Older LGBT+ health inequalities in the UK: setting a research agenda

Abstract

Lesbian, gay, bisexual and trans+ a (LGBT+) people report poorer health than the general population and worse experiences of healthcare particularly cancer, palliative/end-of-life, dementia and mental health provision. This is attributable to: a) social inequalities, including 'minority stress'; b) associated health-risk behaviours (e.g. smoking, excessive drug/alcohol use, obesity); c) loneliness and isolation, affecting physical/mental health and mortality; d) anticipated/experienced discrimination and e) inadequate understandings of needs among healthcare providers. Older LGBT+ people are particularly affected, due to the effects of both cumulative disadvantage and ageing. There is a need for greater and more robust research data to support growing international and national government initiatives aimed at addressing these health inequalities. We identify seven key research strategies: 1) Production of large datasets; 2) Comparative data collection; 3) Addressing diversity and intersectionality among LGBT+ older people; 4) Investigation of healthcare services' capacity to deliver LGBT+ affirmative healthcare and associated education and training needs; 5) Identification of effective health promotion and/or treatment interventions for older LGBT+ people, and sub-groups within this umbrella category; 6) Development an (older) LGBT+ health equity model; 7) Utilisation of social justice concepts to ensure meaningful, change-orientated data production which will inform and support government policy, health promotion and healthcare interventions.

The mental health and experiences of discrimination of LGBTQ+ people during the COVID-19 pandemic: Initial findings from the Queerantine Study

“…However, where evidence does exist, this overwhelmingly suggests that higher levels of pre-existing health conditions compared to cisgender and heterosexual populations, may place the LGBTQ+ community at additional risk of adverse prognosis. This includes long-term chronic illness, and higher rates of smoking and asthma among LGBTQ+ people [2][3][4][5][6][7][8]; higher rates of obesity, and alcohol consumption among lesbian, bisexual, and queer women [7 9 10]; and increased likelihood of being immunocompromised (e.g. HIV+ with a low CD4 cell count or with untreated HIV) among gay men and transgender people [11].…”

Applying a Capabilities Approach to Understanding Older LGBT People’s Disclosures of Identity in Community Primary Care

“…The public health case for disclosure of LGBT status in healthcare, in contrast, rests primarily on population-level benefits to disclosure: that collecting data on the whole LGBT population could improve the capabilities of LGBT people to achieve good health, for example through better understandings of risk, and targeting of interventions [ 5 ]. These collective capabilities are most enhanced if all LGBT people disclose their status.…”

“…However sexual orientation and gender identity are often not consistently recorded in key datasets such as censuses, patient records and mortality registries. This has resulted in a lack of large-scale data on key later-life morbidity and mortality outcomes in LGBT populations, such as cardiovascular disease, diabetes, cancer and other long-term conditions and conditions of ageing [ 5 , 6 , 7 , 8 ]. There are a number of social and practical factors that may underpin this historic lack of data collection, including the small, dispersed nature of the population; the history of criminalisation and pathologisation; concerns about sensitivity and privacy; uncertainty over when and how to record data; and a perception that LGBT populations have few or no distinct health needs [ 9 , 10 , 11 , 12 ].…”

LGBTQ+ focused mental health research strategy in response to COVID-19

“…Several researchers and health organisations have shown that health research disparities exist between lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ+) populations and heterosexual people. 1 , 2 , 3 Such research gaps have contributed to a health knowledge deficit for LGBTQ+ populations and resulted in few evidence-based interventions that address the many health inequities that disproportionately affect these populations across the lifespan. 1 Evidence points to LGBTQ+ populations having greater rates of chronic disease (eg, diabetes, coronary heart disease, and certain forms of cancer), social health problems (eg, violence, discrimination, exclusion, and loneliness), and mental health symptoms and disorders (eg, depression, anxiety, substance use, and suicide).…”

“…1 Evidence points to LGBTQ+ populations having greater rates of chronic disease (eg, diabetes, coronary heart disease, and certain forms of cancer), social health problems (eg, violence, discrimination, exclusion, and loneliness), and mental health symptoms and disorders (eg, depression, anxiety, substance use, and suicide). 1 , 2 , 3 , 4 Despite calls for the inclusion of sexual and gender identity being collected as part of demographic information in health research and the creation of LGBTQ+ focused health interventions, 1 , 2 , 3 such calls have not been fully addressed.…”