Hostname: page-component-cd9895bd7-gxg78 Total loading time: 0 Render date: 2024-12-25T07:58:49.465Z Has data issue: false hasContentIssue false

Health and socio-economic inequalities by sexual orientation among older women in the United Kingdom: findings from the UK Household Longitudinal Study

Published online by Cambridge University Press:  15 April 2020

Laia Bécares*
Affiliation:
Department of Social Work and Social Care, University of Sussex, Falmer, UK
*
*Corresponding author. Email: [email protected]

Abstract

Lesbian, gay, bisexual and queer (LGBQ) women living in the United Kingdom (UK) experience worse health than their heterosexual peers throughout their lives, but less is known about health inequalities in older age. This study uses population-level data to examine inequalities among LGBQ older women and women who prefer not to disclose their sexuality, compared to heterosexual women. Analyses use data from women aged 50 and older who were active in Waves 3 and 7 of the UK Household Longitudinal Study (also known as Understanding Society) (N = 8,209) to examine inequalities in socio-economic conditions, health and alcohol consumption across sexual orientation groups. LGBQ older women are on average younger and have higher socio-economic resources than their heterosexual peers. In contrast, women who prefer not to disclose their sexual orientation are older and have the lowest income and educational qualifications. Results of the health inequalities analyses show that LGBQ older women are almost twice as likely as heterosexual older women to engage in harmful alcohol consumption. Older women who prefer not to disclose their sexuality have worse physical and mental health than heterosexual older women. The health of LGBQ older women and women who prefer not to disclose their sexual orientation is one of the most neglected research areas in UK gerontology. Findings of this study contribute to our understanding of their social and health circumstances, and illuminate methodological limitations in existing data.

Type
Article
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Addis, S, Davies, M, Greene, G, MacBride-Stewart, S and Shepherd, M (2009) The health, social care and housing needs of lesbian, gay, bisexual and transgender older people: a review of the literature. Health and Social Care in the Community 17, 647658.CrossRefGoogle ScholarPubMed
Adelman, M (1990) Stigma, gay lifestyles, and adjustment to aging: a study of later-life gay men and lesbians. Journal of Homosexuality 20, 732.CrossRefGoogle ScholarPubMed
Aspinall, P (2009) Estimating the Size and Composition of the Lesbian, Gay and Bisexual Population in Britain (Research Report No. 37). Manchester, UK: Equality and Human Rights Commission.Google Scholar
Baumeister, R (2000) Gender differences in erotic plasticity: the female sex drive as socially flexible and responsive. Psychological Bulletin 126, 347374.CrossRefGoogle ScholarPubMed
Booker, C, Rieger, G and Unger, J (2017) Sexual orientation health inequality: evidence from Understanding Society, the UK Longitudinal Household Study. Preventive Medicine 101, 126132.CrossRefGoogle Scholar
Bowleg, L (2012) The problem with the phrase ‘women and minorities’: intersectionality, an important theoretical framework for public health. American Journal of Public Health 102, 12671273.CrossRefGoogle Scholar
Bowleg, L, Huang, J, Brooks, K, Black, A and Burkholder, G (2003) Triple jeopardy and beyond: multiple minority stress and resilience among black lesbians. Journal of Lesbian Studies 7, 87108.CrossRefGoogle ScholarPubMed
Bryan, A, Kim, H-J and Fredriksen-Goldsen, K (2017) Factors associated with high-risk alcohol consumption among LGB older adults: the roles of gender, social support, perceived stress, discrimination, and stigma. The Gerontologist 57, S95S104.CrossRefGoogle Scholar
