- Health disparities for sexual minorities are complex and are linked to myriad factors.
- These disparities stem from being exposed to different levels of particular stressors and different experiences accessing healthcare and socioeconomic circumstances compared to heterosexual people.
- Influences on cardiovascular health are also multifactorial and include many environmental and lifestyle factors, including diet, alcohol, smoking, stress, and poverty.
- A recent analysis assessed the potential impact of these factors on cardiovascular health and showed that lesbian and bisexual women have lower cardiovascular health scores than their heterosexual counterparts.
Health disparities affecting gay, lesbian, and bisexual people have been acknowledged for decades, but the extent and causes are unclear.
One area that has gained interest recently is cardiovascular health.
To investigate the difference in exposure to cardiovascular risk factors between sexual orientation groups, researchers analyzed data from a cohort of 169,434 individuals who lived across 21 cities in France.
They used a health score developed by the American Heart Association called the Life’s Essential 8 score in 2022. This scoring system uses healthy diet, physical activity, managing weight, smoking status, fasting blood glucose, blood pressure, and total cholesterol, as well as sleep, to calculate a score. Scores range from 0-100%. Higher scores mean better heart health.
This score had been an update of a previous score developed by the American Heart Association called the Life’s Essential 7 score, which didn’t include data on sleep. Researchers noted that the Life’s Essential 8 score had not yet been used to investigate the cardiovascular health risk of sexual minorities.
The researchers found that after adjustment for confounders, such as level of education, lesbian or bisexual women had lower cardiovascular health scores and hence worse heart health than heterosexual women.
Their results were published in the Journal of the American Heart Association.
LGBTQ+ vs. heterosexual health
Research historically has shown that LGBTQ+ people have worse health than their heterosexual counterparts in many areas.
A report published by NHS Digital in 2021 showed lesbian, gay, and bisexual adults were more likely to report having a limiting longstanding illness and having ‘bad’ or ‘very bad’ health than heterosexual adults.
Lesbian, gay, and bisexual people are also more likely to report having lower mental well-being and over twice as likely to have said they have mental, behavioral, or neurodevelopmental disorders than heterosexual people.
Alcohol abuse is one area that has received some attention from researchers. One Australian study found that lesbian and bisexual women had greater levels of alcohol abuse and poorer mental health than heterosexual women. Bisexual women were more affected by this disparity than lesbian women.
The NHS Digital report showed lesbian, gay, and bisexual people were also more likely to smoke, with 31% of lesbian and bisexual women reporting smoking, nearly twice as many as the 16% of heterosexual women who did so.
However, there are some areas of health where gay, lesbian, and bisexual people may have better health outcomes than heterosexual people. They are less likely to have musculoskeletal conditions, for example.
The current study, however, shows that lesbian, and bisexual women may have worse cardiovascular health.
Comparing heart health among sexual minorities
In this study, researchers discovered that lesbian women had 0.95 points lower scores out of 100 than heterosexual women, and bisexual women scored 0.78 points lower than heterosexual women.
This was true after researchers adjusted the data for factors such as age, region, employment and education status, alcohol use, mental health status, housing, and family history. They did not collect any information on gender identity.
Gay and bisexual men showed the opposite trend, with gay men having 2.72 points higher cardiovascular health scores than heterosexual men, and bisexual men had 0.83 points higher scores after adjustment.
Dr. Scout, executive director of the National LGBT Cancer Network and an LGBTQIA+ health researcher who was not involved in the research, told Medical News Today:
“This study’s findings are intriguing in that we might have expected there to be higher risk across sexual minority populations due to the well-known cumulative effect of a lifetime of stressors on the sexual minority sample. That said, it does echo some other work to see this increased risk among sexual minority women specifically.”
Why lesbian or bi women have worse heart health
The authors of the paper say that it is unclear what the reasons behind the results could be and are careful to warn further research needs to be done to determine potential causes.
They pointed out that lesbians are more likely to be overweight or obese than heterosexual women and that gay men are less likely to be obese than heterosexual men as a potential reason for the findings.
Jessica Halem, senior director of Eidos, the LGBTQ+ Health Initiative at the University of Pennsylvania, who was not involved in the research, told MNT that it was likely multiple barriers to healthcare access and stressors experienced by lesbian and bisexual women contributed to the disparity shown in the study.
“Unfortunately, the same barriers and stressors that result in our worse cardiovascular health also lead to higher rates of cancer too. As the study finds, lesbian and bisexual women have higher rates of smoking and living in poverty combined with frequent negative healthcare experiences.”
Researchers suggest that one reason for the lower cardiovascular health score for lesbian and bisexual women could be lower contact with healthcare providers, for example, during pregnancy or accessing contraception. This was supported by analysis showing lesbian women who had been pregnant had similar cardiovascular scores to heterosexual women.
The paper shed light on the topic but could be said to “raise more questions than answers,” said Dr. Scout.
“As researchers, we look forward to the day we have robust longitudinal data on the full sexual and gender minorities communities that tracks many of our known health risk factors,” he added.
“When we have [longitudinal data on sexual and gender minorities], we will start to really see the full picture. Importantly, while first studies raise new questions, we have to celebrate the fact that we are getting new data about a health issue for our communities. I hope researchers use studies like this to justify getting sexual and gender minority measures into future studies on this topic.”
— Dr. Scout
Influence of alcohol and tobacco companies
Halem pointed to commercial pressures that could contribute to the findings, including funding of LGBTQ+ events and media by tobacco and alcohol companies.
“The first and largest funders of most Pride celebrations were tobacco and alcohol companies. Cigarettes were given away free in gay bars. Big tobacco spent millions on marketing campaigns to target us – and it worked. Alcohol companies continue to take out full-page color ads in our newspapers. Ads no nonprofit could ever afford,” she said.
“Before any other funder, before any other corporation, before any legal rights or marriage equality – tobacco and alcohol companies were the only ones speaking to LGBTQ+ people – and we listened. They had us in their sights, and they won. Gay bars continue for many to be the only place we can be safe, seen, and sexy. I am thankful for those spaces, but we need more ways to build community now,” she added.
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