Bellows Zachary, Kim Chungah, Bai Yihong, Cao Peiya, Chum Antony
School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada.
Department of Epidemiology and Biostatistics, Western University, London, Ontario.
PLoS One. 2025 Mar 17;20(3):e0305019. doi: 10.1371/journal.pone.0305019. eCollection 2025.
While prior studies have shown LGB individuals have elevated risk of poor mental health, poor physical health, and substance use, existing study designs may be improved by using representative samples, wider ranges of health outcomes, heterosexual comparison groups, and disaggregated data. The goal of this study is to provide estimates of multiple health disparities across sexual orientations in Canada based on these principles.
Using data from 2009-2014 Canadian Community Health Surveys, a sample of 19,980,000 weighted individuals was created. Outcomes included mental health, physical health, binge drinking, illicit drug use, and cannabis use. The study used logistic regression models adjusted by covariates, stratified by sex, to estimate health disparities across sexual orientations over time.
Among LGB individuals, there was evidence for elevated risk of poor mental health (i.e. gay men, bisexual men, bisexual women), poor physical health (i.e. bisexual men, bisexual women), binge drinking (i.e. lesbians, bisexual women), illicit drug use (i.e. lesbians, bisexual women), and cannabis use (i.e. lesbians, bisexual women) relative to their heterosexual counterparts. Those identifying as 'don't know' or 'refuse' showed reduced odds of substance use. Bisexual women exhibited highest disparities in health outcomes, e.g. OR=3.3, 95% 2.58 to 4.22 for poor mental health. Trends over time showed worsening mental health among bisexual women (relative to changes in heterosexual women), and decreasing substance use in gay and bisexual men, and lesbians.
This study highlights health disparities across sexual orientations in Canada, especially bisexual women, calling for targeted interventions (e.g. increased training of service providers in working with bisexual women and community outreach against biphobia). Future research should aim to explore these disparities longitudinally while also including the use of administrative-linked health data to reduce potential bias in self-reported data.
虽然先前的研究表明，女同性恋、男同性恋和双性恋（LGB）群体心理健康状况不佳、身体健康状况不佳以及药物使用问题的风险较高，但现有的研究设计可以通过使用代表性样本、更广泛的健康结果范围、异性恋对照组和分类数据来加以改进。本研究的目的是基于这些原则，对加拿大不同性取向人群的多种健康差异进行评估。
利用2009年至2014年加拿大社区健康调查的数据，创建了一个包含1998万加权个体的样本。研究结果包括心理健康、身体健康、狂饮、非法药物使用和大麻使用情况。该研究使用了经协变量调整的逻辑回归模型，并按性别分层，以估计不同性取向人群随时间推移的健康差异。
与异性恋者相比，LGB群体中存在心理健康状况不佳（即男同性恋者、双性恋男性、双性恋女性）、身体健康状况不佳（即双性恋男性、双性恋女性）、狂饮（即女同性恋者、双性恋女性）、非法药物使用（即女同性恋者、双性恋女性）和大麻使用（即女同性恋者、双性恋女性）风险升高的证据。那些选择“不知道”或“拒绝回答”的人使用药物的几率较低。双性恋女性在健康结果方面表现出最大的差异，例如，心理健康状况不佳的比值比（OR）为3.3，95%置信区间为2.58至4.22。随着时间的推移，双性恋女性的心理健康状况恶化（相对于异性恋女性的变化），男同性恋者、双性恋男性和女同性恋者的药物使用情况减少。
本研究突出了加拿大不同性取向人群之间的健康差异，尤其是双性恋女性，呼吁采取有针对性的干预措施（例如，增加服务提供者与双性恋女性合作的培训，并开展反对双性恋恐惧症的社区宣传活动）。未来的研究应旨在纵向探索这些差异，同时还应使用与行政记录相关的健康数据，以减少自我报告数据中的潜在偏差。