Bush, K, Kivlahan, D, McDonell, M, Fihn, S and Bradley, K (1998) The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Archives of Internal Medicine 3, 17891795.CrossRefGoogle Scholar
Cochran, S, Grella, C and Mays, V (2012) Do substance use norms and perceived drug availability mediate sexual orientation differences in patterns of substance use? Results from the California Quality of Life Survey II. Journal of Studies on Alcohol and Drugs 73, 675685.CrossRefGoogle ScholarPubMed
Cochran, S, Drescher, J, Kismödi, E, Giami, A, García-Moreno, C, Atalla, E, Marais, A, Meloni Vieira, E and Reed, G (2014) Proposed declassification of disease categories related to sexual orientation in the International Statistical Classification of Diseases and Related Health Problems (ICD-11). Bulletin of the World Health Organization 92, 672679.CrossRefGoogle Scholar
Collins, P (2000) Black Feminist Thought: Knowledge, Consciousness, and the Politics of Empowerment. New York, NY: Routledge.Google Scholar
Crenshaw, K (1993) Mapping the margins: intersectionality, identity politics, and violence against women of color. Stanford Law Review 43, 12411299.CrossRefGoogle Scholar
Dannefer, D (2003) Cumulative advantage/disadvantage and the life course: cross-fertilizing age and social science theory. The Journals of Gerontology: Series B 58(6), S327S337.CrossRefGoogle ScholarPubMed
D'Augelli, A and Grossman, A (2001) Disclosure of sexual orientation, victimization, and mental health among lesbian, gay, and bisexual older adults. Journal of Interpersonal Violence 16, 10081027.CrossRefGoogle Scholar
Deevey, S (1990) Older lesbian women: an invisible minority. Journal of Gerontological Nursing 16, 3539.CrossRefGoogle Scholar
de Vries, B and Hoctel, P (2006) The family-friends of older gay men and lesbians. In Teunis N, and Herdt G, (eds), Sexual Inequalities and Social Justice. Berkeley, CA: University of California Press, pp. 213232.Google Scholar
Elder, G (1994) Time, human agency, and social change: perspectives on the life course. Social Psychology Quarterly 57, 415.Google Scholar
Elliott, M, Kanouse, D, Burkhart, Q, Abel, G, Lyratzopoulos, G, Beckett, M, Schuster, M and Roland, M (2014) Sexual minorities in England have poorer health and worse health care experiences: a national survey. Journal of General Internal Medicine 30, 916.CrossRefGoogle ScholarPubMed
Fish, J and Anthony, D (2005) UK National Lesbians and Health Care Survey. Women & Health 41, 3, 2745.CrossRefGoogle ScholarPubMed
Fredriksen-Goldsen, K and Muraco, A (2010) Aging and sexual orientation: a 25-year review of the literature. Research on Aging 32, 372413.CrossRefGoogle ScholarPubMed
Fredriksen-Goldsen, K, Kim, H-J, Barkan, S, Muraco, A and Hoy-Ellis, C (2013) Health disparities among lesbian, gay, and bisexual older adults: results from a population-based study. American Journal of Public Health 103, 18021809.CrossRefGoogle ScholarPubMed
Fredriksen-Goldsen, K, Simoni, J, Kim, H, Lehavot, K, Walters, K, Yang, J and Hoy-Ellis, C (2014) The health equity promotion model: reconceptualization of lesbian, gay, bisexual, and transgender (LGBT) health disparities. American Journal of Orthopsychiatry 84, 653663.CrossRefGoogle ScholarPubMed
Gonzales, G and Henning-Smith, C (2015) Disparities in health and disability among older adults in same-sex cohabiting relationships. Journal of Aging and Health 27, 432453.CrossRefGoogle ScholarPubMed
Government Equalities Office (2018) National LGBT Survey. The Research Report. Manchester, UK: Government Equalities Office.Google Scholar
Greenland, K and Nunney, R (2008) The repeal of Section 28: it ain't over ’til it's over. Pastoral Care in Education 26, 243251.CrossRefGoogle Scholar
Grossman, A, D'Augelli, A and Hershberger, S (2000) Social support networks of lesbian, gay, and bisexual adults 60 years of age and older. Journals of Gerontology: Psychological Sciences and Social Sciences 55B, 171179.CrossRefGoogle Scholar
