Health disparities among lesbian, gay, and bisexual people in the Canadian Longitudinal Study on Aging: A 6-year follow-up

Abstract:

Objectives: Cross-sectionally measured health disparities are well documented among sexual minority (lesbian, gay, bisexual) Canadian adults, yet the timing of these disparities is not understood, especially in harder-to-reach older adult populations. We estimated the prevalence and incidence of health and health-related outcomes over 6 years of follow-up in an older sample of Canadian adults.

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Methods: Our analysis used data from the Canadian Longitudinal Study on Aging (CLSA), a prospective cohort of adults aged 45-85 (baseline, 2011-2015), with follow-up over 6 years (2015-2021; n = 45,079). Respondents who self-identified as lesbian, gay, bisexual, or another sexual minority identity at either baseline or first follow-up were considered LGB+. Study outcomes included physical health, mental health, health care service use, negative health behaviours, and other health-related behaviours (e.g., rentership). We computed adjusted prevalence ratios (PRs) and relative risks (RRs) stratified by sex (female/male) using modified Poisson regression with robust error variance.

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Findings: Older sexual minority adults had a greater prevalence of and were at elevated risk of new-onset mental health diagnoses (e.g., depression: RRF = 2.03, 95% CI: 1.39, 2.96; RRM = 2.15, 95% CI: 1.50, 3.08). Older sexual minority adults also initiated psychological services more than older heterosexual adults (e.g., RRF = 1.43, 95% CI: 1.10, 1.85; RRM = 1.39, 95% CI: 1.05, 1.83). There was evidence of other prevalence differences between men and women, but with no difference in longitudinal risk (e.g., memory problems: PRF = 1.78, 95% CI: 1.24, 2.55; RRF = 1.70, 95% CI: 0.97, 2.95).

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Conclusion: Older sexual minority Canadians face disproportionate health challenges, particularly in mental health. Our findings demonstrate the importance of inclusive and affirming gerontological care in supporting the healthy aging of sexual minority Canadians.