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. 2024 Apr 25;331(19):1638–1645. doi: 10.1001/jama.2024.4459

Disparities in Mortality by Sexual Orientation in a Large, Prospective Cohort of Female Nurses

Sarah McKetta 1,2,✉, Tabor Hoatson 1, Landon D Hughes 1,2, Bethany G Everett 3, Sebastien Haneuse 4, S Bryn Austin 5,6,7, Tonda L Hughes 8, Brittany M Charlton 1,2,6,9
PMCID: PMC11046401  PMID: 38662342

Key Points

Question

Do bisexual and lesbian women have higher risks of premature mortality than heterosexual women?

Findings

Bisexual and lesbian participants in the Nurses’ Health Study II died an estimated 37% and 20% sooner, respectively, than heterosexual participants.

Meaning

Lesbian, gay, and bisexual women experienced earlier all-cause mortality, highlighting the need to address upstream individual and structural determinants of health disparities.

Abstract

Importance

Extensive 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.

Objective

To examine differences in mortality by sexual orientation.

Design, Setting, and Participants

This 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.

Exposures

Sexual orientation (lesbian, bisexual, or heterosexual) assessed in 1995.

Main Outcome and Measure

Time to all-cause mortality from assessment of exposure analyzed using accelerated failure time models.

Results

Among 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 Relevance

In 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.

This prospective cohort study compares the differences in time to mortality across sexual orientation in female nurses participating in the Nurses’ Health Study II.

Introduction

Lesbian, gay, and bisexual (LGB) women have systematically worse physical,1 mental,1,2 and behavioral health2,3 than heterosexual women. These disparities are due to chronic and cumulative exposure to stressors (including interpersonal and structural stigma4) that propagates and magnifies ill health throughout the life course, manifesting in disparities across a breadth of adverse health outcomes that tend to become more pronounced as individuals age (ie, weathering).5

National surveys started enumerating sexual orientation only within the past decade, and very few longitudinal cohort studies collect sexual orientation data. Therefore, despite extensive evidence of sexual orientation–related disparities in risk factors, few studies have been able to examine mortality differences by sexual orientation.6,7 Even fewer studies have focused on LGB women specifically, though some have demonstrated higher premature mortality risks for LGB women than heterosexual women.8,9 One study found the risk for premature mortality doubled among LGB women.8

Research on sexual orientation–related premature mortality has not elucidated differences within subgroups of LGB women; this is concerning because bisexual women experience unique stressors related to sexual orientation concealment,10,11 which may result in worse health.12 For example, bisexual women have higher magnitudes of disparities in substance use,13 cardiovascular disease,2 depression,14 and anxiety14 than lesbian women. Given these elevated risks, mortality disparities may be more pronounced among bisexual women than among lesbian women. A study conducted in Sweden found bisexual women had the highest hazard of all-cause mortality of any LGB subgroup under examination.15 To date, no studies examining mortality disparities in the US have differentiated between the sexual orientations of bisexual and lesbian.

We examined differences in mortality by sexual orientation in a longitudinal study of female nurses assessed over 3 decades. We hypothesized that LGB women would have earlier mortality than heterosexual women, but the risks would vary and bisexual women would have more pronounced mortality disparities.

Methods

The Nurses’ Health Study II is a longitudinal cohort of 116 429 female nurses born between 1945 and 1964 and recruited in 1989 (recruitment and survey details appear in eAppendix 1 in Supplement 1).16 This analysis refers to the participants as women, although gender identity was not assessed in this sample; all participants were recruited based on female sex and self-report of being female.

Eligible participants were those alive in 1995 (N = 116 149; >99% of original cohort) when sexual orientation was first assessed by asking, “Whether or not you are currently sexually active, what is your sexual orientation or identity? (Please choose one answer.)” Participants could choose 1 of the following responses: heterosexual; lesbian, gay, or homosexual (henceforth, lesbian); bisexual; none of these; or prefer not to answer. In the sensitivity analyses described below, associations with mortality for participants who were missing sexual orientation or responded as “none of these” or “prefer not to answer” were investigated.

