Sexual Orientation and Access to Heart Healthcare
Disparities in health care access have prevailed in the health system for centuries. While these disparities are recognized today, many reports continue to highlight the inequality that people who identify as lesbian, gay, bisexual, and transgender (LGBT) face when navigating the health system.
However, disparities are not specific to heart failure or the LGBT community. Health disparities occur across all disease states and encompass other factors such as sex, ethnicity, immigration status, age, socioeconomic status, and religion.
What are health disparities?
Health disparity, as defined by the National Institutes of Health, is “a significant disparity in the overall rate of disease incidence, prevalence, morbidity, or mortality in the specified population as compared with the general population."1 Disparities are differences in care or outcomes or inequality in health access. Examples of how health disparities impact cardiovascular disease include the following:2-4
- African Americans are less likely than non-Hispanic whites to be referred for heart catheterization, a procedure used to diagnose and treat heart conditions.
- African Americans are less likely to achieve their cholesterol targets than white patients.
- Immigrants are less likely than US-born citizens to seek treatment for their heart symptoms and implement positive lifestyle measures to reduce their risk of heart disease.
Discrimination in the LGBT community
56% of LGBT adults report feeling discrimination from a healthcare professional at some point in their lives.5 One survey found that adolescents who faced family rejection as a result of their sexual orientation have a higher risk of suicides, illegal drug use, and engagement in unprotected sex. This is in comparison to those adolescents who felt accepted by their families for their sexual orientation.6
Being discriminated against can result in long-term anxiety, stress, and depression.4 This aligns with the prevalence of depression, suicide and drug abuse in youths of sexual minorities. Recent studies have also shown that this can lead to poor heart outcomes.
Sexual orientation disparities in heart disease
One study analyzed 12,000 adolescents living in the United States and followed them until about 30 years of age. 520 of these adolescents identified as lesbian, gay, or bisexual. The study examined certain health markers, such as C-reactive protein (a measure of inflammation in the body), blood pressure, and pulse rate.
Men and women
The study found that gay and bisexual men had significantly higher elevations in C-reactive protein, blood pressure, and pulse rate compared to heterosexual men.7 This was after accounting for health behaviors like smoking and alcohol consumption. However, this wasn't observed in bisexual and lesbian women. This could be because women have a delayed risk of heart disease, and the study only analyzed women of young adulthood.
Reducing health disparities
Reducing health care disparities in the LGBT community won't happen overnight; however, we are headed on the right track. We need to continue to address implicit biases and raise awareness and support for the community.
Have you experienced any disparities in your heart failure care due to your sex, age, religion, or ethnicity? Share your experiences below!
Do you use exercise to help manage your heart failure?