Lesbian, gay, and bisexual (LGB) veterans die younger than heterosexual veterans due to alcohol related harms. This study investigated specific alcohol harms and whether this disproportionate burden experienced by LGB veterans is more prominent in certain harms versus others.
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Lesbian, gay, and bisexual (LGB) populations engage in more drinking and have higher rates of alcohol use disorder relative to heterosexual populations. Research suggests that being discriminated against is associated with higher rates of alcohol-related health issues among LGB people. Disparities in alcohol use and subsequent health issues are even more stark for LGB veterans; LGB veterans are more likely to die from alcohol related harms and do so at a younger age than non-LGB veterans with similar levels of alcohol use. This disparity may be due to the added stress of identifying as an LGB person and being in the military– such individuals must navigate the highly demanding (and often traumatizing) military environment while being isolated from their peers and non-military LGB community members. It is unknown how specific causes of death related to alcohol use differ between LGB and heterosexual veterans. A better understanding of these differences can offer clues on where and how to intervene on LGB veterans’ alcohol use behavior.
This study was a follow-up to an already published analysis of Veteran’s Health Administration electronic health record data. People included in the analysis (N=5,402,606) were veteran patients enrolled in the Veteran’s Health Administration between October 1999 and July 2019. Veterans were classified as LGB based on a validated machine learning-based language processing computer program designed to scan written electronic health records. Veterans without text documentation who had one or more administrative code indicating sexual minority orientation (e.g., diagnosis code Z72.52 [High risk homosexual behavior]) were also included. This resulted in a cohort of 102,085 LGB veterans. All veterans who did not have documentation of LGB identity/behavior in text or codes comprised the heterosexual cohort (n = 5,300,521).
The research team measured alcohol consumption via scores of a modified version of the Alcohol Use Disorder Identification Test (AUDIT-C) contained within veterans’ electronic medical records. If a person had multiple AUDIT-C scores, the researchers selected one at random. AUDIT-C scores range from 0 (no past year alcohol use) to 12 (daily heavy drinking in the past year). AUDIT-C items were used to estimate average drinks per day. These scores were then used to group veterans into birth-sex-specific drinking cut-offs: no, low, medium, and high alcohol use.
The researchers looked at two measures of loss of life due to alcohol. The first measure was alcohol-attributable deaths, which refers to deaths due directly (e.g., alcoholic liver disease) or indirectly (e.g., hypertension) to excessive alcohol consumption. Alcohol-attributable deaths were classified using diagnosis codes sourced from the National Death Index (a Centers for Disease Control and Prevention maintained repository of death records/cause of death codes). The authors also classified deaths using the Centers for Disease Control and Prevention’s Alcohol-Related Disease Impact application to specify deaths known to be associated with alcohol use. The second measure was years of potential life lost per alcohol-attributable death. This measure estimates the average years a person would have lived if they had not died prematurely.
The researchers examined whether years of potential life lost for each alcohol attributable death differed as a function of sexual identity and gender. The four sexual identity/gender groups were: heterosexual men (referent), heterosexual women, LGB men, and LGB women. The researchers also ranked the top ten alcohol-related deaths for these groups. Causes of death were then compared across groups to determine if there were differences in harms across sexual identity and gender (i.e., if some groups were more vulnerable to certain harms than others).
LGB veterans died of alcohol-related health issues younger than heterosexual veterans.
LGB veterans were more likely to die due to alcohol and died earlier than heterosexual veterans. For example, alcohol-related liver disease was the top cause of alcohol attributable death for all veterans, but the age at which veterans died of this condition varied across birth sexes and sexual orientation. LGB and heterosexual men died due to alcohol liver disease, on average at ages 57.5 and 62.8 (19 and 24 years younger than expected), and LGB and heterosexual women died at ages 50.4 and 53.8 respectively (32 and 35 years younger than expected).
LGB male and all female veterans were more likely to die suddenly due to alcohol relative to heterosexual men.
