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Try out PMC Labs and tell us what you think. Learn More. Fredriksen-Goldsen originated the study, synthesized the conceptualization and analyses, and led article preparation. Kim contributed to the data analyses, conceptualization, and interpretation. Barkan assisted in the interpretation and synthesis of the findings and discussion. Muraco participated in the development and writing of the article. Hoy-Ellis conducted the literature review and participated in the development of the article. All authors participated in conceptualization and interpretation of findings and in the writing and editing of the article.
We investigated health disparities among lesbian, gay, and bisexual LGB adults aged 50 years and older. LGB older adults had higher risk of disability, poor mental health, smoking, and excessive drinking than did heterosexuals. Lesbians and bisexual women had higher risk of cardiovascular disease and obesity, and gay and bisexual men had higher risk of poor physical health and living alone than did heterosexuals.
Lesbians reported a higher rate of excessive drinking than did bisexual women; bisexual men reported a higher rate of diabetes and a lower rate of being tested for HIV than did gay men. Tailored interventions are needed to address the health disparities and unique health needs of LGB older adults. Research across the life course is needed to better understand health disparities by sexual orientation and age, and to assess subgroup differences within these communities.
Changing demographics will make population aging a defining feature of the 21st century. Not only is the population older, it is becoming increasingly diverse. A review of 25 years of literature on LGB aging found that health research is glaringly sparse for this population and that most aging-related studies have used small, non-population-based samples.
Several important studies have begun to document health disparities by sexual orientation in population-based data and have revealed important differences in health between LGB adults and their heterosexual counterparts, including higher risks of poor mental health, smoking, and limitations in activities.
In addition, important subgroup differences in health are beginning to be documented among LGB adults.
For example, bisexual women are at higher risk than lesbians for mental distress and poor general health. Most studies to date address the health needs of LGB adults aged 18 years and older 9 or those younger than 65 years. A few studies have begun to examine health disparities among LGB adults aged 50 years and older. The researchers also found that older gay and bisexual men report higher rates of hypertension and diabetes than do heterosexual men. Examining to what extent sexual orientation is related to health disparities among LGB older adults is a first step toward developing a more comprehensive understanding of their health and aging needs.
We analyzed population-based data from the Washington State Behavioral Risk Factor Surveillance System WA-BRFSS to compare lesbians and bisexual women and gay and bisexual men with their heterosexual counterparts aged 50 years and older on key health indicators: outcomes, chronic conditions, access to care, behaviors, and screening. We also compared subgroups to identify differences in health disparities by sexual orientation among LGB older adults. Each year, disproportionate stratified random sampling is used to select eligible households, and from each selected household 1 adult is randomly selected as the respondent.
We selected 50 years as the lower age limit to be consistent with health studies focusing on sexual minority older adults, 13,14 as well as research addressing specific chronic health conditions 16,17 and older adult health and well-being, such as the Health and Retirement Study and other population-based studies. The age range Older bi single female w the sample for LGB older adults was 50 to 98 years 50—94 years for women and 50—98 years for men. To measure sexual orientation, survey respondents were asked to select 1 of the following: heterosexual or straight, homosexual gay or lesbianbisexual, or something else.
We categorized relationship status as married versus partnered a member of an unmarried couple versus other divorced, widowed, separated, or never married. Health outcomes recommended and validated by CDC in our study were poor physical health, disability, and poor mental health. The BRFSS asked respondents whether they had ever been told by a health professional they had arthritis, asthma, diabetes not included if prediabetes or gestational diabetes alonehigh blood pressure not included if borderline or during pregnancy aloneor high cholesterol.
As recommended by other health studies, we deated cardiovascular disease CVD as diagnosis by a physician of a heart attack, angina, or stroke. The BRFSS measured health screening, according to public health guidelines for older adults, by whether respondents received a flu shot in the past year, 29 an HIV test ever, a mammogram for women in the past 2 years, 30 and a prostate-specific antigen test for men in the past year.
We conducted analyses separately by gender. We also tested statistical ificance of differences in background characteristics between lesbians and bisexual women and between gay and bisexual men. We then estimated weighted prevalence rates of health indicators, which were health outcomes, chronic conditions, access to care, behaviors, and screening, by sexual orientation lesbian and bisexual vs heterosexual women; gay and bisexual vs heterosexual men.
We conducted a series of adjusted logistic regressions, with control for sociodemographic characteristics age, income, and educationto test associations between health-related indicators and sexual orientation. We also conducted adjusted logistic regression analyses to examine health disparities between lesbian and bisexual women and between gay and bisexual men.
Table 1 illustrates the weighted prevalence of background characteristics by sexual orientation among older adults. Lesbians and bisexual women were younger, had more education, and had higher rates of employment than did heterosexual women; income levels were similar. Lesbians and bisexual women were less likely to be married and more likely to be partnered than were their heterosexual counterparts, but the average of children in the household and the likelihood of living alone were similar. We found no differences in other background characteristics.
Estimates were weighted; ificance tests were conducted to examine the association between background Older bi single female w and sexual orientation lesbians and bisexual women vs heterosexual women; gay and bisexual men vs heterosexual men. Gay and bisexual men were ificantly younger and more highly educated than were heterosexual men; income levels and employment rates were similar. Gay and bisexual men were less likely than heterosexual men to be married but more likely to be partnered; they also had fewer children in the household, were more likely to live alone, and were more likely to be non-Hispanic Whites.
