同性戀或雙性戀女性與異性戀女性相比更容易過早死亡

美國哈佛大學Brittany M. Charlton團隊研究了大型前瞻性女護士隊列中性取向死亡率的差異。這一研究成果發表在2024年4月25日出版的《美國醫學會雜志》上。

大量證據表明，女同性戀、男同性戀和雙性戀（LGB）女性的健康狀況存在差異，包括身體、心理和行為健康狀況比異性戀女性差。這些因素與過早死亡有關，但很少有研究調查LGB女性過早死亡的差異，以及她們是否因女同性戀或雙性戀身份而不同。

為了探討性取向對死亡率的影響，研究組進行了一項前瞻性隊列研究，檢查了不同性取向的死亡時間差異，并根據出生隊列進行了校正。參與者是1945年至1964年出生的女護士，最初于1989年在美國招募參加護士健康研究II，并隨訪至2022年4月。1995年評估了性取向（女同性戀、雙性戀或異性戀）。主要結局為使用加速失效時間模型分析暴露評估的全因死亡時間。

在116149名符合條件的參與者中，90833人（78%）擁有有效的性取向數據。在這90833名參與者中，89821人（98.9%）被認定為異性戀，694人（0.8%）被認定是女同性戀，318人（0.4%）被認為是雙性戀。在報告的4227例死亡中，大多數是異性戀參與者（n?=?4146；累計死亡率4.6%），其次是女同性戀參與者（n?=?49；累計死亡率為7.0%）和雙性戀參與者（n?=?32；累計死亡率10.1%）。與異性戀參與者相比，LGB參與者的死亡時間更早（校正后的加速因子，0.74[95%CI，0.64-0.84]）。這些差異在雙性戀參與者中最大（校正后的加速因子，0.63[95%置信區間，0.51-0.78]），其次是女同性戀參與者（校正后加速因子，0.80[95%可信區間，0.68-0.95]）。

研究結果表明，在其他方面基本相同的女護士樣本中，與異性戀女性相比，被認定為女同性戀或雙性戀的參與者在研究期間的死亡時間明顯更早。這些死亡時間的差異凸顯了解決可改變的風險傳播和延續差異的上游社會力量的緊迫性。

附：英文原文

Title: Disparities in Mortality by Sexual Orientation in a Large, Prospective Cohort of Female Nurses

Author: Sarah McKetta, Tabor Hoatson, Landon D. Hughes, Bethany G. Everett, Sebastien Haneuse, S. Bryn Austin, Tonda L. Hughes, Brittany M. Charlton

Issue&Volume: 2024-04-25

Abstract:

Importance  Extensive evidence documents health disparities for lesbian, gay, and bisexual (LGB) women, including worse physical, mental, and behavioral health than heterosexual women. These factors have been linked to premature mortality, yet few studies have investigated premature mortality disparities among LGB women and whether they differ by lesbian or bisexual identity.

Objective  To examine differences in mortality by sexual orientation.

Design, Setting, and Participants  This prospective cohort study examined differences in time to mortality across sexual orientation, adjusting for birth cohort. Participants were female nurses born between 1945 and 1964, initially recruited in the US in 1989 for the Nurses’ Health Study II, and followed up through April 2022.

Exposures  Sexual orientation (lesbian, bisexual, or heterosexual) assessed in 1995.

Main Outcome and Measure  Time to all-cause mortality from assessment of exposure analyzed using accelerated failure time models.

Results  Among 116149 eligible participants, 90833 (78%) had valid sexual orientation data. Of these 90833 participants, 89821 (98.9%) identified as heterosexual, 694 (0.8%) identified as lesbian, and 318 (0.4%) identified as bisexual. Of the 4227 deaths reported, the majority were among heterosexual participants (n=4146; cumulative mortality of 4.6%), followed by lesbian participants (n=49; cumulative mortality of 7.0%) and bisexual participants (n=32; cumulative mortality of 10.1%). Compared with heterosexual participants, LGB participants had earlier mortality (adjusted acceleration factor, 0.74 [95% CI, 0.64-0.84]). These differences were greatest among bisexual participants (adjusted acceleration factor, 0.63 [95% CI, 0.51-0.78]) followed by lesbian participants (adjusted acceleration factor, 0.80 [95% CI, 0.68-0.95]).

Conclusions and Relevance  In an otherwise largely homogeneous sample of female nurses, participants identifying as lesbian or bisexual had markedly earlier mortality during the study period compared with heterosexual women. These differences in mortality timing highlight the urgency of addressing modifiable risks and upstream social forces that propagate and perpetuate disparities.

DOI: 10.1001/jama.2024.4459

Source: https://jamanetwork.com/journals/jama/fullarticle/2818061