LGB male and all female veterans were more likely to die due to acute alcohol attributable deaths (e.g., alcohol related deaths that happened suddenly) compared to heterosexual men. For instance, suicide was the third most common cause of death among LGB male and all female veterans.
LGB male and all female veterans had higher years of potential life lost relative to heterosexual men.
When adjusted for age (US-based men and women have a calculated life expectancies of 76.2 and 81.2 respectively) LGB male and all female veterans were more likely to die earlier and suddenly because of alcohol. This combination of factors contributed to these veterans missing more potential years of life. For example, LGB males and all females died from sudden alcohol poisoning at ages 46.8, 46.1, and 43.6 years of age, respectively. By comparison, heterosexual males died to alcohol poisoning at age 49.1.
The results of this study suggest that the etiology of alcohol-related diseases (from hazardous alcohol use to alcohol use disorders, to resultant disease [e.g., cirrhosis], and ultimately death) may occur faster among veteran women and LGB men relative to heterosexual male veterans.
The researchers found that although alcohol had a universally negative health effect, LGB male and all female veterans were more impacted earlier in life by alcohol’s health effects than heterosexual male veterans. LGB males and all females died due to alcohol at younger ages than heterosexual males. In addition, these deaths were often due to violence (e.g., suicide) or quickly developing conditions (e.g., alcohol poisoning). Together these findings suggest that the progression from hazardous alcohol use to harms may be accelerated among LGB men and women veterans. Previous research does suggest that sex assigned at birth impacts alcohol liver disease etiology, however, it is unclear how the intersection of sexual orientation and sex assigned at birth impacts this relationship.
The results of this work also highlight an opportunity for Veterans Health Administration services to more effectively address female and LGB veterans’ needs. That is, although all sampled veterans had access to healthcare, there were notable health disparities between LGB/female and heterosexual male veterans. Particularly, the worse health outcomes among the sampled veterans may not have been due to lack of service utilization – another study conducted by the researchers suggests that LGB veterans access more healthcare services than heterosexual veterans. Findings here and from prior work suggest the notable alcohol-related health disparity among LGB and female Veterans may not be due to differences in service utilization but rather the lack of specific attention to LGB/women’s needs in those health care services.
Indeed, the present work suggests there is a need for interventions targeting LGB/female veterans’ hazardous alcohol use behavior. Specifically, the data suggest that LGB/female veterans may benefit from behavioral interventions earlier than heterosexual male veterans. Beyond this, however, the scope of the presented research precludes suggesting the best intervention strategies.
Research has been done testing alcohol interventions for veterans, however continued work is needed. Namely the previous study suggested female veterans did not benefit as much from the intervention as men, so more work is needed to determine how best to intervene on female veterans’ alcohol use. It is also unknown how many LGB veterans received the intervention, so it is unclear how LGB veterans would benefit from this treatment. It is critical for researchers to further investigate strategies to mitigate the alcohol-related disease morbidity/mortality among LGB/female veterans.
In this study, the researchers found that although there were notable universal negative alcohol-attributable health impacts overall, American LGB veterans and all female veterans died younger due to alcohol-related health issues compared to American male heterosexual veterans. Results of this research suggest that the progression from hazardous alcohol use to health problems may be accelerated among LGB men and women veterans. It is plausible that minority-related stress among female veterans and LGB veterans as well as and related stigma and discrimination among LGB individuals may increase vulnerability to health impacts, but there is a need to further investigate the factors responsible for this accelerated impact. In the interim, it is also critical to develop outreach strategies that decrease acute harms (e.g., alcohol poisoning) and chronic health problems (e.g., liver cirrhosis) due to alcohol with strategies tailored to the specific needs and experiences of LGB/female veterans.
