Dataset Information

Sexual orientation identity in relation to unhealthy body mass index: individual participant data meta-analysis of 93 429 individuals from 12 UK health surveys.

ABSTRACT:

Background

Lesbian, gay and bisexual adults are more likely than heterosexual adults to experience worse health outcomes. Despite increasing public health interest in the importance of maintaining a healthy body weight, no study has considered sexual orientation identity (SOI) and unhealthy BMI categories among adults in the UK population.

Methods

Individual participant data meta-analysis using pooled data from population health surveys reporting on 93 429 adults with data on SOI, BMI and study covariates.

Results

Adjusting for covariates and allowing for between-study variation, women identifying as lesbian (OR = 1.41, 95% CI: 1.16, 1.72) or bisexual (OR = 1.24, 95% CI: 1.03, 1.48) were at increased risk of overweight/obesity compared to heterosexual women, but men identifying as gay were at decreased risk (OR = 0.72, 95% CI: 0.61, 0.85) compared to heterosexual men. Increased risk of being underweight was seen for women identifying as 'other' (OR = 1.95, 95% CI: 1.07, 3.56), and men identifying as gay (OR = 3.12, 95% CI: 1.83, 5.38), bisexual (OR = 2.30, 95% CI: 1.17, 4.52), 'other' (OR = 3.95, 95% CI: 1.85, 8.42).

Conclusions

The emerging picture of health disparities in this population, along with well documented discrimination, indicate that sexual orientation should be considered as a social determinant of health.

SUBMITTER: Semlyen J

PROVIDER: S-EPMC8414914 | biostudies-literature | 2020 Feb

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Sexual orientation identity in relation to unhealthy body mass index: individual participant data meta-analysis of 93 429 individuals from 12 UK health surveys.

Semlyen J J Curtis T J TJ Varney J J

Journal of public health (Oxford, England) 20200201 1

<h4>Background</h4>Lesbian, gay and bisexual adults are more likely than heterosexual adults to experience worse health outcomes. Despite increasing public health interest in the importance of maintaining a healthy body weight, no study has considered sexual orientation identity (SOI) and unhealthy BMI categories among adults in the UK population.<h4>Methods</h4>Individual participant data meta-analysis using pooled data from population health surveys reporting on 93 429 adults with data on SOI, ...[more]

PMID: 30786282

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Project description:ImportanceAddressing health disparities in lesbian, gay, bisexual, transgender, and queer (LGBTQ+) communities has been a significant policy focus for more than a decade. Ensuring access to safe, respectful primary health care from knowledgeable clinicians is crucial for reducing health inequalities.ObjectiveTo assess the engagement of primary care practices in LGBTQ+ affirming care activities and identify practice characteristics associated with increased engagement.Design, setting, and participantsThis cross-sectional study used data from the National Survey of Healthcare Organizations and Systems II, which focused on primary care practices in the US and was administered between June 2022 through February 2023. Participants were primary care physicians and practice managers. Percentages were weighted for national representation. Data were analyzed from November 2023 to December 2024.ExposurePractice characteristics including practice size, ownership, federally qualified health center (FQHC) designation; percentage of patients enrolled in Medicare; percentage of patients enrolled in Medicaid; having accountable care organization (ACO) contracts for Medicare, Medicaid, or commercial insurance; rurality; census region; and LGBTQ+ Equality Score by state policy.Main outcomes and measuresSexual orientation- and gender identity- (SOGI) affirming activities, a composite variable reflecting activity specific to SOGI patients.ResultsAmong 1245 practices in the sample (38.4% response rate), 923 (77.40%) collected data on gender identity, 921 (75.62%) on sexual orientation, and 742 (65.83%) on patients' pronouns. Only 412 practices (34.42%) provided LGBTQ+ training for clinicians and 480 practices (39.20%) provided training for staff. Practices designated as FQHCs had 3.16 (95% CI, 4.60 to 19.73) percentage points higher probability of engaging in all SOGI-affirming activities) compared with non-FQHCs (P = .001). Practices with a Medicaid payer mix at least 50% had 3.28 (95% CI, 1.19 to 5.36) percentage points higher probability than practices with less than 50% Medicaid payer mix (P = .002), and participation in a Medicaid ACO was associated with 4.26 (95% CI, 0.78 to 7.73) percentage points increased probability compared with nonparticipants (P = .02). Each 1-unit increase in the state-level LGBTQ+ Equality Score was associated with 1.07 (95% CI, 0.28 to 1.85) percentage points higher probability of engaging in all SOGI-affirming activities (P = .02). High performance was negatively associated with practice rurality (average marginal effect, -16.00 [95% CI, -29.72 to -2.28]; P = .02), and rural practices were less likely to provide appropriate referrals (average marginal effect, -15.47 [95% CI, -29.22 to -1.72]; P = .03).Conclusions and relevanceThese findings suggest there is a need for federal and state mandates to require LGBTQ+ health care and competency training for health professionals and standardized data collection on SOGI, and these may be particularly important in rural regions. These measures are essential to evaluate practice performance and address health disparities effectively.

