Research suggesting that lesbian, gay and bisexual (LGB) people are more likely to experience long-term health conditions comes as ‘no surprise’, leaders have told Healthcare Leader.
Earlier this week, a study published in BJGP Open (31 August) found that sexual minority adults – especially bisexual adults – are at elevated risk for multimorbidity.
It found that 13 of the 15 long-term conditions it assessed were more prevalent among sexual minority women than their heterosexual peers, with the largest inequalities for mental health problems, neurological conditions, dementia, and back problems.
In particular, LGB women aged 18 to 24 years had multimorbidity at the same level (approximately 20%) as heterosexual women aged 45 to 54 years.
The study – which looked at 1,341,339 responses to the English GP Patient Survey (GPPS) – also reported higher rates of smoking and alcohol abuse among LGB adults, and poorer experiences within the health system.
Responding to the study, Layla McCay, co-chair of the NHS Confederation’s Health and Care LGBTQ+ Leaders Network, told Healthcare Leader the findings are ‘helpful but unfortunately no surprise’.
She said: ‘This is partly linked to the challenges LGBTQ+ people are likely to face throughout our lives as a result of LGBT-phobia and prejudice, for example harassment and abuse, family rejection and homelessness, discrimination in the workplace, and increased smoking and alcohol consumption due to factors including minority stress and available types of LGBTQ+ social support settings.’
Fear of prejudice is associated with health inequalities in that it affects whether people decide to disclose their sexuality or gender identity to medical professionals, she said.
This, in turn, means that the data used in the study ‘likely underestimates the inequalities experienced’.
Ms McCay said: ‘It is clear that stigma, discrimination, and other barriers to accessing and benefitting from healthcare contribute to unacceptable health inequalities for LGBTQ+ people and affect our ability to thrive.’
The NHS must act on the evidence presented by the paper by designing, commissioning and delivering inclusive health services that better meet the needs of LGBTQ+ people, she said.
Managing disproportionate risk
The study authors noted that while management of long-term conditions in primary care is not specific to sexual orientation, provision of high-quality primary care is ‘central to improving the health and health-related quality of life’ of people with long-term conditions and multimorbidity.
That evidence that young sexual minority adults have disproportionately higher inequalities in long- term conditions indicates they are a particularly important group to consider.
The authors said: ‘Evidence of early multimorbidity means that GPs should pay particular attention to prevention, screening, and care for long- term conditions in their sexual minority patients, even in early adulthood.’
It also highlighted that targeted improvements for LGB adults may be important given evidence of poorer primary care experiences.
‘Better supporting the disclosure of sexual orientation in primary care consultations may also have the potential to improve health and healthcare outcomes,’ the authors said.
‘For example, lesbian and bisexual women access less cervical screening; disclosure of sexual orientation in primary care consultations may reduce these inequalities through improved uptake of preventive care.’
However, despite NHS England encouraging the inclusion of sexual orientation monitoring in 2017, the proposed rollout of this data collection ‘remains low and requires further attention’.
This study comes after NHS Digital data revealed LGB people are more than twice as likely to report having mental health problems.
Meanwhile, Peter Molyneux, co-chair of the LGBTQ+ Leaders Network, told Healthcare Leader that the NHS must work ‘to build confidence and trust with LGBTQ+ patients’.