Kim Hyun-Jun, Jen Sarah, Fredriksen-Goldsen Karen I
School of Social Work, University of Washington, Seattle.
Gerontologist. 2017 Feb;57(suppl 1):S30-S39. doi: 10.1093/geront/gnw172.
Few existing studies have addressed racial/ethnic differences in the health and quality of life of lesbian, gay, bisexual, and transgender (LGBT) older adults. Guided by the Health Equity Promotion Model, this study examines health-promoting and health risk factors that contribute to racial/ethnic health disparities among LGBT adults aged 50 and older.
We utilized weighted survey data from Aging with Pride: National Health, Aging, and Sexuality/Gender Study. By applying multiple mediator models, we analyzed the indirect effects of race/ethnicity on health-related quality of life (HRQOL) via demographics, lifetime LGBT-related discrimination, and victimization, and socioeconomic, identity-related, spiritual, and social resources.
Although African Americans and Hispanics, compared with non-Hispanic Whites, reported lower physical HRQOL and comparable psychological HRQOL, indirect pathways between race/ethnicity and HRQOL were observed. African Americans and Hispanics had lower income, educational attainment, identity affirmation, and social support, which were associated with a decrease in physical and psychological HRQOL. African Americans had higher lifetime LGBT-related discrimination, which was linked to a decrease in their physical and psychological HRQOL. African Americans and Hispanics had higher spirituality, which was associated with an increase in psychological HRQOL.
Findings illustrate the importance of identifying both health-promoting and health risk factors to understand ways to maximize the health potential of racially and ethnically diverse LGBT older adults. Interventions aimed at health equity should be tailored to bolster identity affirmation and social networks of LGBT older adults of color and to support strengths, including spiritual resources.
现有的研究很少涉及女同性恋、男同性恋、双性恋和跨性别(LGBT)老年人的健康与生活质量方面的种族/族裔差异。本研究以健康公平促进模型为指导,考察了导致50岁及以上LGBT成年人种族/族裔健康差异的健康促进因素和健康风险因素。
我们使用了来自“骄傲衰老:全国健康、衰老与性取向/性别研究”的加权调查数据。通过应用多种中介模型,我们分析了种族/族裔通过人口统计学特征、与LGBT相关的终身歧视和受害经历,以及社会经济、身份认同相关、精神和社会资源对健康相关生活质量(HRQOL)的间接影响。
与非西班牙裔白人相比,非裔美国人和西班牙裔报告的身体HRQOL较低,而心理HRQOL相当,但观察到了种族/族裔与HRQOL之间的间接路径。非裔美国人和西班牙裔的收入、教育程度、身份认同肯定和社会支持较低,这与身体和心理HRQOL的下降有关。非裔美国人与LGBT相关的终身歧视较高,这与他们身体和心理HRQOL的下降有关。非裔美国人和西班牙裔的精神性较高,这与心理HRQOL的提高有关。
研究结果表明,识别健康促进因素和健康风险因素对于理解如何最大化不同种族和族裔的LGBT老年人的健康潜力非常重要。旨在实现健康公平的干预措施应量身定制,以增强有色人种LGBT老年人的身份认同肯定和社会网络,并支持包括精神资源在内的优势。