Premature mortality higher among women from sexual minorities, research shows

Compared to heterosexual women, bisexual women died 37% earlier and lesbian women 20% earlier, according to results from one of the largest studies of sexual orientation-related disparities in mortality and the first to distinguish between lesbians and bisexual women.

The findings will be published on April 25 in JAMA.

Decades of research have documented that sexual minority women have poorer health—across a variety of physical and mental health outcomes—compared to their heterosexual peers. However, few studies have examined mortality inequality, and none have been able to distinguish mortality inequality among sexual minority subgroups among women.

The new findings, led by researchers at the Harvard Pilgrim Health Care Institute with collaborators from the Harvard TH Chan School of Public Health, the University of Utah, Boston Children’s Hospital and Columbia University, show that these health inequities lead to dramatic disparities in mortality leads.

“Sexual orientation mortality disparities highlight the urgent need to address preventable causes, especially given the increasingly hostile policy environment for LGBTQ people in the US,” said lead author Sarah McKetta, Research Fellow at Harvard Pilgrim Health Care Institute.

Dr. McKetta adds, “LGBTQ people are subjected to unique forms of stigma, prejudice, and discrimination that ‘get under our skin’ in countless ways. These toxic social forces result in chronic stress and unhealthy coping mechanisms, leaving this population vulnerable to poorer health and premature death.”

The researchers used data from the Nurses’ Health Study II, a cohort of more than 100,000 female nurses born between 1945 and 1964 and studied prospectively since 1989. Eligible participants were those alive in 1995 when sexual orientation was first assessed .

The research team linked participants’ reported sexual orientation to nearly 30 years of death certificates. The results showed that sexual minority women died an average of 26% earlier than heterosexual women. These differences were driven by both bisexual women – who died 37% earlier – and lesbian women – who died 20% earlier.

The ability to stratify results by subgroup of sexual orientation, researchers say, was a major strength of the study. “Bisexual women face various stressors from outside and within the LGBTQ community, which have their roots in biphobia. Furthermore, bisexual people are often excluded from various communities because they are assumed to be straight or gay based on the gender of their partner.” said senior author Brittany Charlton, an associate professor of population medicine at Harvard Medical School at the Harvard Pilgrim Health Care Institute.

“The more pronounced premature mortality rate among bisexual women is troubling and underscores the need for targeted interventions to reduce these disparities across all sexual minority groups.”

The researchers offer suggestions for actionable first steps that can be implemented across the care continuum. These include evidence-based preventive screening for sexual minority women without assumptions based on identity, increased screening and referrals to treatment for tobacco, alcohol, and other substance use, and mandatory, culturally informed training for health care providers caring for sexual minority patients .

“While our findings are striking in themselves, they may underscore the real disparity in the general population of the United States. The study participants were all nurses and therefore have many protective factors that the general population does not have,” noted Dr. McKetta op.

“Future research should investigate the specific factors that exacerbate or mitigate these risks so that we can develop targeted interventions to ensure that all people have the opportunity to live long, healthy lives.”

Dr. Charlton added: “It is imperative that we work to tackle the systems and structures that undermine the well-being and dignity of LGBTQ people.”