Guasp, A (2011) Lesbian, Gay and Bisexual People Later in Life. London: Stonewall.Google Scholar
Hagger-Johnson, G, Taibjee, R, Semlyen, J, Fitchie, I, Fish, J, Meads, C and Varney, J (2013) Sexual orientation identity in relation to smoking history and alcohol use at age 18/19: cross-sectional associations from the Longitudinal Study of Young People in England (LSYPE). BMJ Open 3, e002810.CrossRefGoogle Scholar
Hatzenbuehler, M (2009) How does sexual minority stigma ‘get under the skin’? A psychological mediation framework. Psychological Bulletin 135, 707730.CrossRefGoogle Scholar
Hunt, R and Fish, J (2008) Prescription for Change: Lesbian and Bisexual Women's Health Check 2008. London: Stonewall.Google Scholar
Hunt, R and Minsky, A (2006) Reducing Health Inequalities for Lesbian Gay and Bisexual People: Evidence of Health Care Needs. London: Stonewall and Department of Health.Google Scholar
Kehoe, M (1986) Lesbians over 65. Journal of Homosexuality 12, 3/4, 139152.CrossRefGoogle ScholarPubMed
King, M (2016) Older Lesbian, Gay and Bisexual Adults: Identities, Intersections and Institutions. Abingdon, UK: Routledge.CrossRefGoogle Scholar
King, M and Nazareth, I (2006) The health of people classified as lesbian, gay and bisexual attending family practitioners in London: a controlled study. BMC Public Health 6, 127.CrossRefGoogle ScholarPubMed
King, M, McKeown, E, Warner, J, Ramsay, A, Johnson, K, Cort, C, Wright, L, Blizard, R and Davidson, O (2003) Mental health and quality of life of gay men and lesbians in England and Wales: controlled, cross-sectional study. British Journal of Psychiatry 183, 552558.Google ScholarPubMed
Knies, G (2014) Understanding Society – The UK Household Longitudinal Study: Waves 1–4, 2009–2013, User Manual. Colchester, UK: Institute for Social and Economic Research, University of Essex.Google Scholar
Lewis, R, Derlega, V, Griffin, J and Krowinski, A (2003) Stressors for gay men and lesbians: life stress, gay-related stress, stigma consciousness, and depressive symptoms. Journal of Social and Clinical Psychology 22, 716729.CrossRefGoogle Scholar
Maylor, E, Reimers, S, Choi, J, Collaer, M, Peters, M and Silverman, I (2007) Gender and sexual orientation differences in cognition across adulthood: age is kinder to women than to men regardless of sexual orientation. Archives of Sexual Behavior 36, 235249.CrossRefGoogle ScholarPubMed
McCall, L (2005) The complexity of intersectionality. Signs 30, 17711800.CrossRefGoogle Scholar
McLean, K (2007) Hiding in the closet? Bisexuals, coming out and the disclosure imperative. Journal of Sociology 43, 151166.CrossRefGoogle Scholar
McParland, J and Camic, P (2016) Psychosocial factors and ageing in older lesbian, gay and bisexual people: a systematic review of the literature. Journal of Clinical Nursing 25, 34153437.CrossRefGoogle ScholarPubMed
Mercer, C, Bailey, J, Johnson, A, Erens, B, Wellings, K, Fenton, K and Copas, A (2007) Women who report having sex with women: British national probability data on prevalence, sexual behaviors, and health outcomes. American Journal of Public Health 97, 11261133.CrossRefGoogle ScholarPubMed
Meyer, I (2003) Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychological Bulletin 129, 674697.CrossRefGoogle ScholarPubMed
Pachankis, J (2007) The psychological implications of concealing a stigma: a cognitive-affective-behavioral model. Psychological Bulletin 133, 328345.CrossRefGoogle ScholarPubMed
Powdthavee, N and Wooden, M (2015) Life satisfaction and sexual minorities: evidence from Australia and the United Kingdom. Journal of Economic Behavior & Organization 116, 107126.CrossRefGoogle ScholarPubMed