Project description:ImportanceSexual minority (ie, people who self-identify as gay, lesbian, bisexual, and other nonheterosexual identities) and gender minority (ie, people who self-identify as transgender, nonbinary, or other noncisgender identities) adults report worse health outcomes compared with heterosexual and cisgender adults, respectively. Although social risk factors (SRFs; eg, housing instability) are associated with health outcomes, little is known about the prevalence of SRFs among sexual and gender minority adults.ObjectiveTo examine differences in the prevalence of SRFs by sexual orientation and gender identity among adults.Design, setting, and participantsThis cross-sectional study used Behavioral Risk Factor Surveillance System data collected from January 2022 to February 2023 for adults aged 18 years or older residing in 22 US states.ExposureSelf-reported sexual orientation and gender identity.Main outcomes and measuresOutcome measures were dissatisfaction with life, lack of emotional support, social isolation, employment loss in the past 12 months, Supplementary Nutrition Assistance Program participation in the past 12 months, insufficient food, inability to pay bills, inability to pay utilities, lack of transportation, and stress. Survey weights were applied. Multivariable linear regression models were used to measure the association between sexual orientation and gender identity for each outcome.ResultsThe study sample comparing outcomes by sexual orientation included 178 803 individuals: 84 881 men (48.5%; 92.9% heterosexual; 7.1% sexual minority) and 93 922 women (51.5%; 89.4% heterosexual; 10.6% sexual minority). The study sample comparing outcomes by gender identity included 182 690 adults (99.2% cisgender; 0.8% gender minority). Of sexual minority women, 58.1% reported at least 1 SRF compared with 36.5% of heterosexual women. Sexual minority women were significantly more likely to report social isolation (difference, 7.4 percentage points [PP]; 95% CI, 4.9-10.0 PP) and stress (difference, 12.2 PP; 95% CI, 9.8-14.7 PP) compared with heterosexual women. A greater proportion of sexual minority men (51.1%) reported at least 1 SRF than heterosexual men (34.0%); the largest magnitudes of inequity were in dissatisfaction with life (difference, 7.9 PP; 95% CI, 5.8-10.1 PP) and stress (difference, 6.7 PP; 95% CI, 4.5-8.9 PP). Of gender minority adults, 64.1% reported at least 1 SRF compared with cisgender adults (37.1%). Gender minority adults were significantly more likely to report social isolation (difference, 14.8 PP; 95% CI, 9.9-19.7 PP) and stress (difference, 17.0 PP; 95% CI, 11.9-22.1 PP).Conclusions and relevanceIn this cross-sectional study, sexual and gender minority adults were significantly more likely to report multiple SRFs. These findings suggest that policies and community-based systems to advance socioeconomic equity among sexual and gender minority adults are critical.

Dataset Information

Sexual orientation identity in relation to unhealthy body mass index: individual participant data meta-analysis of 93 429 individuals from 12 UK health surveys.

Background

Methods

Results

Conclusions

Publications

Sexual orientation identity in relation to unhealthy body mass index: individual participant data meta-analysis of 93 429 individuals from 12 UK health surveys.

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