Quantifying additive and multiplicative effects of socially stigmatized identities on self-reported overall health

Individuals with one or more socially stigmatized identities experience extensive health disparities. However, most studies consider the effects of only individual stigmatized identities. Further, the effects of individual identities and their intersections on overall health have not been quantified. We used participant-reported survey data collected in the All of Us Research Program and released to the controlled tier in April 2023 to statistically estimate the first and second order effects of 47 stigmatized identities on self-reported overall health. After using false discovery rate to adjust for testing multiple hypotheses, 29 individual stigmas had statistically significant effects on self-reported overall health and 116 pairs of stigmas did. All significant individual effects were negative or neutral except for skin cancer. Those with the largest negative effect on self-rated overall health are difficulty walking or climbing stairs, unemployed or unable to work, difficulty with errands, and low educational attainment. Pairs of intersecting stigmas had a mix of negative and positive incremental effects, indicating that some stigmatized identities are negative modifiers, such as depression, and other combinations are less negative that the sum of their individual negative effects, such as having difficulty with multiple types of activities of daily living. Taken together, there are numerous pairs of stigmatized identities that significantly affect self-reported overall health and therefore should be considered in research and clinical care.