While the number of sexual minority older adults is notably increasing, the identification of health disparities by sexual orientation among older adults is a major gap in aging research. Sexual minorities were acknowledged as a health disparate population in Healthy People 2020. However, as the CDC Health Disparities and Inequalities Report (CDC, 2011) identifies, one of the biggest gaps in health disparities research is by sexual orientation. Little is known about health-related needs and concerns among lesbian, gay, and bisexual older adults. This is one of the first studies to comprehensively examine health disparities of LGBT older adults utilizing a population-based data.
Methods In this research, we analyzed older adults, age 50 or older, selected from the Washington State Behavioral Risk Factor Surveillance System (BRFSS). The BRFSS is an annual, state-based, and random-digit-dialed telephone survey of the non-institutionalized adults. Washington State has included the measure of sexual orientation since 2003, so 7 years of data were aggregated from 2003 to 2009. Sample weights provided by WA BRFSS were applied to all the analyses to adjust unequal probabilities of selection resulting from sample design, non-response, and telephone non-coverage. All the analyses were conducted separately by gender. Prevalence rates of health-related indicators, including examine health care access, health behaviors, health conditions, and health status, were estimated and compared by sexual orientation. For the comparison, we conducted logistic regression analyses which included dummy variables indicating lesbians, bisexuals, and heterosexuals for women and gays, bisexuals, and heterosexuals for men with coding heterosexuals as the reference group. The logistic regression models controlled for age, household income, and education.
Results Of the 51270 female respondents whose age were 50 and older, 477(0.99%) were lesbian and 245 (0.50%) were bisexual, and 50548 (98.51%) were heterosexual. Of the 32643 male respondents aged 50 and older, 396 (1.27%) were gay, 192 (0.51%) were bisexual, and 32055 (98.22%) were heterosexual. Among older adult women, lesbians were more likely to report current smoking (AOR=1.83; p<.001) and binge drinking (AOR=1.63; p<.05) than heterosexual women. Lesbians were also more likely to be obese (AOR=1.41; p<.01) and disabled (AOR=1.45; p<.01) than heterosexual women. Bisexual women showed higher prevalence rates of life-time asthma (AOR=1.67; p<.01) and disability (AOR=1.56; p<.05) than heterosexual women. Among older adult men, gay men showed higher prevalence rates of current smoking (AOR=1.42; p<.05), poor physical health (AOR=1.47; p<.05), and mental distress (AOR=2.14; p<.001) than heterosexual men; bisexual men showed higher prevalence rates of disability (AOR=1.88; p<.01).
Conclusions and implications We observed similar and dissimilar health disparity patterns among older adult lesbians, gay men, and bisexual women and men. Culturally tailored interventions that respond to unique health-related needs of sexual minority sub-groups need to be developed. In addition, future research needs to further investigate what risk and protective factors are associated with such disparities among sexual minority older adults.