Lesbian and bisexual women die earlier than straight women, decades long study finds
May 14, 2024According to a recent study, lesbian and bisexual women have a significantly shorter life expectancy than heterosexual women, which is likely attributed in part to discrimination.
The impact of sexuality on health has been a focal point of research for years, accumulating a substantial amount of evidence that LGBTQ+ individuals face higher instances of negative health outcomes ranging from mental health struggles to chronic illnesses. However, the effect of these outcomes on mortality rates was less explored.
Last month, the Journal of the American Medical Association (JAMA) published a paper analyzing data spanning decades from the Nurses’ Health Study II initiated in 1989, part of several studies into risk factors for major chronic diseases in women. The research examined the influence of sexuality on early death rates among over 100,000 U.S. nurses, revealing a concerning disparity in the longevity of lesbian and bisexual women compared to their heterosexual counterparts.
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The findings showed that participants who identified as lesbian or bisexual had a 26% higher premature mortality rate—lesbian women at 20% and bisexual women at 37%—than those identifying as heterosexual.
Sarah McKetta, the lead author of the JAMA study and a postdoctoral fellow at Harvard Medical School, shared insights with ‘NBC News’: “One of the advantages of this study is that we were able to separate out bisexual and lesbian participants, because we had enough people and we followed them for long enough that we can actually look at those risks separately, which no other U.S. study has been able to do.”
Despite anticipating disparities based on existing research, McKetta noted the unexpectedly stark differences in mortality rates they encountered.
Compiling information on premature death rates within LGBTQ+ communities has been challenging due to the lack of systematic inclusion of sexual orientation questions in U.S.A. studies until 2014. However, the Nurses Health Study II was ahead of its time; in 1995, participants were given the choice to self-identify their sexual orientation in a follow-up survey, providing the data used by McKetta and her team alongside records from the National Death Index.
“We’ve known for a really long time that there are systemic and highly reproducible health disparities for LGB people, particularly LGB women, across many outcomes,” McKetta said. Discrepancies have been observed in areas such as tobacco and alcohol use, mental health, and chronic diseases. The real challenge, according to McKetta, lies in quantifying how these disparities translate into premature mortality rates due to significant data limitations.
“This was an opportunity for us to actually quantify the magnitude of that disparity.”
The study model not only allowed the comparison of mortality rates but also helped deduce how specific health outcomes influenced these differences. Research spanning twenty years prior unveiled a twofold increase in alcohol and tobacco use and elevated risks of breast cancer, cardiovascular disease, and depression among lesbian and bisexual participants, leading McKetta and her team to attribute these disparities largely to preventable causes.
“This isn’t something that just happened; this is something that is due to chronic processes and we think is also multifactorial,” McKetta emphasized, highlighting that further analysis involving non-smokers showed the same mortality disparities. “It’s not because of one thing; it’s because of a lot of things.”
Central to these factors are various forms of discrimination and isolation that lesbian and bisexual women endure daily, from health care interactions to social environments—referred to by McKetta as “toxic social exposures.” These interactions contribute to harmful behaviours and negative mental and physical health outcomes, particularly pronounced in bisexual women, who face higher risks of substance abuse and sexual victimisation, and generally poorer health compared to lesbian and heterosexual women.
“If this isn’t research that you typically do, it can be really easy to think that because sexuality is a spectrum, that the risk kind of goes up as people get more exclusively lesbian, more exclusively gay. But actually, the healthcare risks are much more pronounced for bisexual folks,” McKetta explained. “They have these dual pressures given their identity, and they experience discrimination from both inside and outside of queer communities.”
Despite the "grim" reality portrayed in the study for participants born between 1945 and 1964, McKetta remains hopeful that the findings will draw attention to the systemic issues contributing to poor health outcomes for LGBTQ+ women and people, aiming to prevent similar shortened lifespans in future generations.
“One of the things that I was worried about with this study is that the takeaway would be that it kills to be gay,” she remarked. “It doesn’t kill to be gay. It kills to be discriminated against. And that’s the lived experience of lesbian and gay women and bisexual women who are just trying to walk through the world.”
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