The main outcome of interest was time to all-cause mortality from assessment of exposure. Mortality was determined in the Nurses’ Health Study II when (1) study personnel were notified about a participant’s death via correspondence with a close contact and the death was subsequently confirmed in the National Death Index (NDI) or (2) a participant had not responded to several questionnaires in a row (study personnel checked to see if they had a death record in the NDI).

The linkages to the NDI were confirmed via names and other identifying information such as social security numbers or birth dates. The linkages to the NDI were confirmed through December 31, 2019; however, ongoing death follow-up (eg, via family communication that was not yet confirmed with the NDI) was assessed through April 30, 2022. In the sensitivity analyses, only NDI-confirmed deaths (ie, through December 31, 2019) were examined.

Because younger cohorts endorse LGB orientation at higher rates,17,18 to account for the possibility of spurious associations due to cohort we adjusted for birth cohort, which was categorized in 5-year increments (ie, 1945-1949, 1950-1954, 1955-1959, 1960-1964). We chose not to further control for other health-related variables that vary in distribution across sexual orientation (eg, diet, smoking, alcohol use) because these are likely on the mediating pathway between LGB orientation and mortality. Therefore, controlling for these variables would be inappropriate because they are not plausible causes of both sexual orientation and mortality (ie, confounders) and their inclusion in the model would likely attenuate disparities between sexual orientation and mortality.19 However, to determine whether disparities persisted above and beyond the leading cause of premature mortality (ie, smoking20), we conducted sensitivity analyses among the subgroup of participants (n = 59 220) who reported never smoking between 1989 and 1995 (year when sexual orientation information was obtained).

The association between sexual orientation and mortality was quantified using time-to-event analyses. Specifically, unadjusted probability of mortality, stratified by sexual orientation, was first examined with Kaplan-Meier curves. Next, time to mortality was modeled using accelerated failure time models,21 which focus on comparisons between groups in terms of the relative timing of events rather than the risk or the hazard at a particular point in time (as is the case for the Cox model); comparisons based on the timing are likely more relevant to this study because LGB individuals are vulnerable to psychosocial and physical stressors that accumulate over the life course, which is consistent with the weathering hypotheses.5 However, as a secondary analysis, Cox proportional hazards models were used.

The time scale for the analyses was the number of years since exposure ascertainment (ie, 1995), with person-time right censored at the final date of mortality assessment (ie, April 30, 2022). After reviewing Cox-Snell residuals and an assessment of a variety of choices using the Akaike information criterion, the results are reported based on accelerated failure time models with a log-logistic distribution for the baseline error terms (ie, in the referent category of heterosexual women). Throughout, estimation and inference were based on maximum likelihood methods. In sensitivity analyses, estimates are shown using alternative distributions.

We tested for differences in time to death comparing LGB women vs heterosexual women, as well as comparing bisexual women vs lesbian women, using Wald tests with an α value of .05. We first examined the timing of mortality comparing LGB participants vs heterosexual participants and then further compared risks among lesbian, bisexual, and heterosexual participants. From these models, estimates (after exponentiating the slope parameters) can be interpreted as acceleration factors, which quantify how much sooner (if the estimated acceleration factor is <1.0) or later (if the estimated acceleration factor is >1.0) events occur in time.22,23

Sexual orientation was missing for 25 316 participants (22.0% of eligible sample). Thirteen percent of participants (n = 15 092) were missing data on sexual orientation due to item nonresponse (n = 14 478) or because they selected “none of these” or “prefer not to answer” (n = 614). Other participants did not return a 1995 questionnaire (n = 10 224; 9%). The results are presented using complete case analyses (n = 90 833). Sensitivity analyses were conducted across different patterns of missingness (additional details on missingness appear in eAppendix 2 in Supplement 1) as well as using multiple imputation to predict missing sexual orientation for all participants who responded to the 1995 survey. The analyses were conducted in R version 4.2.0 (R Foundation for Statistical Computing).