Rosario, M, Schrimshaw, E and Hunter, J (2008) Butch/femme differences in substance use and abuse among young lesbian and bisexual women: examination and potential explanations. Substance Use & Misuse 43, 10021015.CrossRefGoogle ScholarPubMed
Schrimshaw, E, Siegel, K, Downing, M and Parsons, J (2013) Disclosure and concealment of sexual orientation and the mental health of non-gay-identified, behaviorally bisexual men. Journal of Consulting and Clinical Psychology 81, 141153.CrossRefGoogle ScholarPubMed
Sedlovskaya, A, Purdie-Vaughns, V, Eibach, R, LaFrance, M, Romero-Canyas, R and Camp, N (2013) Internalizing the closet: concealment heightens the cognitive distinction between public and private selves. Journal of Personality and Social Psychology 104, 695715.CrossRefGoogle ScholarPubMed
Seelman, K (2019) Differences in mental, cognitive, and functional health by sexual orientation among older women: analysis of the 2015 Behavioral Risk Factor Surveillance System. The Gerontologist 59, 749759.CrossRefGoogle ScholarPubMed
Semlyen, J, King, M, Varney, J and Hagger-Johnson, G (2016) Sexual orientation and symptoms of common mental disorder or low wellbeing: combined meta-analysis of 12 UK population health surveys. BMC Psychiatry 16, 67.CrossRefGoogle ScholarPubMed
Semlyen, J, Curtis, T and Varney, J (2020) Sexual orientation identity in relation to unhealthy body mass index: individual participant meta-analysis of 93,429 individuals from 12 UK health surveys. Journal of Public Health 42, 98106.Google ScholarPubMed
Shahab, L, Brown, J, Hagger-Johnson, G, Michie, S, Semlyen, J, West, R and Meads, C (2017) Sexual orientation identity and tobacco and hazardous alcohol use: findings from a cross-sectional English population survey. BMJ Open 7, e015058.CrossRefGoogle ScholarPubMed
Sharp, C (1997) Lesbianism and later life in an Australian sample: how does development of one affect anticipation of the other? Journal of Gay, Lesbian, and Bisexual Identity 2, 247263.Google Scholar
Simoni, J, Smith, L, Oost, K, Lehavot, L and Fredriksen-Goldsen, K (2017) Disparities in physical health conditions among lesbian and bisexual women: a systematic review of population-based studies. Journal of Homosexuality 64, 3244.CrossRefGoogle ScholarPubMed
Slevin, K (2008) Disciplining bodies: the aging experiences of older heterosexual and gay men. Generations 32, 3642.Google Scholar
StataCorp (2013) Stata Statistical Software: Release 13. College Station, TX: StataCorp LP.Google Scholar
The Lancet (2019) Editorial: Advancing LGBTIQ rights. The Lancet 389, 2164.Google Scholar
Traies, J (2015) Old lesbians in the UK: community and friendship. Journal of Lesbian Studies 19, 1, 3549.CrossRefGoogle ScholarPubMed
Traies, J (2016) The Lives of Older Lesbians: Sexuality, Identity and the Life Course. Basingstoke, UK: Palgrave Macmillan.CrossRefGoogle Scholar
Trocki, K, Drabble, L and Midanik, L (2005) Use of heavier drinking contexts among heterosexuals, homosexuals and bisexuals: results from a National Household Probability Survey. Journal of Studies on Alcohol and Drugs 66, 105110.CrossRefGoogle ScholarPubMed
University of Essex, Institute for Social and Economic Research, NatCen Social Research and Kantar Public (2018) Understanding Society: Waves 1–8, 2009–2017 and Harmonised BHPS: Waves 1–18, 1991–2009, 11th Edn. Colchester, UK: UK Data Service.Google Scholar
Wallace, S, Cochran, S, Durazo, E and Ford, C (2011) The health of aging lesbian, gay and bisexual adults in California. Policy brief (UCLA Center for Health Policy Research), (PB2011-2), 1–8Google Scholar
Ware, J, Kosinski, M and Keller, S (1996) A 12-item short-form health survey: a construction of scales and preliminary tests of reliability and validity. Medical Care 34, 220233.CrossRefGoogle ScholarPubMed
Wright, E and Perry, B (2006) Sexual identity distress, social support, and the health of gay, lesbian, and bisexual youth. Journal of Homosexuality 51, 81110.CrossRefGoogle ScholarPubMed