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Trauma among sexual minority women heightens cardiometabolic risk
Lesbian and bisexual women who reported experiencing childhood, adulthood or lifetime trauma were more likely to report obesity, hypertension and type 2 diabetes when compared with women who did not experience traumatic life events, according to findings published in the Journal of Women’s Health.
“A growing number of studies, including my previous work, indicate that sexual minority (lesbian, bisexual and other non-heterosexual) women have higher rates of cardiometabolic risk than heterosexual women; however, factors that contribute to this elevated risk are not well understood,” Billy A. Caceres, PhD, RN, AGPCNP-BC, a postdoctoral research fellow in the Program for the Study of LGBT Health at Columbia University School of Nursing, New York, told Endocrine Today. “Previous studies in the general population have found that traumatic experiences are associated with cardiometabolic risk and higher incidence of heart disease in women. Because sexual minority women generally report higher rates of traumatic experiences than heterosexual women, we conducted an analysis of data from the Chicago Health and Life Experiences of Women (CHLEW) study, a 19-year longitudinal study of the health of sexual minority women, to examine whether trauma (including abuse and neglect) across the life span potentially contributed to cardiometabolic risk in sexual minority women.”
Caceres and colleagues analyzed data from 547 women who identified as lesbian (n = 323), bisexual (n = 137) or mostly lesbian (n = 87) participating in wave 3 of the CHLEW study. Researchers used multinomial logistic regression to examine correlates of trauma, followed by multiple logistic regression analysis to examine the associations of different forms of trauma throughout the life course (childhood, adulthood and lifetime), with psychosocial and behavioral risk factors and self-reported cardiometabolic risk (obesity, hypertension and diabetes). Childhood trauma included physical abuse, sexual abuse and parental neglect before age 18 years. Adulthood trauma included physical abuse, sexual abuse and intimate partner violence. To assess behavioral risk factors, researchers asked participants about smoking, binge drinking, overeating and illegal drug use.
Researchers found that childhood trauma was associated with higher odds of overeating in the past 3 months (adjusted OR = 1.44; 95% CI, 1.07-1.92). There were no other observed associations between trauma and behavioral risk factors.
The researchers also found that all forms of trauma were associated with a higher report of all cardiometabolic risk factors apart from type 2 diabetes. However, when assessing childhood trauma alone, researchers observed an association with type 2 diabetes in adulthood that persisted after adjustment for psychosocial and behavioral risk factors (aOR = 1.58; 95% CI, 1.02-2.44). Adulthood trauma was associated with higher odds for reporting obesity (aOR = 1.22; 95% CI, 1.01-1.49), as was lifetime trauma (aOR = 1.16; 95% CI, 1.01-1.33). Similarly, adulthood trauma was associated with higher odds for reporting hypertension (aOR = 1.3; 95% CI, 1.01-1.68), as was lifetime trauma (aOR = 1.22; 95% CI, 1.01-1.46), according to researchers.
“The findings point to a link between experiencing certain forms of trauma and self-reported cardiometabolic risk in this population,” Caceres said. “Even after accounting for known risk factors (such as current tobacco use, heavy drinking and overeating), we found that childhood trauma was associated with higher rates of diabetes, and adulthood and lifetime trauma were associated with higher rates of obesity and hypertension in sexual minority women. This work adds to the existing literature about factors that contribute to cardiometabolic risk in sexual minority women.”
Caceres noted that, because cardiometabolic risk was assessed based on participant self-reporting, future work is needed to examine whether traumatic experiences are associated with objective measures of cardiometabolic risk, such as elevated blood pressure and BMI.
“Clinicians must recognize that the unique social stressors (such as victimization, discrimination and fear of rejection) that sexual minority women might experience can impact their health and well-being,” Caceres said. “Many sexual minority women may feel the need to hide their sexual orientation from clinicians because of fear of discrimination or that it will impact the quality of their health care. A first step in addressing cardiometabolic health, but also the overall health of sexual minority women, is to assess sexual orientation and gender identity in clinical practice. This is a growing trend across health care systems in the United States but many clinicians lack training in LGBT health and may feel uncomfortable assessing these. Creating open and welcoming environments for sexual minority women is crucial to reduce their potential fears about health care encounters.” – by Regina Schaffer
For more information:
Billy A. Caceres, PhD, RN, AGPCNP-BC, can be reached at Columbia University School of Nursing, 622 W. 168th St., New York, NY 10032; email: bac2134@cumc.columbia.edu.
Disclosures: The authors report no relevant financial disclosures.