HIV Insight: Mortality in Postmenopausal Women by Sexual Orientation and Veteran Status

PURPOSE OF THE STUDY:

To examine differences in all-cause and cause-specific mortality by sexual orientation and Veteran status among older women.

DESIGN AND METHODS:

Data were from the Women's Health Initiative, with demographic characteristics, psychosocial factors, and health behaviors assessed at baseline (1993-1998) and mortality status from all available data sources through 2014. Women with baseline information on lifetime sexual behavior and Veteran status were included in the analyses (N = 137,639; 1.4% sexual minority, 2.5% Veteran). The four comparison groups included sexual minority Veterans, sexual minority non-Veterans, heterosexual Veterans, and heterosexual non-Veterans. Cox proportional hazard models were used to estimate mortality risk adjusted for demographic, psychosocial, and health variables.

RESULTS:

Sexual minority women had greater all-cause mortality risk than heterosexual women regardless of Veteran status (hazard ratio [HR] = 1.20, 95% confidence interval [CI]: 1.07-1.36) and women Veterans had greater all-cause mortality risk than non-Veterans regardless of sexual orientation (HR = 1.14, 95% CI: 1.06-1.22), but the interaction between sexual orientation and Veteran status was not significant. Sexual minority women were also at greater risk than heterosexual women for cancer-specific mortality, with effects stronger among Veterans compared to non-Veterans (sexual minority × Veteran HR = 1.70, 95% CI: 1.01-2.85).

IMPLICATIONS:

Postmenopausal sexual minority women in the United States, regardless of Veteran status, may be at higher risk for earlier death compared to heterosexuals. Sexual minority women Veterans may have higher risk of cancer-specific mortality compared to their heterosexual counterparts. Examining social determinants of longevity may be an important step to understanding and reducing these disparities.

Full article at: http://goo.gl/ij9Twq

By: Lehavot K1, Rillamas-Sun E2, Weitlauf J3, Kimerling R4, Wallace RB5, Sadler AG6, Woods NF7, Shipherd JC8, Mattocks K9, Cirillo DJ10, Stefanick ML11,Simpson TL12.

1Health Services Research & Development, VA Puget Sound Health Care System and Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. keren.lehavot@va.gov.
2Division of Public Health Sciences, Fred Hutchinson Cancer Research Center and Health Services Research & Development, VA Puget Sound Health Care System, Seattle, Washington.
3Sierra Pacific Mental Illness, Research, Education and Clinical Center and Center for Innovation to Implementation, VA Palo Alto Health Care System, California. Department of Psychiatry & Behavioral Sciences and Stanford Cancer Institute, California.
4VA Palo Alto Health Care System, Menlo Park, California.
5University of Iowa College of Public Health, Iowa City.
6Iowa City VA Medical Center.
7University of Washington School of Nursing, Seattle.
8VA Boston Healthcare System, National Center for PTSD Women's Health Sciences, Boston University School of Medicine, Massachusetts. LGBTProgram Patient Care Services, Washington DC.
9VA Central Western Massachusetts, Leeds. University of Massachusetts Medical School, Worcester.
10Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, the University of Iowa Department of Epidemiology, New York.
11Stanford Prevention Research Center, Stanford University School of Medicine, California.
12Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System and Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle.
Gerontologist. 2016 Feb;56 Suppl 1:S150-62. doi: 10.1093/geront/gnv125.