Lesbians and bisexual women had similar rates of poor physical health, disability, and poor mental health. Adjusted logistic regression models controlled for age, income, and education; heterosexuals were coded as the reference group. Although the unadjusted prevalence rates of disability were similar between sexual minority and heterosexual men, the analyses with adjustment for sociodemographic characteristics showed that gay and bisexual men were more likely than their heterosexual counterparts to have a disability.
We did not observe differences in health outcomes between gay and bisexual men. The unadjusted odds of asthma for lesbians and bisexual women were ificantly higher than for heterosexual women, but the difference did not remain ificant when the analyses adjusted for sociodemographic differences. We observed no ificant differences in chronic conditions between lesbians and bisexual women in the adjusted analyses. The adjusted odds of diabetes were ificantly higher for bisexual men We detected no other ificant differences in chronic conditions between gay and bisexual men. As shown in Table 3although we found no ificant difference in the prevalence of having a health care provider, lesbians and bisexual women were less likely than heterosexual women to have health insurance coverage and more likely to experience financial barriers to health care.
These differences, however, did not remain ificant after adjustment for sociodemographic characteristics. We detected no ificant differences in health care access indicators between lesbians and bisexual women. In the unadjusted analyses, gay and bisexual men were less likely than heterosexual men to have health insurance coverage, but the difference did not remain ificant after Older bi single female w.
No ificant differences appeared in the indicators of health care access between gay and bisexual men. Lesbians 9. We observed no differences in health behaviors between gay and bisexual men. We observed no ificant differences in health screenings between older lesbians and bisexual women. In the initial analyses, sexual minority men were ificantly less likely than heterosexual men to receive a prostate-specific antigen test, but the difference was not ificant after adjustment for sociodemographic characteristics.
Although we found no ificant differences between gay and bisexual men in the prevalence of receiving a flu shot or a prostate-specific antigen test, bisexual men We conducted one of the first studies to comprehensively examine leading CDC-defined health indicators among LGB older adults in population-based data. The findings reveal ificant health disparities among LGB older adults, with both strengths and gaps across the continuum of health indicators examined. Our suggest that some health disparity patterns that have been found in LGB adults at younger ages 9,10 persist in later life, including higher likelihoods of disability, poor mental health, and smoking, and, among lesbians and bisexual women, excessive drinking and obesity.
We also found some health disparities—heightened risks of CVD among lesbian and bisexual women and of poor physical health and excessive drinking among gay and bisexual men—that may emerge later in the life course. Such health disparities likely have detrimental consequences for the quality of life of these LGB older adults. According to the life course perspective, social context, cultural meaning, and structural location in addition to time, period, and cohort affect aging processes, including health.
Elevated risks of disability and poor mental health among LGB older adults may be Older bi single female w with experiences of stigmization 37—39 and victimization, 39—41 especially in light of the profound impact that events at a given stage of life can have on subsequent stages. Although our study was deed to identify health disparities among LGB older adults, further research is needed to compare LGB age cohorts and health changes over time.
Heightened risks of disability and poor physical and mental health among older gay and bisexual men may also be related to HIV. With the advances in antiretroviral therapies, more adults with HIV are living into old age, 45,46 and older adults living with HIV have been found to be at increased risk of disability and poor physical and mental health. Elevated risks of smoking and excessive drinking are of major concern among LGB older adults. Although smoking and excessive drinking are leading causes of preventable morbidity and mortality, 47 most prevention campaigns target only younger populations.
research has found that LGB adults smoke at much higher rates than their heterosexual counterparts, 9,10,50 and our findings illustrate that such disparities persist among LGB older adults. We also found that older sexual minority women were more likely than older heterosexual women to drink excessively, which has also been documented in studies of younger sexual minority women. Existing research documents that drinking rates decline with age among older adults in general.
It may be that the rate of decline in drinking among older gay and bisexual men is slower than among older heterosexual men.
Older lesbians and bisexual women were more likely than their heterosexual counterparts to be obese and to have CVD; older gay and bisexual men were less likely than heterosexuals to be obese. The higher prevalence of obesity among lesbians and bisexual women than heterosexual women is well documented, 55 but increased risk of CVD has rarely been reported.
Our subgroup analyses revealed that diabetes was more common in older bisexual than gay men, even though the obesity rates for the 2 groups were similar. The association between type 2 diabetes and obesity is well known. We observed some positive trends in preventive screenings, such as the higher likelihood of receiving a flu shot and an HIV test for gay and bisexual than for heterosexual men.
Lesbians and bisexual women were more likely than their heterosexual peers to receive an HIV test. Yet we also found evidence of gaps and missed opportunities for prevention. For example, among sexual minority older men, bisexual men were less likely than gay men to obtain an HIV test. Older lesbians and bisexual women were less likely than heterosexual women to report having had a mammogram. Efforts to promote mammography screening among older lesbians and bisexual women is particularly important, because higher risks of breast cancer have been documented among sexual minority women, attributable to elevated prevalence of obesity, substance use, and nulliparity.
We observed several important differences in background characteristics by sexual orientation. Contrary to existing stereotypes, despite higher levels of education among LGB older adults, and the higher likelihood of employment among lesbians and bisexual women, LGB older adults do not have higher incomes than do heterosexuals, as observed in other population-based data. A recent study found Older bi single female w for gay men, being legally married is associated with mental health benefits.Older bi single female w
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