Marriage Equality and Activity Limitations Among Older Adults in Same-Sex Relationships

In the USA, 37 states and the District of Columbia had legalized same-sex marriage (SSM) via court decision or legislation before the 2015 Obergefell v. Hodges ruling legalized SSM nationwide.

With pooled cross-sections of 48,098 older adults with same-sex partners/spouses from the 2008–2019 American Community Survey and state-level policy data; we estimated the relationship between the right to marry and the presence of activity limitations. Using the 2013–2019 ACS, we also estimated the relationship between marital status itself and the presence of activity limitations.

In a baseline model with demographic characteristics but without state or year fixed effects, the likelihood of activity limitations was statistically significantly lower in states where SSM had been legal for at least 5 years or where SSM had become legal at the state level relative to a state without SSM. In the presence of fixed effects, the likelihood of activity limitations was not statistically significantly associated with the duration or method of SSM policy, but men and women who were living with a same-sex spouse were less likely than their counterparts who were living with an unmarried same-sex partner to experience activity limitations.

Compared to their counterparts in states where SSM was not yet legal, adults living with same-sex partners/spouses were less likely to experience activity limitations if they lived in a state that had legalized SSM relatively early, but this relationship likely reflects unobservable factors that influenced both the policy environment and health of older sexual minorities. Older adults who were married to a same-sex spouse were less likely than those who cohabited with a same-sex partner to experience activity limitations, suggesting that marriage enhances health or that healthier adults are more likely to marry.

Our findings suggest that favorable attitudes toward SSM, rather than the policy itself, enhance the health of older gays and lesbians. Because attitudes toward SSM can improve over time after court decisions or favorable legislation, both methods of change hold the promise of enhancing LGBTQ health.