Results

Among 90 833 participants in the Nurses’ Health Study II with valid sexual orientation data, 89 821 (98.9%) identified as heterosexual, 694 (0.8%) identified as lesbian, and 318 (0.4%) identified as bisexual (Table). Overall, 4227 deaths were reported. The cumulative mortality over the 27-year study period was 4.6% (n = 4146) for heterosexual participants and 8.0% (n = 81) for LGB participants (corresponding to 7.0% [n = 49] for lesbian participants and 10.1% [n = 32] for bisexual participants). Heterosexual and LGB participants were equally likely to belong to minoritized racial or ethnic groups (both 6.1%). A larger proportion of heterosexual participants (65.4%) reported never smoking relative to LGB participants (46.1%).

Table. Distribution of All Study Variables Among Participants in the Nurses’ Health Study II by Reported Sexual Orientation.

No. (%)
Heterosexual
(n = 89 821; 98.9%)		 Lesbian
(n = 694; 0.8%)		 Bisexual
(n = 318; 0.4%)
Birth cohort
1945-1949 16 254 (18.1) 164 (23.6) 62 (19.5)
1950-1954 30 011 (33.4) 236 (34.0) 118 (37.1)
1955-1959 28 525 (31.8) 211 (30.4) 101 (31.8)
1960-1964 15 031 (16.7) 83 (12.0) 37 (11.6)
Minoritized racial or ethnic identity 5440 (6.1) 34 (4.9) 28 (8.8)
American Indian or Alaska Native 47 (0.1) 0 1 (0.3)
Asian 1151 (1.3) 4 (0.6) 1 (0.3)
Black 1203 (1.3) 6 (0.9) 7 (2.2)
Latino 1477 (1.6) 8 (1.2) 8 (2.5)
Multiracial 1503 (1.7) 16 (2.3) 11 (3.5)
Native Hawaiian or Pacific Islander 59 (0.1) 0 0
Non-Hispanic White 83 689 (93.2) 657 (94.7) 287 (90.3)
Other or unknown race or ethnicity 692 (0.8) 3 (0.4) 3 (0.9)
Reported never smoking during 1989-1995 58 754 (65.4) 320 (46.1) 146 (45.9)
Died by April 2022 4146 (4.6) 49 (7.0) 32 (10.1)
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The mortality curves increased faster for LGB participants (P < .001 using the log-rank test; Figure 1). Compared with lesbian participants, there was more divergence for bisexual participants from heterosexual participants, but it did not reach statistical significance (P = .09 using the log-rank test for the comparison between bisexual participants and lesbian participants).

Figure 1. Probability of Death Through April 2022 in Participants in the Nurses’ Health Study II, by Reported Sexual Orientation.

Figure 1.

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The cohort-adjusted, model-based estimates for the sexual orientation differences in time to mortality (with adjustment for birth cohort) appear in Figure 2. The unadjusted estimates appear in eTable 1 in Supplement 1. Compared with heterosexual women, LGB women had earlier mortality (adjusted acceleration factor, 0.74 [95% CI, 0.64-0.84]). Examining subgroups within LGB women, bisexual participants died sooner (adjusted acceleration factor, 0.63 [95% CI, 0.51-0.78]) than lesbian participants (adjusted acceleration factor, 0.80 [95% CI, 0.68-0.95]), relative to heterosexual participants, though the results did not reach significance at the .05 level (adjusted acceleration factor, 0.78 [95% CI, 0.59-1.02] comparing bisexual women vs lesbian women).

Figure 2. Model-Based Estimates of Acceleration Factors for Time to Mortality From Baseline in Participants in the Nurses’ Health Study II.

Figure 2.

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All estimates were adjusted for birth cohort (1945-1949, 1950-1954, 1955-1959, and 1960-1964). The whiskers correspond to the 95% CI.

In a secondary analysis, disparities with interaction by race and ethnicity were examined. Disparities in mortality were higher in magnitude among racial and ethnic minority LGB women (acceleration factor, 0.48 [95% CI, 0.31-0.75]; eTable 2 in Supplement 1) than among non-Hispanic White, LGB women (acceleration factor, 0.77 [95% CI, 0.67-0.89). The patterning in differences in magnitude were consistent across lesbian and bisexual subgroups, but did not achieve statistical significance due to small numbers.