Livingston, N. A., Gatsby, E., Shipherd, J. C., & Lynch, K. E. (2023). Causes of alcohol-attributable death and associated years of potential life lost among LGB and non-LGB veteran men and women in Veterans Health Administration. Addictive behaviors, 139, 107587. doi: 10.1016/j.addbeh.2022.107587
l
Lesbian, gay, and bisexual (LGB) populations engage in more drinking and have higher rates of alcohol use disorder relative to heterosexual populations. Research suggests that being discriminated against is associated with higher rates of alcohol-related health issues among LGB people. Disparities in alcohol use and subsequent health issues are even more stark for LGB veterans; LGB veterans are more likely to die from alcohol related harms and do so at a younger age than non-LGB veterans with similar levels of alcohol use. This disparity may be due to the added stress of identifying as an LGB person and being in the military– such individuals must navigate the highly demanding (and often traumatizing) military environment while being isolated from their peers and non-military LGB community members. It is unknown how specific causes of death related to alcohol use differ between LGB and heterosexual veterans. A better understanding of these differences can offer clues on where and how to intervene on LGB veterans’ alcohol use behavior.
This study was a follow-up to an already published analysis of Veteran’s Health Administration electronic health record data. People included in the analysis (N=5,402,606) were veteran patients enrolled in the Veteran’s Health Administration between October 1999 and July 2019. Veterans were classified as LGB based on a validated machine learning-based language processing computer program designed to scan written electronic health records. Veterans without text documentation who had one or more administrative code indicating sexual minority orientation (e.g., diagnosis code Z72.52 [High risk homosexual behavior]) were also included. This resulted in a cohort of 102,085 LGB veterans. All veterans who did not have documentation of LGB identity/behavior in text or codes comprised the heterosexual cohort (n = 5,300,521).
The research team measured alcohol consumption via scores of a modified version of the Alcohol Use Disorder Identification Test (AUDIT-C) contained within veterans’ electronic medical records. If a person had multiple AUDIT-C scores, the researchers selected one at random. AUDIT-C scores range from 0 (no past year alcohol use) to 12 (daily heavy drinking in the past year). AUDIT-C items were used to estimate average drinks per day. These scores were then used to group veterans into birth-sex-specific drinking cut-offs: no, low, medium, and high alcohol use.
The researchers looked at two measures of loss of life due to alcohol. The first measure was alcohol-attributable deaths, which refers to deaths due directly (e.g., alcoholic liver disease) or indirectly (e.g., hypertension) to excessive alcohol consumption. Alcohol-attributable deaths were classified using diagnosis codes sourced from the National Death Index (a Centers for Disease Control and Prevention maintained repository of death records/cause of death codes). The authors also classified deaths using the Centers for Disease Control and Prevention’s Alcohol-Related Disease Impact application to specify deaths known to be associated with alcohol use. The second measure was years of potential life lost per alcohol-attributable death. This measure estimates the average years a person would have lived if they had not died prematurely.
The researchers examined whether years of potential life lost for each alcohol attributable death differed as a function of sexual identity and gender. The four sexual identity/gender groups were: heterosexual men (referent), heterosexual women, LGB men, and LGB women. The researchers also ranked the top ten alcohol-related deaths for these groups. Causes of death were then compared across groups to determine if there were differences in harms across sexual identity and gender (i.e., if some groups were more vulnerable to certain harms than others).
LGB veterans died of alcohol-related health issues younger than heterosexual veterans.
LGB veterans were more likely to die due to alcohol and died earlier than heterosexual veterans. For example, alcohol-related liver disease was the top cause of alcohol attributable death for all veterans, but the age at which veterans died of this condition varied across birth sexes and sexual orientation. LGB and heterosexual men died due to alcohol liver disease, on average at ages 57.5 and 62.8 (19 and 24 years younger than expected), and LGB and heterosexual women died at ages 50.4 and 53.8 respectively (32 and 35 years younger than expected).
LGB male and all female veterans were more likely to die suddenly due to alcohol relative to heterosexual men.
