Sexual orientation and vulnerability to chronic disease: understanding cardiovascular risk factors and mental health disparities among lesbian, bisexual and heterosexual women

Current research on health disparities among sexual minority women suggests that they may be at increased risk for chronic poor physical and mental health outcomes. However, as of this writing, the existing research typically does not 1) use large, population based samples (limiting the generalizability of those studies), 2) provide an intersectional analysis of disparities based on both sexual orientation and race and 3) adequately establish how risks based on sexual orientation and race can result in both mental and physical morbidity. The purpose of this study is to 1) provide a population-based analysis of cardiovascular risks and mental health disparities among sexual minority women and 2) provide an intersectional analysis of these disparities with a focus on sexual orientation and race. Secondary data analysis was conducted using the National Health and Nutrition Examination Survey (NHANES) 2003-2012, which utilizes a nationally representative, complex, multi-stage sampling method to represent non-institutionalized adults in the United States. The study sample included 7811 women, 95.2% of whom identified as heterosexual, 1.3% identified as lesbian and 3.5% identified as bisexual. Results show that across chronic physical and mental health outcomes, bisexual women fare worse than both lesbian and heterosexual women. Bisexual women are more likely to have an annual household income of less than $20,000, have no health insurance, have a higher log body mass index (BMI), to have been diagnosed with diabetes (even when controlling for family history of diabetes), have poor report mental health days and trouble sleeping. Both lesbian and bisexual women are more likely to engage in nicotine use and binge drinking. Race was also a significant predictor of poor chronic health outcomes. Both black and Hispanic women were more likely to have an annual household income of less than $20,000, have no health insurance, have higher log BMI and report a family history of diabetes (even after controlling for family history of diabetes). Race also seems to be a protective factor such that racially marginalized women were less likely to engage in substance use and less likely to report poor mental health. Future research and chronic disease prevention efforts should focus on health disparities among bisexual women in particular. Population based research should focus on health disparities based on larger samples of both sexual minority and racial minority women. Further recommendations for future research and practice are discussed within the dissertation