Sexuality and respiratory outcomes in the UK: disparities, development and mediators in multiple longitudinal studies

Background

Limited international research suggests sexual minority individuals, in particular sexual minority women, may experience worse asthma outcomes than their heterosexual peers. However, little research has explored if a similar disparity is present in the UK.

Methods

Pooling data from five UK longitudinal studies (total N=86,024, 4,860 (5.65% sexual minority) we examined asthma and lung function by sexuality. To explore the impact of ageing on disparities we compared asthma by sexuality at two time points approximately 10 years apart. To help understand potential causal mechanisms we used respondents aged under 18 as a negative control. Finally, we conducted a mediation analysis to examine the extent to which smoking accounts for asthma disparities.

Findings

Sexual minority respondents were more likely to report asthma (RR 1.43 [95% CI 1.26 to 1.62]) and poor lung function (RR 1.50 [95% CI 1.20 to 1.87]). Sexual minority women (RR 1.51 [95% CI 1.30 to 1.76]) and bisexual respondents (RR 1.75 [95% CI 1.35 to 2.26]) were more likely to report asthma than their heterosexual counterparts. Rates of asthma did not vary by sexuality in <18s and disparities increased between time points in adults supporting the hypothesis that disparities emerge after childhood and widen over the lifecourse. Smoking only partially mediated (proportion mediated 1%) the relationship between sexual minority status and asthma.

Conclusions

This analysis adds substantially to our understanding of how and when asthma and lung function disparities by sexuality in the UK emerge, as well as evidencing the limited role of smoking.

Key Messages

• Our research question was whether respiratory health, in particular asthma, varied by sexuality and how it patterned across the lifecourse.

• We found that sexual minority people were at greater risk of asthma and poor lung function than heterosexual people and this disparity emerges and widens in adulthood.

• Respiratory disease can impact quality of life and mortality risk and understanding patterns and mechanisms of disease in the LGBTQ+ populations can allow us to address health inequalities.