LGB male and all female veterans were more likely to die due to acute alcohol attributable deaths (e.g., alcohol related deaths that happened suddenly) compared to heterosexual men. For instance, suicide was the third most common cause of death among LGB male and all female veterans.
LGB male and all female veterans had higher years of potential life lost relative to heterosexual men.
When adjusted for age (US-based men and women have a calculated life expectancies of 76.2 and 81.2 respectively) LGB male and all female veterans were more likely to die earlier and suddenly because of alcohol. This combination of factors contributed to these veterans missing more potential years of life. For example, LGB males and all females died from sudden alcohol poisoning at ages 46.8, 46.1, and 43.6 years of age, respectively. By comparison, heterosexual males died to alcohol poisoning at age 49.1.
The results of this study suggest that the etiology of alcohol-related diseases (from hazardous alcohol use to alcohol use disorders, to resultant disease [e.g., cirrhosis], and ultimately death) may occur faster among veteran women and LGB men relative to heterosexual male veterans.
The researchers found that although alcohol had a universally negative health effect, LGB male and all female veterans were more impacted earlier in life by alcohol’s health effects than heterosexual male veterans. LGB males and all females died due to alcohol at younger ages than heterosexual males. In addition, these deaths were often due to violence (e.g., suicide) or quickly developing conditions (e.g., alcohol poisoning). Together these findings suggest that the progression from hazardous alcohol use to harms may be accelerated among LGB men and women veterans. Previous research does suggest that sex assigned at birth impacts alcohol liver disease etiology, however, it is unclear how the intersection of sexual orientation and sex assigned at birth impacts this relationship.
The results of this work also highlight an opportunity for Veterans Health Administration services to more effectively address female and LGB veterans’ needs. That is, although all sampled veterans had access to healthcare, there were notable health disparities between LGB/female and heterosexual male veterans. Particularly, the worse health outcomes among the sampled veterans may not have been due to lack of service utilization – another study conducted by the researchers suggests that LGB veterans access more healthcare services than heterosexual veterans. Findings here and from prior work suggest the notable alcohol-related health disparity among LGB and female Veterans may not be due to differences in service utilization but rather the lack of specific attention to LGB/women’s needs in those health care services.
Indeed, the present work suggests there is a need for interventions targeting LGB/female veterans’ hazardous alcohol use behavior. Specifically, the data suggest that LGB/female veterans may benefit from behavioral interventions earlier than heterosexual male veterans. Beyond this, however, the scope of the presented research precludes suggesting the best intervention strategies.
Research has been done testing alcohol interventions for veterans, however continued work is needed. Namely the previous study suggested female veterans did not benefit as much from the intervention as men, so more work is needed to determine how best to intervene on female veterans’ alcohol use. It is also unknown how many LGB veterans received the intervention, so it is unclear how LGB veterans would benefit from this treatment. It is critical for researchers to further investigate strategies to mitigate the alcohol-related disease morbidity/mortality among LGB/female veterans.
In this study, the researchers found that although there were notable universal negative alcohol-attributable health impacts overall, American LGB veterans and all female veterans died younger due to alcohol-related health issues compared to American male heterosexual veterans. Results of this research suggest that the progression from hazardous alcohol use to health problems may be accelerated among LGB men and women veterans. It is plausible that minority-related stress among female veterans and LGB veterans as well as and related stigma and discrimination among LGB individuals may increase vulnerability to health impacts, but there is a need to further investigate the factors responsible for this accelerated impact. In the interim, it is also critical to develop outreach strategies that decrease acute harms (e.g., alcohol poisoning) and chronic health problems (e.g., liver cirrhosis) due to alcohol with strategies tailored to the specific needs and experiences of LGB/female veterans.
