Same-Sex Couples and Cognitive Impairment: Evidence from the Health and Retirement Study.

OBJECTIVES: We provide the first nationally representative population-based study of cognitive disparities among same-sex and different-sex couples in the United States.

METHOD: We analyzed data from the Health and Retirement Study (2000-2016). The sample included 23,669 respondents (196 same-sex partners and 23,473 different-sex partners) aged 50 and older who contributed to 85,117 person-period records (496 from same-sex partners and 84,621 from different-sex partners). Cognitive impairment was assessed using the modified version of the Telephone Interview for Cognitive Status (TICS). Mixed-effects discrete-time hazard regression models were estimated to predict the odds of cognitive impairment.

RESULTS: The estimated odds of cognitive impairment were 78% (p < .01) higher for same-sex partners than for different-sex partners. This disparity was mainly explained by differences in marital status and, to a much lesser extent, by differences in physical and mental health. Specifically, a significantly higher proportion of same-sex partners than different-sex partners were cohabiting rather than legally married (72.98% vs. 5.42% in the study sample), and cohabitors had a significantly higher risk of cognitive impairment than their married counterparts (OR = 1.53, p < .001).

DISCUSSION: The findings indicate that designing and implementing public policies and programs that work to eliminate societal homophobia, especially among older adults, is a critical step in reducing the elevated risk of cognitive impairment among older same-sex couples.