PREVENTING CHRONIC DISEASE PUBLIC
HEALTH
RESEARCH,
PRACTICE,
AND
Volume 12, E192
POLICY
NOVEMBER 2015 ORIGINAL RESEARCH
Selected Diagnosed Chronic Conditions by Sexual Orientation: A National Study of US Adults, 2013 Brian W. Ward, PhD; Sarah S. Joestl, DrPH; Adena M. Galinsky, PhD; James M. Dahlhamer, PhD Suggested citation for this article: Ward BW, Joestl SS, Galinsky AM, Dahlhamer JM. Selected Diagnosed Chronic Conditions by Sexual Orientation: A National Study of US Adults, 2013. Prev Chronic Dis 2015;12:150292. DOI: http://dx.doi.org/ 10.5888/pcd12.150292. PEER REVIEWED
Abstract Introduction Research is needed on chronic health conditions among lesbian, gay, and bisexual populations. The objective of this study was to examine 10 diagnosed chronic conditions, and multiple (≥2) chronic conditions (MCC), by sexual orientation among US adults.
Methods The 2013 National Health Interview Survey was used to generate age-adjusted prevalence rates and adjusted odds ratios of diagnosed chronic conditions and MCC for civilian, noninstitutionalized US adults who identified as gay/lesbian, straight, or bisexual, and separately for men and women. Chronic conditions were selected for this study on the basis of previous research.
Results Hypertension and arthritis were the most prevalent conditions for all groups. Gay/lesbian adults had a 4.7 percentage-point higher prevalence of cancer than bisexual adults, and a 5.6 percentagepoint higher prevalence of arthritis and a 2.9 percentage point higher prevalence of hepatitis than straight adults. The prevalence of chronic obstructive pulmonary disease was 8.1 percentage points higher among bisexual adults than among gay/lesbian adults and 7.0 percentage points higher than among straight adults. These differences remained in the multivariate analyses. Addition-
al differences were found in the sex-stratified analyses. No significant differences were found in MCC by sexual orientation.
Conclusion After age adjustment and controlling for sociodemographic characteristics, only a few significant health disparities for diagnosed chronic conditions were found by sexual orientation, and none for MCC. However, for conditions where differences were found, magnitudes were relatively large. Further examination of these differences among gay/lesbian and bisexual adults could yield a better understanding of why these disparities exist.
Introduction In recent years, the number of studies that examine health disparities in the United States by sexual orientation increased. Collectively these studies examined various lesbian, gay, and bisexual (LGB), or sexual minority health-related topics, including health risk behaviors (1–6), health care access (4–6), and health care service utilization (2,5–8). However, additional research is not only warranted but needed in numerous areas, one of which is the examination of chronic health conditions among LGB populations (9). Although chronic conditions among LGB populations are not completely unexamined, only a few studies explored this topic using nationally representative samples (10,11). Most research on chronic conditions by sexual orientation has been state-level population-based studies generalizable only to the US states in which they were carried out, such as Washington (2,3,5), North Carolina (4), Massachusetts (6,12), or California (13). Conditions examined in these studies include arthritis (2,5), asthma (3,5,6,11), cancer (12), cardiovascular disease (2,4,6,10,13), diabetes (2,5,6), high cholesterol (2), and hypertension (2,5), with results varying depending on the sample used. These studies did not examine whether the conditions co-occurred as multiple (≥2) chronic conditions (MCC). Determining the prevalence of MCC among sexual
The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions.
www.cdc.gov/pcd/issues/2015/15_0292.htm • Centers for Disease Control and Prevention
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NOVEMBER 2015
minorities is important: one in 4 US adults has MCC (14,15), and recent national initiatives have addressed MCC (16–18). In addition, the care and management of MCC is more costly and complex than that of a single condition (19). The objective of this study was to use a descriptive epidemiological approach to examine 10 diagnosed chronic conditions and MCC by sexual orientation using a large, nationally representative sample of the civilian, noninstitutionalized US adult population. All chronic conditions selected for this study were included in previous research on MCC (14,15,17); some conditions (ie, hepatitis, chronic obstructive pulmonary disease [COPD], weak/failing kidneys) may not have previously been examined by sexual orientation using nationally representative data.
