Worse Health for Gay, Lesbian, Bisexual Adults

Pam Harrison

June 27, 2016

Lesbian, gay, and bisexual (LGB) adults in the United States are more likely to report worse physical and mental health than their heterosexual counterparts. They are also more prone to drink and smoke, often heavily, possibly because of chronic stress, which is commonly experienced by members of marginalized groups, new research suggests.

"Findings from our study indicate that LGB adults experience significant health disparities — particularly in mental health and substance use — likely due to the minority stress that LGB adults experience as a result of their exposure to both interpersonal and structural discrimination," investigators led by Gilbert Gonzales, PhD, Vanderbilt University, Nashville, Tennessee, write.

Bisexual adults in particular are at highest risk for psychological distress, possibly because bisexual people are marginalized not only in the larger community but also in the gay and lesbian community.

"Combined with the relative scarcity of bisexual communities and organizations, this ostracizing may lead to social isolation, a risk factor for psychological distress," the researchers add.

The study was published online June 27 in JAMA Internal Medicine.

Heavy Alcohol, Cigarette Use

Using data from the National Health Interview Survey, the investigators compared health and health risk factors for lesbian, gay, and bisexual adults with those of heterosexual adults. The mean age of respondents was 46.8 years.

Beginning in 2013, the survey included a question regarding participants' sexual orientation.

"Approximately 2% of the noninstitutionalized, civilian adult population identified as lesbian, gay or bisexual," the researchers note.

Interestingly, gay, bisexual, and heterosexual men reported the same level of health and functional status.

However, after adjusting for demographic and socioeconomic factors, bisexual men were far more likely to report moderate or severe levels of psychological distress compared with heterosexual men, and they were also much more likely to be heavy drinkers and smokers.

Gay men were also more likely to report moderate or severe levels of psychological distress, as well as heavy alcohol use and moderate levels of smoking, compared with heterosexual men.

Lesbians in turn had an elevated risk of reporting poor or only fair health and having multiple chronic conditions.

They were also more likely to report moderate psychological distress, heavy drinking, and either moderate or heavy smoking compared with heterosexual women.

Bisexual women were significantly more likely to report multiple chronic conditions, moderate to severe psychological distress, and heavy alcohol use compared with heterosexual women. They were also more likely to report moderate cigarette use compared with their heterosexual counterparts.

Table. Odds Ratios Between Health Risks and Sexual Orientation vs Reference Heterosexual Status*

  Gay Men vs Heterosexual Men (P Value) Bisexual Men vs Heterosexual Men (P Value) Lesbians vs Heterosexual Women (P Value) Bisexual Women vs Heterosexual Women (P Value)
Multiple chronic conditions 1.51 (51% greater risk) (.06) 1.47 (47% greater risk) (.33) 1.58 (58% greater risk) (.01) 2.07 (twofold greater risk) (.001)
Moderate psychological distress 1.45 (45% greater risk) (.02) 2.60 (more than 2.5-fold greater risk) (<.001) 1.34 (34% greater risk) (.04) 2.17 (more than twofold greater risk) (<.001)
Severe psychological distress 2.82 (almost 32-fold greater risk) (.001) 4.70 (almost fivefold greater risk) (.002) 1.45 (45% greater risk) (.12) 3.69 (almost 40-fold greater risk) (<.001)
Heavy drinking 1.97 (97% greater risk) (.03) 3.15 (more than threefold greater risk) (.02) 2.63 (more than 2.5-fold greater risk) (<.001) 2.07 (twofold greater risk) (.01)
Moderate smoking 1.98 (98% greater risk) (<.001) 1.22 (22% greater risk ) (.53) 2.14 (more than twofold greater risk) (<.001) 1.60 (60% greater risk) (.03)
Heavy smoking 1.58 (58% greater risk) (.13) 2.10 (more than twofold greater risk) (.03) 2.29 (more than twofold greater risk) (.002) 1.36 (36% greater risk) (.36).

*Not all differences were statistically significant.


Significant Health Disparities

In an accompanying editorial, Mitchell Katz, MD, deputy editor of JAMA Internal Medicine, agrees with the authors that "higher psychological distress and use of unhealthy substances likely reflect the experience of being in a stigmatized minority population.

"However, there is reason to anticipate that with the growing acceptance of sexual minority populations, as evidenced by the rapid increase in the establishment of same-sex marriage in the Unites States and other countries, these disparities will decrease," he adds.

Dr Katz indicates that healthcare professionals can help the lesbian, gay, and bisexual community by creating a supportive environment.

"The important thing is to ask open-ended questions that do not prejudge responses," he notes. For example, physicians might ask a new patient whether he or she has sex with men, women, or both.

"Whatever the answer, following up by asking if the patient has a special partner shows interest and willingness to discuss intimate issues," Dr Katz adds. "In caring for people who have experienced bias and discrimination, support is a very potent medicine."

Dr Gonzales and Dr Katz have disclosed no relevant financial relationships.

JAMA Intern Med. Published online June 27, 2016. Full text, Editorial


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