Livingston, N. A., Gatsby, E., Shipherd, J. C., & Lynch, K. E. (2023). Causes of alcohol-attributable death and associated years of potential life lost among LGB and non-LGB veteran men and women in Veterans Health Administration. Addictive behaviors, 139, 107587. doi: 10.1016/j.addbeh.2022.107587
l
Lesbian, gay, and bisexual (LGB) populations engage in more drinking and have higher rates of alcohol use disorder relative to heterosexual populations. Research suggests that being discriminated against is associated with higher rates of alcohol-related health issues among LGB people. Disparities in alcohol use and subsequent health issues are even more stark for LGB veterans; LGB veterans are more likely to die from alcohol related harms and do so at a younger age than non-LGB veterans with similar levels of alcohol use. This disparity may be due to the added stress of identifying as an LGB person and being in the military– such individuals must navigate the highly demanding (and often traumatizing) military environment while being isolated from their peers and non-military LGB community members. It is unknown how specific causes of death related to alcohol use differ between LGB and heterosexual veterans. A better understanding of these differences can offer clues on where and how to intervene on LGB veterans’ alcohol use behavior.
This study was a follow-up to an already published analysis of Veteran’s Health Administration electronic health record data. People included in the analysis (N=5,402,606) were veteran patients enrolled in the Veteran’s Health Administration between October 1999 and July 2019. Veterans were classified as LGB based on a validated machine learning-based language processing computer program designed to scan written electronic health records. Veterans without text documentation who had one or more administrative code indicating sexual minority orientation (e.g., diagnosis code Z72.52 [High risk homosexual behavior]) were also included. This resulted in a cohort of 102,085 LGB veterans. All veterans who did not have documentation of LGB identity/behavior in text or codes comprised the heterosexual cohort (n = 5,300,521).
The research team measured alcohol consumption via scores of a modified version of the Alcohol Use Disorder Identification Test (AUDIT-C) contained within veterans’ electronic medical records. If a person had multiple AUDIT-C scores, the researchers selected one at random. AUDIT-C scores range from 0 (no past year alcohol use) to 12 (daily heavy drinking in the past year). AUDIT-C items were used to estimate average drinks per day. These scores were then used to group veterans into birth-sex-specific drinking cut-offs: no, low, medium, and high alcohol use.
The researchers looked at two measures of loss of life due to alcohol. The first measure was alcohol-attributable deaths, which refers to deaths due directly (e.g., alcoholic liver disease) or indirectly (e.g., hypertension) to excessive alcohol consumption. Alcohol-attributable deaths were classified using diagnosis codes sourced from the National Death Index (a Centers for Disease Control and Prevention maintained repository of death records/cause of death codes). The authors also classified deaths using the Centers for Disease Control and Prevention’s Alcohol-Related Disease Impact application to specify deaths known to be associated with alcohol use. The second measure was years of potential life lost per alcohol-attributable death. This measure estimates the average years a person would have lived if they had not died prematurely.
The researchers examined whether years of potential life lost for each alcohol attributable death differed as a function of sexual identity and gender. The four sexual identity/gender groups were: heterosexual men (referent), heterosexual women, LGB men, and LGB women. The researchers also ranked the top ten alcohol-related deaths for these groups. Causes of death were then compared across groups to determine if there were differences in harms across sexual identity and gender (i.e., if some groups were more vulnerable to certain harms than others).
LGB veterans died of alcohol-related health issues younger than heterosexual veterans.
LGB veterans were more likely to die due to alcohol and died earlier than heterosexual veterans. For example, alcohol-related liver disease was the top cause of alcohol attributable death for all veterans, but the age at which veterans died of this condition varied across birth sexes and sexual orientation. LGB and heterosexual men died due to alcohol liver disease, on average at ages 57.5 and 62.8 (19 and 24 years younger than expected), and LGB and heterosexual women died at ages 50.4 and 53.8 respectively (32 and 35 years younger than expected).
LGB male and all female veterans were more likely to die suddenly due to alcohol relative to heterosexual men.
LGB male and all female veterans were more likely to die due to acute alcohol attributable deaths (e.g., alcohol related deaths that happened suddenly) compared to heterosexual men. For instance, suicide was the third most common cause of death among LGB male and all female veterans.