Methods Data source Data from the 2013 National Health Interview Survey (NHIS) were used. The NHIS is a multipurpose health survey of US households conducted continuously throughout the year and released annually. It serves as a primary source of health data on the civilian, noninstitutionalized US population. Data collection for the NHIS is conducted using computer-assisted personal interviewing; when necessary, interviewers may complete portions of the interview by telephone (20,21). Data used in this study came from 2 of 4 NHIS modules: the Family Core and the Sample Adult Core. The other 2 modules (Household Composition and Sample Child Core) were not used because they either had no variables needed for our analyses or they had data only on children or adolescents (30.0% and ≤50.0% and should be interpreted with caution. g Estimates have an RSE >50.0%, are considered unreliable, and are not reported. (continued on next page) The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions.
www.cdc.gov/pcd/issues/2015/15_0292.htm • Centers for Disease Control and Prevention
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(continued)
Table 2. Age-Adjusted Prevalence of Selected Diagnosed Chronic Conditions Among Adults, by Sexual Orientation and Sex, United States, 2013a % (95% CI) Conditionb
Total
Gay/Lesbian
Straight
2.5 (1.2–5.3)c,f
Cancer
8.4 (7.9–8.9)
5.7 (3.3–9.7)
Current asthma
8.6 (8.0–9.1)
9.5 (6.2–14.4)
8.5 (7.9–9.0)
12.4 (7.3–20.4)
COPD
6.4 (6.0–6.9)
(3.2–11.0)f,
6.4 (5.9–6.8)
13.6 (6.9–25.2)f
CHD
3.2 (2.9–3.5)
—g
3.2 (2.9–3.5)
—g
Hepatitis
2.5 (2.3–2.8)
3.4 (1.5–7.4)f
2.5 (2.3–2.8)
—g
Stroke
2.5 (2.2–2.7)
2.4 (0.9–6.2)f
2.4 (2.2–2.7)
— g,
1.8 (1.6–2.1)
g,
1.8 (1.6–2.1)
— g,
Weak/failing kidneys
6.0
—
8.4
Bisexual
(8.0–9.0)e
Abbreviations: CHD, coronary heart disease; CI, confidence interval; COPD, chronic obstructive pulmonary disease. a Estimates generated using the 2013 National Health Interview Survey Sample Adult data file (n = 34,557). b Chronic conditions are listed in descending order of prevalence for all adults (total). CIs for certain conditions may overlap and warrant caution in determining rank order. All conditions were measured as ever having been told by a doctor/health professional, with the exception of current asthma (currently being diagnosed with asthma), COPD (ever having been diagnosed with emphysema or COPD, or having been diagnosed with chronic bronchitis in the past 12 months), and weak/failing kidneys (having been diagnosed in the past 12 months). Age-adjustment was to the 2000 US Census projected population using 3 age groups: 18–44, 45–64, and ≥65 years. c Prevalence of this condition was significantly different (2-tailed; P < .05) from those who identified as straight. d Prevalence of this condition was significantly different (2-tailed; P < .05) from those who identified as gay/lesbian. e Prevalence of this condition was significantly different (2-tailed; P < .05) from those who identified as bisexual. f Estimates that have a relative standard error (RSE) >30.0% and ≤50.0% and should be interpreted with caution. g Estimates have an RSE >50.0%, are considered unreliable, and are not reported.
The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions.
10
Centers for Disease Control and Prevention • www.cdc.gov/pcd/issues/2015/15_0292.htm
PREVENTING CHRONIC DISEASE
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Table 3. Logistic Regression of Sexual Orientation and Sociodemographic Characteristics on Selected Diagnosed Chronic Conditions Among Adults, United States, 2013a All Adultsc Conditionb
Mend
P Value
AOR (95% CI)
AOR (95% CI)
Womend
P Value
AOR (95% CI)
P Value
Hypertension Straight
1 [Reference]
—
1 [Reference]
—
1 [Reference]
—
Gay/lesbian
0.97 (0.73–1.30)
.84
0.94 (0.65–1.37)
.76
1.08 (0.70–1.66)
.73
Bisexual
0.78 (0.49–1.23)
.29
1.03 (0.55–1.92)
.93
0.66 (0.34–1.27)
.21
1 [Reference]
—
1 [Reference]
—
1 [Reference]
—
Gay/lesbian
1.52 (1.14–2.05)
.005
1.07 (0.68–1.68)
.78
2.14 (1.45–3.17)
HEALTH
RESEARCH,
PRACTICE,
AND
Volume 12, E192
POLICY
NOVEMBER 2015 ORIGINAL RESEARCH
Selected Diagnosed Chronic Conditions by Sexual Orientation: A National Study of US Adults, 2013 Brian W. Ward, PhD; Sarah S. Joestl, DrPH; Adena M. Galinsky, PhD; James M. Dahlhamer, PhD Suggested citation for this article: Ward BW, Joestl SS, Galinsky AM, Dahlhamer JM. Selected Diagnosed Chronic Conditions by Sexual Orientation: A National Study of US Adults, 2013. Prev Chronic Dis 2015;12:150292. DOI: http://dx.doi.org/ 10.5888/pcd12.150292. PEER REVIEWED
Abstract Introduction Research is needed on chronic health conditions among lesbian, gay, and bisexual populations. The objective of this study was to examine 10 diagnosed chronic conditions, and multiple (≥2) chronic conditions (MCC), by sexual orientation among US adults.
