This population is believed to underutilize health systems and delay health seeking [1, 7, 8]. In contrast, gay men living with a partner are as likely as a male living with a female partner to have a consistent source of care and to have significantly elevated chances of having seen a clinician within the last year [1, 7].
Transgender, bisexual, and intersex people are less likely to utilize the healthcare system than is the population as a whole [7, 8], while research demonstrates that trans-gender people are less likely to be insured than the general population. The underutilization of the healthcare system by bisexuals and intersex people is reported as being due to their perception that healthcare professionals lack the requisite knowledge to support their unique needs [7, 8].
The Morbidity and Mortality Paradox
When we look at health status in terms of mortality rates, we see that men’s life expectancy at all ages is less than that of women in most countries around the world (on average around 6-8 years less). This mortality gap is wider in the former Soviet Union countries. In fact, Russia reached an unprecedented 13-year difference between male and female life expectancies in the 1990s; this is primarily attributed to high rates of circulatory disease among the men [9]. Meanwhile, in the USA and other high-income countries the gap is narrowing. The US 2010 census shows that the gender mortality gap is getting smaller, most significantly in the above 65 year range.
In general, the shorter life expectancy in men is thought to be the result of male behaviors including greater risk taking in relation to tobacco and alcohol use [1, 10]. It is also attributed to masculine attitudes towards health, such as not expressing pain or discomfort or acknowledging emotions [1, 10]. In some low-and middle-income countries in Asia, a deviation from this trend is seen; women’s life expectancy at birth is actually lower than or equal to men’s [11]. This is thought to be due to socially mediated causes including maternal mortality, disparities in access to care, female infanticide, and lack of female empowerment [11]. It is worth noting that, irrespective of the gender mortality trends, about 350,000 women die each year, predominantly in low-and middle-income countries, due to pregnancy and childbirth. Neither of these conditions in isolation constitutes an illness or disorder.
While men in most instances are more likely to die earlier than women, epidemiological information points to greater morbidity in women, based on rates of self-reporting and provider reporting [1, 12]. This finding is further supported by research in the USA that reveals that on a per capita basis women’s spending on health care services exceeds that of males [13]. Another study provides additional cultural insights in that women in Canada were shown to be more likely than men to report unmet health needs; this is within a country that provides universal basic care [14]. Women’s spending rates and their likelihood to report unmet health needs may be either a consequence of or a causative factor in the higher rates of morbidity in women.
Although the medical literature overwhelmingly points to a gender difference, there has been some questioning of the existence and the extent of any gender difference in morbidity. It has been proposed that when lifespan and disease area variation is accounted for, any noted difference in morbidity rates is attenuated [1]. Others reports suggest that the variation is an artifact due to factors such as higher rates of hospitalization due to childbirth in women, women’s increased tendency toward seeking out health services resulting in higher diagnosis rates as well as higher rates of medication usage, and women’s greater inclination to identify complaints believed to be health related [1].
Morbidity in Lesbian, Bisexual, Gay, Transgender, and Intersex Populations
Disparities within LGBT populations as well as differences among them exist in relation to disease patterns and behaviors affecting health. A consistent disparity across LGBT populations is that they are at a higher risk for violence than the general population, with one third to one fourth of this population in the USA having experienced a violent act. Mental health is also an area of special concern, notably depression and anxiety [7, 8]. LGBT people are more than four times as likely to have attempted suicide as the general US population. Eating and body image disorders have a higher prevalence in gay and bisexual men compared to their heterosexual peers [7, 8]. It is believed that all of these mental health conditions are manifested as the result of being marginalized within society, coupled with a history of emotional or physical abuse [7, 8].
Additionally, higher rates of recreational drug use among gay men, higher rates of obesity among lesbians, and overall higher rates of tobacco use in LGBT populations have been reported in the USA and Canada and may result in increased morbidity [7, 8]. The use of tobacco puts this population at a higher risk for lung cancer and chronic obstructive pulmonary disease, obesity increases the risk of a number of non-communicable diseases, and finally recreational drug use can lead to an increased risk of sexually transmitted diseases due to an increase in high-risk sexual behaviors [7].
When we look at other areas of increased disease prevalence we see that lesbians are at a greater risk for morbidity and mortality due to gynecological cancers, especially ovarian cancers [7, 8]. This risk is thought to be compounded by the tendency to delay routine healthcare [7, 8]. Higher cancer risk is also seen in men who have sex with men. They have a higher prevalence of anal human papilloma virus which can result in anal cancer [7, 8].
There
