By Jennifer O’Mann
There are serious disparities between LGBTQI+ people and cisgender people regarding cardiovascular rates, with research by B Caceres and colleagues finding that these disparities are “driven primarily by psychosocial stressors across the lifespan.” This is one of a number of significant health disparities faced by LGBTQI+ members, of which there are around 11 million in the U.S. What factors cause this disparity, and what steps can be taken to ameliorate the problem?
Psychosocial Stressors Faced By The LGBTQI+ Community
Members of the LGBTQI+ community (particularly lesbian, bisexual and transgender women) experience disparities that can affect their cardiovascular health in various ways. Two of the most common stressors are discrimination and bias-motivated violence. LGBTQI+ individuals also face various individual stressors because of their sexual orientation and gender identity. These include shame, hiding sexual orientation and gender identity (SOGI), and expecting rejection from others. They also have a greater degree of interpersonal stressors such as family rejection. All these factors are associated with a higher likelihood of mental illness, substance abuse, and cardiovascular risks. Another factor that can compromise general and cardiovascular health (CVH) is the fact that less than half of all LGBTQI+ people are protected by employment or public accommodation anti-discriminatory laws in their states.
A Combination Of Stressors
In the study by B Caceres and colleagues, it is stated that CVH risks are most likely increased by a combination of LGBTQI+-specific and general life stressors. This is because LGBTQI+ individuals face significant general stressors – including financial problems and adversity on various levels. They are more likely to have been victims of physical and sexual abuse in childhood, they have higher rates of poverty than their heterosexual and cisgender counterparts, and they are more likely to experience interpersonal violence in adulthood. As stated by the researchers, the level of stress faced by individuals very much depends on whether or not they live in a state that provides them due protection.
The Link Between Stressors And Cardiovascular Problems
Minority stressors, combined with general life stressors, can harm cardiovascular health in various ways. For instance, it has been established in various studies that there is an “extraordinarily high frequency of physical and sexual abuse among people admitted for detoxification in an urban inpatient facility.” Stressors can affect cardiovascular health in the long term, but they can also lead to sudden cardiac arrest, which essentially occurs when the heart stops pumping. Common causes include low oxygen levels, severe electrolyte abnormalities, and specific drugs. The increase in sudden cardiovascular death from the consumption of cocaine is far more prevalent than in the past, with the risk in the 19-49 age bracket quadrupling in recent years. LGBTQI+ individuals are also more likely to smoke and some (e.g., sexual minority women) have higher objectively measured obesity than their heterosexual counterparts. Additional issues present at higher percentages in the community are heavy alcohol use and inadequate sleep.
Suggestions For Improvement
Improving cardiovascular health for members of the LGBTQI+ community can begin with the incorporation of LGBTQI+ content into the course content of health professionals. All practicing professionals should have continued education of LGBTQI+ health concerns, in accordance with new findings that arise year by year. Currently, both doctors and nurses have minimal LGBTQI+ content in their curricula, both at the undergraduate and postgraduate levels. Doctors should ask pertinent questions and be educated on specific treatments that can affect CVH in the population. For instance, it is known that despite their hypothesized effects on CVH, gender-affirming hormones can reduce behavioral and psychosocial risk factors for transgender people. Doctors should discuss the pros and cons of different treatments, so their patients are aware of their risks and able to take positive steps to reduce them in other ways (including the adoption of a healthier lifestyle, weight control, and tobacco cessation). Governments should also make a greater effort to improve awareness of the specific risk factors faced by members of the community.
Members of the LGBTQI+ community have a higher risk of CVH problems. Some hormonal treatments, for instance, are thought to have a possibly negative effect on CVH. LGBTQI+ people are also more likely to face more minority and general stressors that can affect their health. Clinicians should receive continuous training and education on LGBTQI+ matters so they can help members of the community buffer the cardiovascular effects of stress.