Methods The 2013 National Health Interview Survey was used to generate age-adjusted prevalence rates and adjusted odds ratios of diagnosed chronic conditions and MCC for civilian, noninstitutionalized US adults who identified as gay/lesbian, straight, or bisexual, and separately for men and women. Chronic conditions were selected for this study on the basis of previous research.
Results Hypertension and arthritis were the most prevalent conditions for all groups. Gay/lesbian adults had a 4.7 percentage-point higher prevalence of cancer than bisexual adults, and a 5.6 percentagepoint higher prevalence of arthritis and a 2.9 percentage point higher prevalence of hepatitis than straight adults. The prevalence of chronic obstructive pulmonary disease was 8.1 percentage points higher among bisexual adults than among gay/lesbian adults and 7.0 percentage points higher than among straight adults. These differences remained in the multivariate analyses. Addition-
al differences were found in the sex-stratified analyses. No significant differences were found in MCC by sexual orientation.
Conclusion After age adjustment and controlling for sociodemographic characteristics, only a few significant health disparities for diagnosed chronic conditions were found by sexual orientation, and none for MCC. However, for conditions where differences were found, magnitudes were relatively large. Further examination of these differences among gay/lesbian and bisexual adults could yield a better understanding of why these disparities exist.
Introduction In recent years, the number of studies that examine health disparities in the United States by sexual orientation increased. Collectively these studies examined various lesbian, gay, and bisexual (LGB), or sexual minority health-related topics, including health risk behaviors (1–6), health care access (4–6), and health care service utilization (2,5–8). However, additional research is not only warranted but needed in numerous areas, one of which is the examination of chronic health conditions among LGB populations (9). Although chronic conditions among LGB populations are not completely unexamined, only a few studies explored this topic using nationally representative samples (10,11). Most research on chronic conditions by sexual orientation has been state-level population-based studies generalizable only to the US states in which they were carried out, such as Washington (2,3,5), North Carolina (4), Massachusetts (6,12), or California (13). Conditions examined in these studies include arthritis (2,5), asthma (3,5,6,11), cancer (12), cardiovascular disease (2,4,6,10,13), diabetes (2,5,6), high cholesterol (2), and hypertension (2,5), with results varying depending on the sample used. These studies did not examine whether the conditions co-occurred as multiple (≥2) chronic conditions (MCC). Determining the prevalence of MCC among sexual
The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions.
www.cdc.gov/pcd/issues/2015/15_0292.htm • Centers for Disease Control and Prevention
1
PREVENTING CHRONIC DISEASE
VOLUME 12, E192
PUBLIC HEALTH RESEARCH, PRACTICE, AND POLICY
NOVEMBER 2015
minorities is important: one in 4 US adults has MCC (14,15), and recent national initiatives have addressed MCC (16–18). In addition, the care and management of MCC is more costly and complex than that of a single condition (19). The objective of this study was to use a descriptive epidemiological approach to examine 10 diagnosed chronic conditions and MCC by sexual orientation using a large, nationally representative sample of the civilian, noninstitutionalized US adult population. All chronic conditions selected for this study were included in previous research on MCC (14,15,17); some conditions (ie, hepatitis, chronic obstructive pulmonary disease [COPD], weak/failing kidneys) may not have previously been examined by sexual orientation using nationally representative data.
