ImportanceExtensive evidence documents health disparities for lesbian, gay, and bisexual (LGB) women, including worse physical, mental, and behavioral health than heterosexual women. These factors have been linked to premature mortality, yet few studies have investigated premature mortality disparities among LGB women and whether they differ by lesbian or bisexual identity.ObjectiveTo examine differences in mortality by sexual orientation.Design, Setting, and ParticipantsThis prospective cohort study examined differences in time to mortality across sexual orientation, adjusting for birth cohort. Participants were female nurses born between 1945 and 1964, initially recruited in the US in 1989 for the Nurses’ Health Study II, and followed up through April 2022.ExposuresSexual orientation (lesbian, bisexual, or heterosexual) assessed in 1995.Main Outcome and MeasureTime to all-cause mortality from assessment of exposure analyzed using accelerated failure time models.ResultsAmong 116 149 eligible participants, 90 833 (78%) had valid sexual orientation data. Of these 90 833 participants, 89 821 (98.9%) identified as heterosexual, 694 (0.8%) identified as lesbian, and 318 (0.4%) identified as bisexual. Of the 4227 deaths reported, the majority were among heterosexual participants (n = 4146; cumulative mortality of 4.6%), followed by lesbian participants (n = 49; cumulative mortality of 7.0%) and bisexual participants (n = 32; cumulative mortality of 10.1%). Compared with heterosexual participants, LGB participants had earlier mortality (adjusted acceleration factor, 0.74 [95% CI, 0.64-0.84]). These differences were greatest among bisexual participants (adjusted acceleration factor, 0.63 [95% CI, 0.51-0.78]) followed by lesbian participants (adjusted acceleration factor, 0.80 [95% CI, 0.68-0.95]).Conclusions and RelevanceIn an otherwise largely homogeneous sample of female nurses, participants identifying as lesbian or bisexual had markedly earlier mortality during the study period compared with heterosexual women. These differences in mortality timing highlight the urgency of addressing modifiable risks and upstream social forces that propagate and perpetuate disparities.

中文翻译：

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一大群未来女护士因性取向而导致的死亡率差异

重要性大量证据证明女同性恋、男同性恋和双性恋 (LGB) 女性的健康差异，包括比异性恋女性更差的身体、心理和行为健康。这些因素与过早死亡有关，但很少有研究调查 LGB 女性过早死亡率的差异，以及她们是否因女同性恋或双性恋身份而有所不同。目的检查不同性取向的死亡率差异。设计、背景和参与者这项前瞻性队列研究考察了差异跨性取向的死亡时间，并根据出生队列进行调整。参与者是 1945 年至 1964 年出生的女护士，最初于 1989 年在美国招募参加护士健康研究 II，并随访至 2022 年 4 月。暴露性取向（女同性恋、双性恋或异性恋）于 1995 年进行评估。主要结果和测量时间使用加速失效时间模型分析暴露评估得出的全因死亡率。结果在 116 149 名符合条件的参与者中，90 833 名 (78%) 拥有有效的性取向数据。在这 90 833 名参与者中，89 821 人（98.9%）被认为是异性恋，694 人（0.8%）被认为是女同性恋，318 人（0.4%）被认为是双性恋。在报告的 4227 例死亡中，大多数是异性恋参与者（n = 4146；累积死亡率 4.6%），其次是女同性恋参与者（n = 49；累积死亡率 7.0%）和双性恋参与者（n = 32；累积死亡率10.1%）。与异性恋参与者相比，LGB 参与者的死亡率更早（调整后的加速因子，0.74 [95% CI，0.64-0.84]）。这些差异在双性恋参与者中最大（调整后的加速因子，0.63 [95% CI，0.51-0.78]），其次是女同性恋参与者（调整后的加速因子，0.80 [95% CI，0.68-0.95]）。 结论和相关性在女护士的同质样本中，与异性恋女性相比，在研究期间，被认定为女同性恋或双性恋的参与者的死亡率明显更早。死亡时间的这些差异凸显了解决可改变的风险和传播和延续差异的上游社会力量的紧迫性。