The secondary and sensitivity analyses with other model distributions for the mortality outcomes, using Cox proportional hazards models, and using only NDI-confirmed deaths appear in eTables 3, 4, and 5 in Supplement 1, respectively. Outcomes of models stratified by sources of missing and with imputed values for missing sexual orientation appear in eTables 6 and 7 in Supplement 1. The results of these analyses reported in Supplement 1 did not meaningfully vary from the results or interpretation shown here. However, the disparities for NDI-confirmed deaths were lower in magnitude due to a smaller number of deaths overall. Among those who reported never smoking (n = 59 220), LGB women had earlier mortality than heterosexual women (acceleration factor for all LGB women, 0.77 [95% CI, 0.62-0.96]; acceleration factor for lesbian participants, 0.80 [95% CI, 0.61-1.05]; acceleration factor for bisexual participants, 0.72 [95% CI, 0.50-1.04]). These estimates were very similar in magnitude and direction to the other analyses; however, the sample size was reduced, leading to very wide 95% CIs for the subgroups of LGB women.

Discussion

Lesbian, gay, and bisexual women died 26% earlier than heterosexual women in a longitudinal cohort of nurses followed up for 3 decades. Both lesbian and bisexual women experienced earlier mortality than heterosexual women; however, the risk was most pronounced among the bisexual participants who died 37% earlier (20% earlier for lesbian participants) than the heterosexual participants.

These dramatic differences highlight the burden of health disparities faced by LGB women. Although a robust literature has elucidated these disparities and processes, these findings are among the first to document the substantial effect these cumulative experiences have on premature mortality among LGB women. Prior research in this cohort demonstrated that LGB women had markedly higher risks of poor chronic and behavioral health than heterosexual women.1 In particular, risk factors for breast cancer and cardiovascular disease were elevated, with both lesbian and bisexual participants reporting twice as much alcohol and tobacco use as heterosexual participants.

Bisexual participants, in particular, had a 50% higher prevalence of hypertension than heterosexual participants. Consistent with findings from other samples,24,25 LGB women had elevated risks of depression as well. These prior health findings were documented when this cohort was in midlife (2 decades ago). Therefore, the majority of the mortality disparity found in the present study is likely attributable to preventable health behaviors and conditions that lead to a range of causes of death. These mechanisms are multifactorial and corroborated by the sensitivity analysis showing that the direction and magnitude of the mortality disparities were largely unchanged even among participants who reported never smoking. Although this analysis did not include cause of death because of extensive missingness (eTable 8 in Supplement 1), the leading causes of death for LGB women in this sample were cancer, respiratory disease, suicide, and cardiovascular disease, consistent with the elevated risk factors demonstrated 20 years ago in this same sample.

A key strength of this study is the ability to ascertain differential risks for bisexual and lesbian women. Critically, bisexual women had the most pronounced disparities in all-cause mortality in this sample. Even though this finding did not achieve statistical significance relative to lesbian women, the magnitude of the disparity was consistent with the study hypothesis, given that bisexual women have higher risks of substance use and have poorer physical and mental health than lesbian women.1,12,13,26,27,28,29 The underlying cause of these disparities is thought to be related to unique stressors that bisexual individuals face relative to other LGB groups. Specifically, bisexual orientation may be more concealable than lesbian orientation because many bisexual women have male partners. Therefore, stressors related to disclosure or staying closeted may be more salient for bisexual women, who are less likely than lesbian women to disclose their identities to their social networks.10,11 This can have both positive and negative effects on mental health.30,31

Nondisclosure has historically been thought of as a protective mechanism (ie, to buffer against interpersonal discrimination by passing); however, emerging evidence suggests that concealing one’s bisexual orientation may lead to more negative internalizing processes, confusion, and isolation from the queer community, which increase risks of adverse health behaviors to cope.32 Indeed, previous studies of mortality among LGB women found that the risks were most pronounced among women who did not disclose their sexual orientation to their immediate family.33 These findings affirm the importance of evaluating health and mortality risks for LGB women as well as the need to probe what specific factors may buffer the effects of adverse social forces that affect LGB women.

