Health Disparities Among Lesbian, Gay, and Bisexual Older Adults: Results From a Population-Based Study

by Sherry Yu

The American Journal of Public Health recently published a study entitled, "Health Disparities Among Lesbian, Gay, and Bisexual Older Adults: Results From a Population-Based Study," which focuses on health disparities among LGB adults aged 50 or older. This week, AJPH Talks sat down with Dr. Karen Fredriksen-Golden to discuss her piece, published in our October 2013 issue.

Q: Do you expect the trend demonstrated in the article to continue to later generations? Why or why not?

Fredriksen-Goldsen: Research of health disparities among LGB populations in the U.S., especially among LGB older adults, is in the early stages of development. This study is one of the first population-based studies focusing on health disparities among LGB older adults. The findings in this paper, as well as our other studies reveal patterns of health disparities in these populations. And, it will be important to investigate how patterns remain similar or change across generations and cohorts of LGB older adults. We believe that health disparities in physical and mental health, as well as adverse health behaviors will likely continue unless we can gain a better understanding of the mechanisms leading to these disparities and based on this information develop and implement interventions to promote health across these diverse populations. Our previous studies found that both risk factors (including discrimination, stigma, and stress) and protective factors (including social and personal resources) are associated with health outcomes among LGB older adults. Interventions at societal, community and individual levels are needed to reduce risk factors and enhance protective factors in these populations. Without such targeted interventions, we believe that the next generation of LGB older adults will experience similar health disparities.

Q: In your opinion, what are some of the future research possibilities derived from this research?

Fredriksen-Goldsen: The data we used in this paper are representative of the aged 50 and older population in Washington State. Future research will need to expand its scope and examine sexual and gender minority older adult health in national U.S. samples. Recently, more population-based health surveys are including measures of sexual orientation. It will also be critical to include measures of gender identity as our other research finds that transgender older adults experience elevated risks in terms of physical and mental health.

Also, as mentioned earlier, various factors are related to health disparities among LGB older adults. However, the cross-sectional nature of existing data limits the ability to disentangle the etiology between variables. In the next stage of our research, we are conducting a longitudinal study to understand the mechanisms and processes overtime that contribute to health disparities in these populations.

Q: The explanation given in the article is social criminalization and discrimination. Are there any alternative explanations?

Fredriksen-Goldsen: In our research we have found that victimization and discrimination are among the strongest predictors of poor health in these communities. In addition, we found that many LGB older adults have differing types of social resources compared to those of heterosexual older adults. For example, as discussed in the paper, rates of being married and having children living in the household are lower among LGB older adults and rates of living alone are higher for gay and bisexual older adults, than those among heterosexual counterparts. Many LGB older adults may lack these types of social resources, which could buffer the impact of victimization and discrimination on health.

Another important factor to consider is the potential lack of health care access. Although almost all the LGB older adults have health insurance, still we find LGB older adults are less likely to have health insurance and more likely to experience financial barriers to healthcare than the heterosexual older adults. These findings suggest that LGB older adults may not be able to obtain timely and necessary health care, which in turn increases the likelihood of poor health outcomes. Some of the research findings in our other studies also suggest that even among LGB older adults who have health care insurance and access to providers, they may not receive proper care due to the lack of culturally competent and sensitive health services.

Q: What is a possible explanation for the disparities between homosexuals and bisexuals?

Fredriksen-Goldsen: It has been standard practice in many health studies to collapse lesbians and bisexual women and gay and bisexual men into single groups representing sexual minorities; however, our findings suggest they are distinct groups that merit attention and tailored intervention efforts.

In this study, we found higher rates of excessive drinking among lesbians compared to bisexual women. Drinking may be a related to social norms and behaviors in lesbian communities that may result in social resources (such as community connections), yet may also create risk for excessive drinking as an adverse health behavior. Whether such social norms continue in later life needs to be further examined. Also, whether bisexual women have built social resources in different ways needs to also be further investigated. Another important disparity observed in the paper was a higher rate of diabetes among bisexual men compared to gay men. Lower overweight and obesity rates in the gay male community are well known; however, these patterns have not been observed among bisexual adult men. Such differences in weight control are likely linked to diabetes prevalence in later life.

In some of our earlier research we examined whether bisexual adults experience poorer health outcomes. For example, we found that bisexual adults are often at higher socio-demographic risk (such as lower incomes), with less access to health care (less likely to have health insurance and more financial barriers to care). Bisexuals also may experience a heightened sense of isolation, which may lead to poor health outcomes. In fact, studies have found that bisexuals experience heightened risks of mental distress and poor general health. However, we did not find significant differences in health outcomes between older adult gay males and bisexual men and lesbians as compared to bisexual women. More research is needed to explore why such disparities are not observed among older adults.

Q: Do you think the results of Washington State can be generalized to the entire country or do you think factors such as same-sex marriage status in the state also matters?

Fredriksen-Goldsen: Washington was one of the first states to include a sexual orientation measure in the Behavioral Risk Factor Behavioral Risk Factor Surveillance System (BRFSS), which allows us to compare differences in health by sexual orientation, age and gender. While this research provides some important findings regarding health disparities among older adults, the findings are not generalizable beyond Washington. Across multiple studies we find that health disparities among LGB older adults are associated with victimization and other stressful life events, and more limited social resources, which suggests to us that similar patterns will be found across states. While the benefits of marriage are well documented in health research, marriage equality did not yet exist in Washington State when the data were collected for this study. How and to what extent different social and political environments interact with the health of LGB older adults are important research questions to further explore once national data are available.  

References: 

Karen I. Fredriksen-Goldsen, Hyun-Jun Kim, Susan E. Barkan, Anna Muraco, and Charles P. Hoy-Ellis.  Health Disparities Among Lesbian, Gay, and Bisexual Older Adults: Results From a Population-Based Study. American Journal of Public Health: October 2013, Vol. 103, No. 10, pp. 1802-1809. 

To read the full article, please visit the following website: http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2012.301110.