One of the largest studies to examine mortality differences by sexual orientation has found that, compared with heterosexual women, bisexual women have a 37% higher risk of premature death, while lesbian women have a 20% higher risk. This study, the first of its kind to distinguish between lesbian and bisexual women, sheds light on a long-standing issue of health inequalities among sexual minority women. While previous research has extensively documented inequalities in various health outcomes between sexual minority women and their heterosexual counterparts, there has been limited research into mortality inequalities, particularly between different subgroups within the sexual minority community.

The recent findings, spearheaded by researchers from the Harvard Pilgrim Health Care Institute in collaboration with institutions such as the Harvard T.H. Chan School of Public Health, the University of Utah, Boston Children's Hospital, and Columbia University, underscore significant health disparities leading to notable differences in mortality rates.

Lead author Sarah McKetta, a Research Fellow at the Harvard Pilgrim Health Care Institute, emphasizes the pressing need to address preventable causes behind these sexual orientation-related disparities, especially in the face of an increasingly hostile policy environment for LGBTQ individuals in the U.S.

Dr. McKetta further explains that LGBTQ individuals face unique forms of stigma, prejudice, and discrimination, which can manifest in various detrimental ways. These societal pressures contribute to chronic stress and unhealthy coping mechanisms, rendering this population more susceptible to poorer health outcomes and premature mortality.

The study's ability to stratify results based on the sexual orientation subgroup is highlighted as a significant strength by researchers. Senior author Brittany Charlton, an associate professor of population medicine at Harvard Medical School and the Harvard Pilgrim Health Care Institute, underscores the distinct stressors faced by bisexual women, both within and outside the LGBTQ community, which stem from biphobia.

Charlton further notes that bisexual individuals often experience exclusion from various communities due to assumptions about their sexual orientation based on the gender of their partner. The heightened premature mortality rate observed among bisexual women is concerning, emphasizing the necessity for targeted interventions aimed at reducing these disparities across all sexual minority groups.

The researchers propose actionable first steps that can be integrated across the healthcare continuum. These include implementing evidence-based preventive screening for sexual minority women without making assumptions based on identity, enhancing screening and referral for treatment of tobacco, alcohol, and other substance use, and mandating culturally-informed training for healthcare providers attending to sexual minority patients. Dr. McKetta notes that while the findings are significant, they may actually highlight an even greater disparity within the broader U.S. population, considering that study participants were all nurses and thus benefited from numerous protective factors not accessible to the general population.

Looking ahead, Dr. McKetta stresses the importance of further research to identify specific factors exacerbating or mitigating these risks, allowing for the development of targeted interventions to ensure everyone has the opportunity for a long and healthy life. Dr. Charlton emphasizes the need to address the systems and structures that undermine the well-being and dignity of LGBTQ individuals, underlining the imperative of collective action in this regard.

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