For Sexual Minorities, Health Disparities Persist Late in Life

A recent article, published in the Psychiatric Services in Advance, examined differences in general health, mental health, substance use, and acute service use between elder lesbian, gay, and bisexual (LGB) adults and their matched heterosexual adults. The results suggest that health disparities are persisting into older adulthood among sexual minorities.

Minority stress results from various forms of discrimination and leads to greater psychological distress, higher suicide risk, and ongoing health disparities. Yet, while prevention and intervention programs for LGBT youth are getting more attention, LGBT elders are often overlooked.

In fact, research has shown that older LGB adults are at higher risk for psychological distress, mental health conditions, and suicidal ideation. In addition, studies suggest that older LGB adults are less likely to seek health services and to have health insurance as they are more likely to face higher financial barriers than heterosexual adults.

This retrospective matched-control study used data from the 2015 New York State Office of Mental Health (NYSOMH) Patient Characteristics Survey (PCS) and Medicaid. The survey sample included 1,659 LGB-identified individuals and 1,659 heterosexual individuals with matching sociodemographic characteristics (e.g., age group, race, education level, employment, region of residence, living situation, criminal justice involvement, and receive of public cash assistance).

The survey also collected information on (1) the presence of serious mental illness and psychiatric diagnosis including schizophrenia/psychotic disorders, depression, bipolar disorder, and anxiety, (2) the presence of disability and disorder including physical disability, developmental disability, autism spectrum disability, and intellectual disability, (3) the presence of substance use disorder including alcohol, other drugs, and tobacco use, (4) chronic medical conditions, and (5) acute service use: inpatient stays and emergency visits.

The study found the following results.

In terms of the prevalence of psychiatric diagnoses, health and substance use disorders, add chronic medical conditions, the results showed that sexual minority older women (lesbian & bisexual) had higher rates of bipolar disorder, obesity, liver disease, cancer, alcohol and substance use disorders, and tobacco use than heterosexual older women. Meanwhile, they had lower rates of intellectual disability, schizophrenia, and anxiety disorder than heterosexual older women.

As for sexual minority older men (gay & bisexual), they had higher rates of bipolar disorder, depression, anxiety, other cardiac issues, and chronic medical conditions than heterosexual older men. However, they had lower rates of serious mental illness, schizophrenia, alcohol and substance use disorders, and tobacco use than heterosexual older men.

When the analysis controlled for demographic characteristics, such as race and socioeconomic status, sexual minority older women were more likely to have a primary diagnosis of bipolar disorder and liver disease and less likely to have a primary diagnosis of schizophrenia than heterosexual women. They also reported higher rates of hearing and visual disabilities, alcohol use disorders, substance use disorders, and tobacco use than heterosexual women. In addition, they are more likely to have experienced inpatient stays and emergency visits related to substance use disorder than heterosexual women.

As for sexual minority men, they were more likely to have a primary diagnosis of depression or anxiety and less likely to have a diagnosis of schizophrenia or serious mental illness than heterosexual men. They reported no significant differences in health and substance use disorders but were more likely to have experienced a cardiometabolic disorder and diabetes. In addition, they are less likely to have experienced inpatient stays related to substance use disorder than heterosexual men.

The authors suggested that their results are consistent with the current literature on mental health-related issues and health disparities in the LGB population. Furthermore, their results on the differences in substance use behaviors and substance-related inpatient stays/emergency visits may be used as evidence to support how minority stress is associated with elevated risk for behavioral health issues among sexual minorities.

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Rowan, G. A., Frimpong, E. Y., Li, M., Chaudhry, S., & Radigan, M. (2021). Health disparities between older lesbian, gay, and bisexual adults and heterosexual adults in the public mental health system. Psychiatric services, appi-ps. https://doi.org/10.1176/appi.ps.202000940