Social
Disparities in mortality by sexual orientation in a large, prospective cohort of female nurses Brittany Charlton* Sarah McKetta Tabor Hoatson Landon Hughes Bethany Everett Sebastien Haneuse S. Bryn Austin Brittany Charlton
Background: Extensive evidence documents health disparities for sexual minority women, including worse physical, mental, and behavioral health than their heterosexual peers. These factors have been linked to premature mortality, yet few studies have investigated premature mortality disparities among sexual minority women and whether these disparities differ by identity (e.g., lesbian or bisexual). Our objective was to examine differences in premature mortality by sexual orientation.
Methods: This prospective cohort study included female nurses born 1945-1964, recruited in 1989 and followed through April 2022. Sexual orientation (lesbian, bisexual, heterosexual identity) was assessed in 1995. We examined differences in time to all-cause mortality from assessment of exposure, analyzed using accelerated failure time models, adjusting for birth cohort.
Results: Among 90,833 participants, 89,821 (98.9%) identified as heterosexual, 318 (0.3%) as bisexual, and 694 (0.8%) as lesbian. Compared to heterosexual participants, and adjusting for birth cohort, sexual minority participants evidenced earlier mortality (acceleration factor [AF]: 0.74, 95% CI: 0.65–0.84). Examining subgroups, these differences were highest in magnitude among bisexual participants (AF: 0.63, [0.51–0.78]; for lesbian participants AF: 0.80 [0.68–0.95]).
Conclusion: Participants who identified as lesbian and bisexual had markedly earlier mortality over the study period relative to those who identified as heterosexual. These dramatic differences in the timing of mortality, in an otherwise largely homogenous sample of female nurses, highlight the urgency of addressing modifiable risks and upstream social forces that propagate and perpetuate disparities.