Health disparities for LGB women are consequences of structural and interpersonal marginalization, which are woven into the day-to-day lives of LGB women in ways that systematically undermine their access to health services and health-promoting behaviors.34,35,36 Lesbian, gay, and bisexual women who disclose their orientation experience high rates of discrimination by health care clinicians,37 leading them to forego or avoid preventive care.30 Furthermore, LGB women experience discrimination from employers, landlords, and service providers,31,38,39,40 leading to financial insecurity, housing instability, and food insecurity41,42 and thereby limiting financial and neighborhood resources for healthy options and health services,43 as well as widening disparities in health insurance.44

Lesbian, gay, and bisexual women often experience disapproval or rejection from their families,45 leading to limited social resources46,47,48,49 and unstable relationships50 that are disproportionately characterized by violence and abuse.51 To cope with these collective stressors, many LGB women self-medicate with tobacco, alcohol, or other drugs,52,53 which increase the risk of chronic health problems and lead to further avoidance of health care for fear of judgment.54,55 Collectively, these experiences of chronic stress may damage the body by dysregulating cardiovascular, metabolic, and immune systems, making LGB women more susceptible to disease and premature death.5 As a result, LGB women are vulnerable to increased risk of premature mortality attributable to a wide range of preventable causes of death, given that these social processes permeate health and health behaviors at all levels, and these health disparities are implicated in multiple disease pathways.

Given that biases in care based on sexual orientation occur at every point in the care continuum, clinicians and health care organizations at all levels, in every specialty, and for all ages have opportunities to intervene in ways that can reduce these disparities and contribute to better health outcomes. Actionable first steps include evidence-based preventive screening for LGB women without making assumptions based on orientation. For example, LGB women are less likely than heterosexual women to receive screening for sexually transmitted infections despite their increased risks because clinicians often assume that LGB women primarily have female sexual partners and are at lower risk.30,56,57,58,59

Screening and treatment referral for tobacco, alcohol, and other substance use need to be available without judgment.60 Recent estimates suggest that 70% of primary care clinicians do not feel comfortable meeting the needs of LGB individuals.61 Many clinicians do not receive mandatory, culturally informed training on caring for LGB patients.62 Training in cultural competency will benefit all clinicians who provide care for LGB individuals—because all clinicians likely do—and will facilitate more open dialogue regarding disclosure and risk assessment. At the structural level, discriminatory laws cause dramatic increases in suicidality, adverse health behaviors, adverse physical health, and experiences of discrimination.4 In its Declaration of Professional Responsibility, the American Medical Association calls for physicians to “advocate for social, economic, educational, and political changes that ameliorate suffering and contribute to human well-being.”63

Limitations

These findings should be interpreted in light of their limitations. First, these findings may underestimate the true disparity in the general US population. The Nurses’ Health Study II is a sample of racially homogeneous female nurses with high health literacy and socioeconomic status, predisposing them to longer and healthier lives than the general public.64,65 The secondary analyses examining disparities demonstrated racial and ethnic minority LGB women had more pronounced disparities than non-Hispanic White LGB women; however, due to sample limitations this analysis did not fully explore the extent of these disparities. Although this sample’s relative homogeneity could adversely affect inference for some research questions, the ability to glean a mortality difference of this magnitude in a sample that otherwise has limited variability speaks to the strength of the association.

Second, the proportion of lesbian- and bisexual-identifying women in the analytic sample (0.8% and 0.3%, respectively) is lower than current population estimates of 1% of US adults (of any gender) identifying as lesbian and 4.2% identifying as bisexual.66 Even though the population proportion of LGB adults has been increasing over the past 3 decades (primarily driven by increases among young people) compared with contemporaneous national surveys from the 1990s, the current sample proportion of lesbian and bisexual women was low.18 This analysis did not adjudicate between a truly lower proportion of LGB women vs misclassification or nonresponse due to concealment and stigma. However, sensitivity analyses imputing missing sexual orientation information based on demographics and responses to subsequent surveys in 2009 and 2017 (when available) did not meaningfully influence the estimates of the disparity.