LGB male and all female veterans had higher years of potential life lost relative to heterosexual men.
When adjusted for age (US-based men and women have a calculated life expectancies of 76.2 and 81.2 respectively) LGB male and all female veterans were more likely to die earlier and suddenly because of alcohol. This combination of factors contributed to these veterans missing more potential years of life. For example, LGB males and all females died from sudden alcohol poisoning at ages 46.8, 46.1, and 43.6 years of age, respectively. By comparison, heterosexual males died to alcohol poisoning at age 49.1.
The results of this study suggest that the etiology of alcohol-related diseases (from hazardous alcohol use to alcohol use disorders, to resultant disease [e.g., cirrhosis], and ultimately death) may occur faster among veteran women and LGB men relative to heterosexual male veterans.
The researchers found that although alcohol had a universally negative health effect, LGB male and all female veterans were more impacted earlier in life by alcohol’s health effects than heterosexual male veterans. LGB males and all females died due to alcohol at younger ages than heterosexual males. In addition, these deaths were often due to violence (e.g., suicide) or quickly developing conditions (e.g., alcohol poisoning). Together these findings suggest that the progression from hazardous alcohol use to harms may be accelerated among LGB men and women veterans. Previous research does suggest that sex assigned at birth impacts alcohol liver disease etiology, however, it is unclear how the intersection of sexual orientation and sex assigned at birth impacts this relationship.
The results of this work also highlight an opportunity for Veterans Health Administration services to more effectively address female and LGB veterans’ needs. That is, although all sampled veterans had access to healthcare, there were notable health disparities between LGB/female and heterosexual male veterans. Particularly, the worse health outcomes among the sampled veterans may not have been due to lack of service utilization – another study conducted by the researchers suggests that LGB veterans access more healthcare services than heterosexual veterans. Findings here and from prior work suggest the notable alcohol-related health disparity among LGB and female Veterans may not be due to differences in service utilization but rather the lack of specific attention to LGB/women’s needs in those health care services.
Indeed, the present work suggests there is a need for interventions targeting LGB/female veterans’ hazardous alcohol use behavior. Specifically, the data suggest that LGB/female veterans may benefit from behavioral interventions earlier than heterosexual male veterans. Beyond this, however, the scope of the presented research precludes suggesting the best intervention strategies.
Research has been done testing alcohol interventions for veterans, however continued work is needed. Namely the previous study suggested female veterans did not benefit as much from the intervention as men, so more work is needed to determine how best to intervene on female veterans’ alcohol use. It is also unknown how many LGB veterans received the intervention, so it is unclear how LGB veterans would benefit from this treatment. It is critical for researchers to further investigate strategies to mitigate the alcohol-related disease morbidity/mortality among LGB/female veterans.
In this study, the researchers found that although there were notable universal negative alcohol-attributable health impacts overall, American LGB veterans and all female veterans died younger due to alcohol-related health issues compared to American male heterosexual veterans. Results of this research suggest that the progression from hazardous alcohol use to health problems may be accelerated among LGB men and women veterans. It is plausible that minority-related stress among female veterans and LGB veterans as well as and related stigma and discrimination among LGB individuals may increase vulnerability to health impacts, but there is a need to further investigate the factors responsible for this accelerated impact. In the interim, it is also critical to develop outreach strategies that decrease acute harms (e.g., alcohol poisoning) and chronic health problems (e.g., liver cirrhosis) due to alcohol with strategies tailored to the specific needs and experiences of LGB/female veterans.
Livingston, N. A., Gatsby, E., Shipherd, J. C., & Lynch, K. E. (2023). Causes of alcohol-attributable death and associated years of potential life lost among LGB and non-LGB veteran men and women in Veterans Health Administration. Addictive behaviors, 139, 107587. doi: 10.1016/j.addbeh.2022.107587
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