Methods Data source Data from the 2013 National Health Interview Survey (NHIS) were used. The NHIS is a multipurpose health survey of US households conducted continuously throughout the year and released annually. It serves as a primary source of health data on the civilian, noninstitutionalized US population. Data collection for the NHIS is conducted using computer-assisted personal interviewing; when necessary, interviewers may complete portions of the interview by telephone (20,21). Data used in this study came from 2 of 4 NHIS modules: the Family Core and the Sample Adult Core. The other 2 modules (Household Composition and Sample Child Core) were not used because they either had no variables needed for our analyses or they had data only on children or adolescents (30.0% and ≤50.0% and should be interpreted with caution. g Estimates have an RSE >50.0%, are considered unreliable, and are not reported. (continued on next page) The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions.
www.cdc.gov/pcd/issues/2015/15_0292.htm • Centers for Disease Control and Prevention
9
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PUBLIC HEALTH RESEARCH, PRACTICE, AND POLICY
NOVEMBER 2015
(continued)
Table 2. Age-Adjusted Prevalence of Selected Diagnosed Chronic Conditions Among Adults, by Sexual Orientation and Sex, United States, 2013a % (95% CI) Conditionb
Total
Gay/Lesbian
Straight
2.5 (1.2–5.3)c,f
Cancer
8.4 (7.9–8.9)
5.7 (3.3–9.7)
Current asthma
8.6 (8.0–9.1)
9.5 (6.2–14.4)
8.5 (7.9–9.0)
12.4 (7.3–20.4)
COPD
6.4 (6.0–6.9)
(3.2–11.0)f,
6.4 (5.9–6.8)
13.6 (6.9–25.2)f
CHD
3.2 (2.9–3.5)
—g
3.2 (2.9–3.5)
—g
Hepatitis
2.5 (2.3–2.8)
3.4 (1.5–7.4)f
2.5 (2.3–2.8)
—g
Stroke
2.5 (2.2–2.7)
2.4 (0.9–6.2)f
2.4 (2.2–2.7)
— g,
1.8 (1.6–2.1)
g,
1.8 (1.6–2.1)
— g,
Weak/failing kidneys
6.0
—
8.4
Bisexual
(8.0–9.0)e
Abbreviations: CHD, coronary heart disease; CI, confidence interval; COPD, chronic obstructive pulmonary disease. a Estimates generated using the 2013 National Health Interview Survey Sample Adult data file (n = 34,557). b Chronic conditions are listed in descending order of prevalence for all adults (total). CIs for certain conditions may overlap and warrant caution in determining rank order. All conditions were measured as ever having been told by a doctor/health professional, with the exception of current asthma (currently being diagnosed with asthma), COPD (ever having been diagnosed with emphysema or COPD, or having been diagnosed with chronic bronchitis in the past 12 months), and weak/failing kidneys (having been diagnosed in the past 12 months). Age-adjustment was to the 2000 US Census projected population using 3 age groups: 18–44, 45–64, and ≥65 years. c Prevalence of this condition was significantly different (2-tailed; P < .05) from those who identified as straight. d Prevalence of this condition was significantly different (2-tailed; P < .05) from those who identified as gay/lesbian. e Prevalence of this condition was significantly different (2-tailed; P < .05) from those who identified as bisexual. f Estimates that have a relative standard error (RSE) >30.0% and ≤50.0% and should be interpreted with caution. g Estimates have an RSE >50.0%, are considered unreliable, and are not reported.
The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions.
10
Centers for Disease Control and Prevention • www.cdc.gov/pcd/issues/2015/15_0292.htm
PREVENTING CHRONIC DISEASE
VOLUME 12, E192
PUBLIC HEALTH RESEARCH, PRACTICE, AND POLICY
NOVEMBER 2015
Table 3. Logistic Regression of Sexual Orientation and Sociodemographic Characteristics on Selected Diagnosed Chronic Conditions Among Adults, United States, 2013a All Adultsc Conditionb
Mend
P Value
AOR (95% CI)
AOR (95% CI)
Womend
P Value
AOR (95% CI)
P Value
Hypertension Straight
1 [Reference]
—
1 [Reference]
—
1 [Reference]
—
Gay/lesbian
0.97 (0.73–1.30)
.84
0.94 (0.65–1.37)
.76
1.08 (0.70–1.66)
.73
Bisexual
0.78 (0.49–1.23)
.29
1.03 (0.55–1.92)
.93
0.66 (0.34–1.27)
.21
1 [Reference]
—
1 [Reference]
—
1 [Reference]
—
Gay/lesbian
1.52 (1.14–2.05)
.005
1.07 (0.68–1.68)
.78
2.14 (1.45–3.17)
