Reading - Smalley, Warren & Barefoot, 2018 - Disparities
LGBT Health: Meeting the Needs of Gender and Sexual Minorities
Chapter 6: Chronic Illnesses and Conditions in Gender and Sexual Minority Individuals
Population trends show an increase in chronic conditions due to aging, improved medical care and increased survival rates.
Chronic conditions lack a standardized definition but generally include:
Duration (lasting at least a year)
Limitation in function (self-reported)
Gender and sexual minority (GSM) individuals face health inequalities leading to higher prevalence of certain chronic conditions compared to cisgender heterosexuals.
Theories on Chronic Condition Prevalence
Compression of Morbidity Theory: Suggests disparities narrow as only the healthiest survive into older age.
Cumulative Disadvantage Hypothesis: Proposes the gap in health disparities widens due to accumulated burdens over time, linked to chronic stress.
Health inequalities in GSM may lead to significant chronic diseases.
Data Collection Recommendations
The 2011 Institute of Medicine (IOM) report advocated for data collection on GSM individuals, including sexual orientation and gender identity in health surveys.
Surveillance studies like BRFSS have begun to include this data, noting prevalence of chronic conditions among GSM individuals.
Prevalence of Chronic Conditions
Study focus on hypertension/CVD, asthma, diabetes, and self-reported poor health among GSM versus cisgender populations.
Despite limited literature, particular studies indicate:
Higher chronic condition prevalence in GSM individuals.
Limited data on conditions affecting transgender individuals specifically.
Risk Factors for Chronic Disease
Major risk factors include:
Physical Inactivity: Linked to CVD and diabetes.
Obesity: Higher rates found in GSM women compared to heterosexual women.
Tobacco and Alcohol Use: GSM populations have higher rates of tobacco use and excessive drinking.
Stress: Higher stress in GSM individuals impacts overall health, influencing chronic conditions.
Specific Chronic Conditions Overview
Hypertension and Cardiovascular Disease (CVD)
Hypertension is prevalent (approx. 33% of Americans) and a key risk factor for CVD.
Mixed evidence on hypertension prevalence in GSM populations:
Some studies show no significant differences, others indicate increased risk, particularly among older GSM women.
Stress and living in high-prejudice communities may contribute to CVD risk among GSM individuals.
Asthma
Asthma impacts breathing, affecting over 10 Americans daily.
Studies show mixed results, with some evidence indicating higher prevalence in GSM individuals:
Higher rates of asthma in lesbians and bisexual women versus cisgender heterosexuals.
Diabetes
Diabetes prevalence is increasing; conditions vary between type 1 (insulin dependent) and type 2 (lifestyle factors).
Evidence of elevated risk is inconsistent among studies, especially for bisexual men and older LGBTQ+ individuals.
Overall Self-Reported Health
GSM populations report poorer health compared to cisgender heterosexual individuals, often influenced by varying health constructs and social support perceptions.
Significant differences in self-reported health were found particularly in younger age groups of GSM individuals.
Racial and Ethnic Disparities
Studies suggest differences in chronic condition prevalence based on race/ethnicity within GSM populations, necessitating deeper exploration into social identities.
Role of Age and Outness
Aging and timing of identity development impact chronic health risks; older GSM individuals may experience cumulative health impacts.
Outness also affects health - those fully out experience different health outcomes than those who conceal their identity.
Mental Health Impact
Mental health disparities exist between GSM and cisgender populations, influencing chronic health conditions.
Access to Care
GSM individuals face disparities in healthcare access and utilization of preventive services, potentially leading to untreated chronic conditions.
Biological Causality
Proposed mechanisms for health disparities include:
Hypothalamic-pituitary-adrenal axis alterations affecting stress responses and immune function.
Autonomic nervous system reactivity linked to discrimination and stress.
Conclusion
Increased chronic condition prevalence in GSM populations highlights the need for ongoing research and data collection.
Understanding mechanisms behind health disparities can inform strategies for improvement in health outcomes for these populations.
LGBT Health: Meeting the Needs of Gender and Sexual Minorities
Chapter 6: Chronic Illnesses and Conditions in Gender and Sexual Minority Individuals
Population Trends: Recent data indicates that due to factors such as aging populations, advancements in medical care, and increased survival rates, there is a notable rise in the prevalence of chronic conditions across various demographics, including gender and sexual minorities (GSM).
Understanding Chronic Conditions: Chronic conditions are commonly characterized by:
A minimum duration of one year.
Self-reported limitations in daily functioning. These conditions are not uniformly defined, leading to variations in study methodologies and outcomes.
Health Inequalities: GSM individuals often experience significant health disparities which contribute to a higher prevalence of chronic diseases compared to cisgender heterosexual individuals. This situation necessitates a deeper understanding of the underlying factors that contribute to these inequities.
