| dc.description.abstract | LGBTQ+ (including lesbian, gay, bisexual, transgender, queer, and other-non heterosexual) middle and older age adults have significantly worse health outcomes than their non-SGM counterparts. This includes higher prevalence and severity of chronic health conditions, higher risk for multiple cancers, and higher risk for Alzheimer’s Disease and related dementias (ADRD).This project adapts the National Institute on Aging’s health disparities framework to examine how behavioral, sociocultural, and structural determinants shape LGBTQ+ health and health care experiences from early adulthood into older age. In Aim 1, we estimate prevalence and adjusted prevalence ratios of subjective cognitive decline (SCD), severity of SCD, and receipt of social support for severe SCD that impairs a person’s ability to complete instrumental activities of daily living stratified by sex and sexual orientation. To do so, we pooled 2015-2019 Behavioral Risk Factor Surveillance System (BRFSS) data. We find that compared to heterosexual peers, sexual minority women were 22% more likely (95%CI:3% to 44%, p<0.05) to report IADL impairments due to cognitive decline but were 17% less likely (95%CI:1% to 31%, p<0.05) to receive any social support with IADL impairment; sexual minority men were 25% more likely (95%CI: 0% to 56%, p<0.05) to report IADL impairments due to cognitive decline but reported no significant difference in receiving social support with IADL impairments. In Aim 2, we use data on n=954 LGBTQ+ adults ages 50-76 from the Vanderbilt University Social Networks, Aging, and Policy Study. We used latent class analysis to identify sub-groups of patient experiences based on seven indicators of LGBTQ+ patients’ reports of their clinician’s LGBTQ+ clinical and cultural competency. Compared to individuals in the Affirming class (34% of the sample), those in the Neutral class (60% of the sample) were 12.4 percentage points less likely to have ever been tested for HIV and 17.1 percentage points less likely to have been recently tested for HIV, both p<0.001; those in the Discriminatory class (6% of the sample) were 12.2 percentage points less likely to have recently received an influenza vaccination and 14.8 percentage points less likely to have recently completed a colorectal cancer screening, both p<0.05.In Aim 3, we used a difference-in-difference-in-difference linear regression analysis with state and year fixed effects study design. Data come from the 2016–2018 BRFSS of adults ages 18-64. States with conscientious objection laws (Illinois and Mississippi) were compared to 6 comparison states (Wisconsin, Minnesota, Ohio, Texas, Louisiana, and Virginia). Conscientious objection laws were associated with a 9.3 percentage point increase in no lifetime HIV test among sexual minority adults (95% CI, 3.3 to 15.3 percentage points p=0.008), a 28% relative increase using survey-weighted regression; and a 5.1 percentage point increase in no lifetime HIV test among sexual minority adults (95% CI, 1.3 to 8.9 percentage points p=0.015), a 15% relative increase using coarsened exact matching-weighted regression. We estimated no statistically significant association between conscientious objection laws and changes in lifetime HIV testing among heterosexual adults, and larger significant increases among sexual minority men and younger sexual minority adults. Using national health survey and original longitudinal panel data, we find that that LGBTQ+ populations continue to experience high rates of unmet care, though affirming care experiences can improve uptake of high-value preventive care. Findings help to inform policy and programmatic interventions to advance health equity for LGBTQ+ populations in midlife and older age. | |
