Assessing and Decomposing Drivers of Disparities in Cardiovascular Health Outcomes in Sexual Minorities

PROJECT SUMMARY Sexual minority (SM) individuals (e.g., lesbian, gay, bisexual) are considered at higher cardiovascular disease risk due to the discrimination based on sexual orientation. Experiences of discrimination including internal and interpersonal discrimination have led to higher rates of risk factors like smoking, binge drinking, and substance use compared to straight adults. Additional studies have also suggested issues in health care access and quality of care and that minority stress may be adversely affecting physiologic processes. However, there is limited data on cardiovascular health conditions of SM adults and various demographic subgroups (e.g., sexual orientation x race). This makes it difficult to develop health programs to improve health and address disparities in this population. This project will examine disparities by sexual orientation in cardiovascular health conditions. Specifically, the team will: (1) assess disparities in prevalence and incidence according to sexual orientation of selected cardiovascular-related condition (cardiometabolic conditions, cardiovascular disease) and (2) examine and decompose the role of social determinants on cardiovascular health disparities. Further, in a sub-aim, the team will explore the mediating role of telomere length in explaining cardiometabolic health disease disparities by sexual orientation. These aims will be achieved by linkage of survey data from the Kaiser Permanente Research Bank (KPRB) datasets with the Kaiser Permanente electronic health records. The analysis will identify significant disparities and, through decomposition methods, quantify the role of selected social determinants (e.g., education, income, discrimination) in driving these disparities. Results of this work can be used to set health program targets while decomposition results can guide the selection of strategies to address disparities. It also serves as a foundational work for more in-depth epidemiologic, translational, and implementation research on SM disparities.