Theories on Chronic Condition Prevalence
Compression of Morbidity Theory: This theory posits that health disparities may diminish over time as only the healthiest individuals survive into older age, potentially reducing the incidence of chronic conditions.
Cumulative Disadvantage Hypothesis: In contrast, this hypothesis suggests that health disparities widen over time due to accumulated stressors and disadvantages, leading to poorer health outcomes in GSM populations.
These theories inform public health approaches aimed at addressing chronic illnesses within GSM communities.
Data Collection Recommendations
The 2011 Institute of Medicine (IOM) report strongly advocates for the inclusion of sexual orientation and gender identity data in health surveys. This data is critical to understanding health outcomes for GSM individuals, who continue to be underrepresented in health research studies.
Surveillance initiatives, such as the Behavioral Risk Factor Surveillance System (BRFSS), have begun to include data on GSM populations, focusing on disparity observations regarding chronic conditions.
Prevalence of Chronic Conditions
Studies are primarily centered on conditions such as hypertension, cardiovascular disease (CVD), asthma, diabetes, and overall self-reported health statuses among GSM individuals in comparison to cisgender populations. Evidence suggests:
There is a consistently higher prevalence of chronic conditions in GSM populations.
Data on transgender individuals are notably limited, emphasizing the need for more focused research.
Risk Factors for Chronic Disease
Major risk factors that disproportionately affect GSM individuals include:
Physical Inactivity: Linked to higher occurrences of cardiovascular disease and diabetes, particularly in sedentary populations within the GSM community.
Obesity: Rates of obesity are notably higher in GSM women compared to their heterosexual counterparts, leading to increased health risks.
Tobacco and Alcohol Use: GSM populations engage in tobacco use and excessive alcohol consumption at rates higher than the general population, compounding their health risks.
Stress: Chronic stress experienced by GSM individuals, often stemming from societal prejudice, has a direct correlation with overall health and the development of chronic conditions.
Specific Chronic Conditions Overview
Hypertension and Cardiovascular Disease (CVD): Approximately 33% of Americans are reported to have hypertension, which stands as a significant risk factor for cardiovascular issues.
Research presents mixed evidence regarding hypertension prevalence in GSM populations, with some studies indicating no substantial differences while others note increased risks, particularly in older GSM women. Stress factors related to living in communities with high levels of discrimination may elevate CVD risks among GSM individuals.
Asthma: A condition that severely impacts daily life, affecting over 10% of Americans. Findings regarding asthma prevalence among GSM groups are inconsistent, with some studies showing higher rates among lesbians and bisexual women when compared to cisgender heterosexual women. More research is needed to substantiate these claims.
Diabetes: This chronic condition's prevalence has been on the rise, with a crucial distinction between type 1 (insulin-dependent) and type 2 (closely linked to lifestyle choices). While evidence remains inconsistent regarding elevated risks among bisexual men and older LGBTQ+ individuals, early detection and management strategies are imperative.
Overall Self-Reported Health: Studies indicate that GSM populations report worse overall health compared to cisgender heterosexual individuals. Perceptions of health may be influenced by various constructs including social support availability, highlighting a complex interplay between societal factors and health outcomes.
Racial and Ethnic Disparities
Within GSM populations, chronic condition prevalence is disproportionately affected by race and ethnicity, calling for deeper examination of intersecting social identities and their impact on health inequalities.
Role of Age and Outness
The impacts of aging and the timing of identity development can significantly affect chronic health risks; for instance, older GSM individuals may experience compounded health issues originating from a lifetime of stress and discrimination. Furthermore, the degree of ‘outness’—the extent to which individuals disclose their sexual orientation or gender identity—also influences health outcomes, as those who are fully out may experience different health consequences compared to those who live in secrecy due to fear of stigmatization.
Mental Health Impact
Mental health disparities are notable between GSM and cisgender populations and are significantly related to chronic health conditions. Access to mental health resources remains crucial for improving overall well-being in these communities.
Access to Care
Systematic barriers prevent many GSM individuals from accessing adequate healthcare services and utilizing preventive measures, which may lead to worsening chronic conditions not addressed in a timely manner.
Biological Causality
Proposed biological mechanisms contributing to health disparities include:
Alterations in the hypothalamic-pituitary-adrenal (HPA) axis, influencing stress response and immune functionality.
Variability in autonomic nervous system reactivity, which can be exacerbated by experiences of discrimination and chronic stress.
Conclusion
The increased prevalence of chronic conditions among GSM populations highlights an urgent need for ongoing research and comprehensive data collection. Developing a more profound understanding of the mechanisms behind these health disparities is crucial for informing effective interventions and improving health outcomes for gender and sexual minorities.