Third, even though this analysis did not examine changes in sexual orientation over time due to concerns related to inducing selection bias, only a small proportion of participants (3.7% of women identifying as LGB in 1995 and 6.8% of women identifying as heterosexual in 1995) reported a different sexual orientation at a later time point when the national climate was more accepting. Therefore, we anticipate that sexual orientation identities were largely stable over the duration of the study and that any misclassification based on using the 1995 measure underestimates the true disparity. However, the sexual orientation measure available in 1995 assessed only 3 (lesbian, bisexual, or heterosexual) identities and no sexual behavior or attractions, which are important dimensions of sexual orientation and may be critical sources of heterogeneity that warrant future inquiry.

Conclusions

In 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.

Supplement 1.

eAppendix 1. Recruitment strategy for the Nurses’ Health Study 2

eAppendix 2. Missingness

eTable 1. Unadjusted model-based estimates of acceleration factors (AF), for time to mortality from baseline by reported sexual orientation among participants in the Nurses’ Health Study 2

eTable 2. Model-based estimates of acceleration factors (AF), for time to mortality from baseline by reported sexual orientation among participants in the Nurses’ Health Study 2, with interaction by race and ethnicity

eTable 3. Model-based estimates of acceleration factors (AF), for time to mortality from baseline by reported sexual orientation among participants in the Nurses’ Health Study 2, modeled using alternative distributions for mortality outcomes

eTable 4. Model-based risk for survival by reported sexual orientation among participants in the Nurses’ Health Study 2, modeled using Cox Proportional Hazards models

eTable 5. Model-based estimates of acceleration factors (AF), for time to mortality from baseline by reported sexual orientation among participants in the Nurses’ Health Study 2, using only NDI-confirmed deaths with linked data through 2019

eTable 6. Model-based estimates of acceleration factors (AF), for time to mortality from baseline by reported sexual orientation among participants in the Nurses’ Health Study 2, including those who were missing measures of sexual orientation

eTable 7. Model-based estimates of acceleration factors (AF), for time to mortality from baseline by reported sexual orientation among participants in the Nurses’ Health Study 2 with missing sexual orientation values imputed

eTable 8. Cause-specific mortality among participants in Nurses’ Health Study 2, by reported sexual orientation

eReferences

jama-e244459-s001.pdf (218.9KB, pdf)
Supplement 2.

Data sharing statement

jama-e244459-s002.pdf (15.2KB, pdf)

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Supplement 1.

eAppendix 1. Recruitment strategy for the Nurses’ Health Study 2

eAppendix 2. Missingness

eTable 1. Unadjusted model-based estimates of acceleration factors (AF), for time to mortality from baseline by reported sexual orientation among participants in the Nurses’ Health Study 2

eTable 2. Model-based estimates of acceleration factors (AF), for time to mortality from baseline by reported sexual orientation among participants in the Nurses’ Health Study 2, with interaction by race and ethnicity

eTable 3. Model-based estimates of acceleration factors (AF), for time to mortality from baseline by reported sexual orientation among participants in the Nurses’ Health Study 2, modeled using alternative distributions for mortality outcomes

eTable 4. Model-based risk for survival by reported sexual orientation among participants in the Nurses’ Health Study 2, modeled using Cox Proportional Hazards models

eTable 5. Model-based estimates of acceleration factors (AF), for time to mortality from baseline by reported sexual orientation among participants in the Nurses’ Health Study 2, using only NDI-confirmed deaths with linked data through 2019

eTable 6. Model-based estimates of acceleration factors (AF), for time to mortality from baseline by reported sexual orientation among participants in the Nurses’ Health Study 2, including those who were missing measures of sexual orientation

eTable 7. Model-based estimates of acceleration factors (AF), for time to mortality from baseline by reported sexual orientation among participants in the Nurses’ Health Study 2 with missing sexual orientation values imputed

eTable 8. Cause-specific mortality among participants in Nurses’ Health Study 2, by reported sexual orientation

eReferences

jama-e244459-s001.pdf (218.9KB, pdf)
Supplement 2.

Data sharing statement

jama-e244459-s002.pdf (15.2KB, pdf)

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