Examining Cardiovascular Disease and Human Papilloma Virus Among a Nationally Representative Sample of Lesbian and Bisexual Women In The United States
Background: Sexual minority women (including lesbian and bisexual women) are at a higher risk for numerous diseases. It was previously unknown if this increase in risk translated into higher disease burden. The aim of this dissertation was to compare the prevalence of oral HPV, the risk of cardiovascular disease (CVD), and the incidence of CVD between sexual minority and heterosexual women in a nationally representative sample of adult women. ^ Methods: Data were obtained from the National Health and Nutrition Examination Survey from 2001-2014. All participants who completed the sexual behavior module and specified their sexual orientation was “lesbian,” “bisexual,” or “heterosexual” were eligible for analysis. Participants were included classified as sexual minority women by either identification as lesbian or bisexual. Each group was compared to heterosexual women when sample size allowed. Sensitivity analysis were conducted to compare heterosexual women who had ever had sex with a woman (hetero-WSW) with heterosexual women who had never had sex with a woman (hetero-NSW). ^ Oral HPV prevalence was obtained from laboratory tests using an oral rinse and strain was classified into high-risk and low-risk for causing cancer. Univariate and multivariate logistic regression models were used to compare lesbian versus heterosexual and bisexual versus heterosexual prevalence of oral HPV. Sensitivity models compared oral HPV prevalence between hetero-WSW with hetero-NSW. ^ Risk of CVD was obtained by computing the Framingham Risk Score (FRS) based on age, high-density cholesterol (HDL), total cholesterol, systolic blood pressure (SBP), use of hypertensive medications, smoking status, and diabetes status. An alternative risk score (FRS-BMI) utilized body mass index (BMI) in place of laboratory measurements. Weighted univariate and multivariable regression models were used to compare risk of CVD between sexual minority women (defined as lesbian, bisexual, or hetero-WSW) versus hetero-NSW. ^ Incidence of CVD was obtained by calculating person-time to CVD event defined as heart attack or stroke. Participants were censored at current age if they had never had a CVD. Univariate and multivariate Cox proportional hazards models were used to compare incidence of CVD between lesbian and heterosexual and bisexual versus heterosexual participants. ^ Results: Sexual minority women experienced a higher burden of disease including: prevalence of oral HPV in bisexual versus heterosexual women, higher risk of CVD in bisexual and hetero-WSW versus heterosexual women, and higher incidence of CVD in combined lesbian and bisexual versus heterosexual women. Current smokers and black and Hispanic women who identified as lesbian or heterosexual experienced even higher disease burden. However, nearly all of these results were attenuated by either smoking status. Conclusions: We determined sexual minority women are at increased risk and experience a higher burden of disease including oral HPV, and CVD risk and incidence. Even within this high-risk group, we identified other characteristics, most notably current smokers, who represent the highest risk of disease. These findings provide information on burden of disease and also point to groups which would most benefit from tailored interventions.^
Women's studies|LGBTQ studies|Epidemiology
Cox, Vanessa, "Examining Cardiovascular Disease and Human Papilloma Virus Among a Nationally Representative Sample of Lesbian and Bisexual Women In The United States" (2017). Texas Medical Center Dissertations (via ProQuest). AAI10617672.