Study: Lesbian, bisexual women die earlier than heterosexual women

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A groundbreaking study of over 100,000 women finds that sexual minority women—those who identify as bisexual or lesbian—die earlier compared to heterosexual women. The study was conducted by researchers at Harvard T.H. Chan School of Public Health, the University of Utah, Boston Children’s Hospital and Columbia University and reveal that health inequities among women consequently lead directly to significant and shocking differences in mortality rates. 

The objective of the study was to examine differences in mortality by sexual orientation. The study participants were asked about their sexual orientation in 1995 and researchers tracked the orientation of participants after they died with 30 years of death records. 

The researchers said that women facing societal pressures and chronic stress were more likely to develop unhealthy coping mechanisms that could lead to an earlier death. 

The study results were published in the journal JAMA (The Journal of the American Medical Association), a peer-reviewed medical journal published 48 times a year by the American Medical Association. It publishes original research, reviews and editorials covering all aspects of biomedicine.

The key finding is that compared to heterosexual women, bisexual women died 37% sooner and lesbian women 20% sooner than their heterosexual peers. These data are results from one of the largest studies to examine sexual orientation-related inequities in mortality and the first to differentiate between lesbians and bisexual women.

JAMA explains that the researchers asked: “Do bisexual and lesbian women have higher risks of premature mortality than heterosexual women?” The study then analyzed data from the Nurses’ Health Study II, a cohort of over 100,000 female nurses, “linking sexual orientation data with nearly 30 years of death records. They found that, on average, sexual minority women died 26% sooner than heterosexual women. Stratifying results by sexual orientation subgroup, the researchers found that bisexual women died 37% sooner and lesbian women died 20% sooner.” 

The study delineates how decades of research have documented that sexual minority women have worse health across various physical and mental health outcomes relative to their heterosexual peers. As the research states, “Extensive evidence documents health disparities for lesbian, gay and bisexual (LGB) women, including worse physical, mental and behavioral health than heterosexual women. These factors have been linked to premature mortality, yet few studies have investigated premature mortality disparities among LGB women and whether they differ by lesbian or bisexual identity.”

Participants were female nurses born between 1945 and 1964, initially recruited in the U.S. in 1989 for the Nurses’ Health Study II, and followed up through April 2022—33 years of their life-spans. Eligible participants were those alive in 1995 when sexual orientation was first assessed.

The study states the reason for the vast difference in death rates was explained succinctly: discrimination shortens lives. Similar studies examining the impact of racism on survival rates have been conducted. 

Sarah McKetta, a postdoctoral research fellow at the Harvard Pilgrim Health Care Institute and the lead author of the study, explained that LGBTQ+ people experience stigma, prejudice and discrimination that result in chronic stress and unhealthy coping mechanisms, making the population vulnerable to worse health and premature mortality.

McKetta is a social epidemiologist whose work focuses on measurement of structural stigma using multiple empiric approaches ranging from laws and policies to social attitudes. Her work also includes examining how changing gender structures impact substance use, women’s health and sexual and reproductive health. Her clinical background is in sexual health and prior to her doctoral training, she spent four years working in patient care and women’s health research at Planned Parenthood.

“The sexual orientation-related inequities in mortality highlight the urgent need to address preventable causes, particularly given the increasingly hostile policy climate for LGBTQ people in the U.S.,” McKetta said.

McKetta adds, “LGBTQ people are subjected to unique forms of stigma, prejudice, and discrimination that ‘get under the skin’ in a myriad of ways. These toxic social forces result in chronic stress and unhealthy coping mechanisms, which make this population vulnerable to worse health and premature mortality.”

Brittany Charlton, senior author of the study and associate professor in the Department of Epidemiology, commented on the more pronounced premature mortality rate among bisexual women, calling it “troubling.” 

“Bisexual women face distinct stressors from outside, as well as within, the LGBTQ community that are rooted in biphobia,” Charlton said. 

Charlton is an Associate Professor at Harvard Medical School and Harvard Pilgrim Health Care Institute in the Department of Population Medicine and at the Harvard T.H. Chan School of Public Health in the Department of Epidemiology. She is also the Co-Director of the Harvard SOGIE (Sexual Orientation and Gender Identity and Expression) Health Equity Research Collaborative and Adjunct Faculty at The Fenway Institute. Charlton is also known as a leading scholar documenting reproductive health and cancer disparities affecting sexual and gender minorities.

“Additionally, bisexual people are often excluded from various communities because they’re assumed to be straight or gay based on their partner’s gender,” she said.

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

The researchers make suggestions for actionable first steps that can be implemented throughout the care continuum. They include evidence-based preventive screening for sexual minority women without assumptions based on identity, increased screening and treatment referral 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 on their own, they just might underscore the true disparity in the general United States population. Study participants were all nurses and therefore have many protective factors that the general population doesn’t have,” McKetta said.

McKetta continued, “Future research needs to examine the specific factors that exacerbate or ameliorate these risks, so we can develop targeted interventions to ensure all people have the opportunity to live long, healthy lives.”

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

Other Harvard Chan School co-authors of the study were Landon Hughes, Sebastien Haneuse and Bryn Austin.

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