being White and heterosexual. The RERI indicated that female adults who were of another race and LGB experienced a relative excess risk of MI occurrence 2-fold higher (RERI: 1.99, 95% Confidence Interval: 0.33-3.65, p = 0.04) as that of those who were White only or heterosexual only. CONCLUSIONS: MI occurrence is high for all LGB females, we found that MI occurrence is especially high for females with LGB and "another" racial/ethnic identities.