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Premature mortality higher among sexual minority women — study

Findings show that sexual minority women died much sooner than heterosexual women, with bisexual women having the most pronounced differences. This highlights the urgent need to address sexual orientation-related inequities in preventable illness, including a focus on the systems and laws that drive health inequities.

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Compared to heterosexual women, bisexual women died 37% sooner and lesbian women 20% sooner.

This is according to results of a study — “Disparities in Mortality by Sexual Orientation in a Large, Prospective Cohort of Female Nurses” by Sarah McKetta, Tabor Hoatson, Landon D. Hughes, Brittany M. Charlton, et al — that was published in JAMA.

Decades of research have documented that sexual minority women have worse health — across various physical and mental health outcomes — relative to their heterosexual peers. However, few studies examined inequities in mortality, and none have been able to differentiate mortality inequities amongst sexual minority subgroups in women.

In the new study, the findings reveal these health inequities are leading to dramatic differences in mortality.

“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,” said lead author McKetta.

The researchers used data from the Nurses’ Health Study II, a cohort of over 100,000 female nurses born between 1945–1964 and surveyed prospectively since 1989. Eligible participants were those alive in 1995 when sexual orientation was first assessed. The study team linked participant-reported sexual orientation to nearly 30 years of death records. Results showed that sexual minority women died, on average, 26% sooner than heterosexual women. These disparities were driven by both bisexual women—who died 37% sooner—and lesbian women—who died 20% sooner.

The ability to stratify results by sexual orientation subgroup, researchers say, was a key strength in the study. “Bisexual women face distinct stressors from outside, as well as within, the LGBTQ community that are rooted in biphobia. Additionally, bisexual people are often excluded from various communities because they’re assumed to be straight or gay based on their partner’s gender,” said co-author Charlton. “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 suggested “actionable first steps that can be implemented throughout the care continuum.” These 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 healthcare providers caring for sexual minority patients.

Said McKetta: “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.”

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

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