Why Are Mortality Rates Higher for Lesbian and Bisexual Women?

New research suggests that discrimination and social stigma are partly to blame.

Key Points

• Lesbian and bisexual women are at higher risk for a variety of adverse health outcomes.
• New long-term studies show that lesbian and bisexual women tend to die much earlier.

Iowa Hawkeyes guard Caitlin Clark in action during a game.

The causes of the increased mortality rates are diverse but also include systemic discrimination, social stigma, stress, and isolation.

New long-term studies show that lesbian and bisexual women tend to die much earlier.

The causes of the increased mortality rates are diverse but also include systemic discrimination, social stigma, stress, and isolation.

 

It's well-known that members of the LGBTQIA+ community tend to be more susceptible to health problems than their cisgender, heterosexual counterparts.

A new study has highlighted just how tragic the consequences can be. It shows that lesbian and bisexual women die much sooner than their heterosexual counterparts. The study authors suspect that social bias and prejudice are two of the main reasons for this.

Do lesbian and bisexual women die earlier than heterosexual women?

A 2024 study from the JAMA Network found that women who identify as lesbian died 20% earlier than heterosexuals, and bisexual women died 37% earlier.

The analysis includes decades of data from the Nurses' Health Study II, which examines chronic disease risk factors in women, including data from more than 100,000 nurses in the United States.

As part of the study, which began in 1989, participants were asked about their sexual orientation in 1995. Researchers looked at 30 years of death records to determine the relationship between participants' life expectancies and sexual orientation in the 2024 study. "The size and duration of the Nurses' Health Study II allowed the researchers to study lesbian and bisexual participants separately, something that had not been done before in U.S. studies," Sarah McKetta, a postdoctoral researcher at Harvard University and lead author of the new study, told NBC News.

"Until 2014 in the U.S., it was not common to include information about study participants' sexual orientation, which made it difficult for researchers to study early mortality among sexual minorities," she said.

 

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Why do lesbian and bisexual women die earlier?

A 2021 study found that LGBTQIA+ people, especially women, experience greater disparities in physical and mental health compared to cisgender and heterosexual people.

These challenges typically affect members of the LGBTQIA+ community throughout their lives, from adolescence to late adulthood, negatively impacting their overall health and quality of life.

"These systematic and highly replicable differences encompass almost every negative health outcome, including chronic diseases, mental health issues, and risky behaviors like drinking and smoking," Macchetta told NBC News.

"For virtually every outcome we looked at across multiple studies, we found lesbian, gay, and bisexual women to be at higher risk," she said, adding that the study is an opportunity to quantify and examine the magnitude of these disparities. A new study found that women who identify as lesbian or bisexual are twice as likely as heterosexuals to use alcohol and tobacco and have higher rates of breast cancer, cardiovascular disease and depression.

Even when additional analyses were based only on participants who had never smoked, the mortality differences remained.

What are the risk factors that affect life expectancy for lesbian and bisexual women?

Several factors could contribute to the difference in mortality rates, according to the study authors.

"First, many LGBTQIA+ people experience prejudice, discrimination, and societal bias, which leads to chronic stress," said Dr. Carrie Candrian, vice president of the Lesbian Health Foundation at the Gay and Lesbian Medical Association (GLMA).

Extensive research has shown that chronic stress can affect the body and lead to a variety of health problems, including cardiovascular disease and mood disorders.

"To make matters worse, many people turn to unhealthy coping mechanisms, especially when they feel isolated," Candrian said. "I think one of the things this [study] does well is show the impact of increasing stress levels through internalized stigma, which I think is really important."

Many people are afraid to reveal their identity, and this affects many aspects of life, including family, work, personal relationships, housing, and financial security.

"This fear affects people's physical and mental health, and their ability to build true friendships and communities, which are the foundation of health and quality of life," Candrian said. "Fear that they'll lose their job if they stay open? Does that mean they'll lose their family?"

"These are serious fears that have a huge impact on people's health. And I think women in general have been historically marginalized, but when you add in other identities like lesbian and bisexual, it just makes everything even bigger," Candrian said. Additionally, many LGBTQIA+ people have difficulty receiving medical care due to institutional barriers and fear of discrimination from individual health care providers.

"This could be a missed opportunity to address health issues early -- when they're more treatable -- or prevent them altogether," says Kandrian.

For example, a 2024 report from the American Cancer Society (ACS) found that homophobia and transphobia may indirectly increase LGBTQIA+ people's chances of developing cancer.

"Because they have such a bad history of dealing with the health care system, they tend to receive delayed treatment more than heterosexuals, which also impacts their mortality rates," she says.

As for why bisexual women tend to die earlier than lesbians, studies have shown that women attracted to multiple genders tend to have poorer physical and mental health conditions and are at higher risk for substance abuse and sexual violence. "This may be in part due to the additional stress caused by biphobia in the LGBTQIA+ community and society in general," Kandrian said. "They are often stigmatized as 'confused,' which is awful."

"Bisexual people are often excluded from certain groups because they are assumed to be heterosexual or gay based on the gender of their partner," Brittany Charlton, lead author of the study and an associate professor at Harvard University, said in a press release.

"These factors may further impact bisexual people's ability to feel a sense of belonging and community," Kandrian said.

"One of the things that worried me about this study is that it might lead to the conclusion that being gay is deadly," McKenna told NBC News. "Being gay is not life-threatening." Being discriminated against is deadly, and that is the lived experience of lesbian, gay and bisexual women as they try to navigate the world."

How can lesbian and bisexual women improve their mental health?

"The responsibility for improving the mental health of women who identify as lesbian and bisexual should lie with society and the health care system, not with individuals," Kandrian said. "It's not right to put the burden on these people. It's important to make sure the health care system is safe and comfortable first."

"Health care providers must recognize the importance of people being able to disclose their identity without fear and convey that understanding and acceptance to the LGBTQIA+ community. It's not the responsibility of lesbian and bisexual women, but they can help facilitate this change by advocating for better care," Kandrian said. She added that there needs to be more understanding that fear and prejudice against LGBTQIA+ people "literally takes years of their lives away."

Kandrian also encouraged lesbian and bisexual women to avoid excessive drinking and smoking and to try to find ways to socialize with other lesbian and bisexual women who aren't involved in these activities.

"Community acts as another kind of protective factor against physical and mental illness. 'You can't underestimate the power of having a community, because it immediately relieves the stress of having to hide," she said. "It's a huge help."

Many state and local governments have established LGBTQIA+ groups. However, if there are no such organizations in your area, you can advocate for one or even start one yourself.

 

National groups can provide resources. These include:

• The Trevor Project
• SAGE
• The National Center for Lesbian Rights
• The National LGBTQ Task Force
• Mental Health America 

 

According to Mind UK, a non-profit based in England and Wales that focuses on supporting people disproportionately affected by mental health issues, including members of the LGBTQIA+ community, embracing your identity can also go a long way towards improving your mental health.

In addition to talking to trusted friends, family, and other members of the LGBTQIA+ community, working with a therapist who specializes in LGBTQIA+ experiences can help you do this.

 

Conclusion

Although the findings are bleak, the study reflects a growing interest in understanding sexuality and its relationship to health, which is important, Kandrian noted.

If you are a lesbian or bisexual woman, talk to your health care provider about taking responsibility for your health. If you need a provider, the GLMA LGBTQ+ Healthcare Directory can help you find one.