title: Mortality in Postmenopausal Women by Sexual Orientation and Veteran Status.
abstract: OBJECTIVE
  To examine differences in all-cause and cause-specific mortality by sexual orientation and Veteran status among older women.
  
  
  METHODS
  Data were from the Women's Health Initiative, with demographic characteristics, psychosocial factors, and health behaviors assessed at baseline (1993-1998) and mortality status from all available data sources through 2014. Women with baseline information on lifetime sexual behavior and Veteran status were included in the analyses (N = 137,639; 1.4% sexual minority, 2.5% Veteran). The four comparison groups included sexual minority Veterans, sexual minority non-Veterans, heterosexual Veterans, and heterosexual non-Veterans. Cox proportional hazard models were used to estimate mortality risk adjusted for demographic, psychosocial, and health variables.
  
  
  RESULTS
  Sexual minority women had greater all-cause mortality risk than heterosexual women regardless of Veteran status (hazard ratio [HR] = 1.20, 95% confidence interval [CI]: 1.07-1.36) and women Veterans had greater all-cause mortality risk than non-Veterans regardless of sexual orientation (HR = 1.14, 95% CI: 1.06-1.22), but the interaction between sexual orientation and Veteran status was not significant. Sexual minority women were also at greater risk than heterosexual women for cancer-specific mortality, with effects stronger among Veterans compared to non-Veterans (sexual minority × Veteran HR = 1.70, 95% CI: 1.01-2.85).
  
  
  CONCLUSIONS
  Postmenopausal sexual minority women in the United States, regardless of Veteran status, may be at higher risk for earlier death compared to heterosexuals. Sexual minority women Veterans may have higher risk of cancer-specific mortality compared to their heterosexual counterparts. Examining social determinants of longevity may be an important step to understanding and reducing these disparities.
authors.affiliation: Health Services Research & Development, VA Puget Sound Health Care System and Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. keren.lehavot@va.gov.
authors.forename: Keren
authors.initials: K
authors.lastname: Lehavot
authors.affiliation: Division of Public Health Sciences, Fred Hutchinson Cancer Research Center and Health Services Research & Development, VA Puget Sound Health Care System, Seattle, Washington.
authors.forename: Eileen
authors.initials: E
authors.lastname: Rillamas-Sun
authors.affiliation: Sierra Pacific Mental Illness, Research, Education and Clinical Center and Center for Innovation to Implementation, VA Palo Alto Health Care System, California. Department of Psychiatry & Behavioral Sciences and Stanford Cancer Institute, California.
authors.forename: Julie
authors.initials: J
authors.lastname: Weitlauf
authors.affiliation: VA Palo Alto Health Care System, Menlo Park, California.
authors.forename: Rachel
authors.initials: R
authors.lastname: Kimerling
authors.affiliation: University of Iowa College of Public Health, Iowa City.
authors.forename: Robert B
authors.initials: RB
authors.lastname: Wallace
authors.affiliation: Iowa City VA Medical Center.
authors.forename: Anne G
authors.initials: AG
authors.lastname: Sadler
authors.affiliation: University of Washington School of Nursing, Seattle.
authors.forename: Nancy Fugate
authors.initials: NF
authors.lastname: Woods
authors.affiliation: VA Boston Healthcare System, National Center for PTSD Women's Health Sciences, Boston University School of Medicine, Massachusetts. LGBT Program Patient Care Services, Washington DC.
authors.forename: Jillian C
authors.initials: JC
authors.lastname: Shipherd
authors.affiliation: VA Central Western Massachusetts, Leeds. University of Massachusetts Medical School, Worcester.
authors.forename: Kristin
authors.initials: K
authors.lastname: Mattocks
authors.affiliation: Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, the University of Iowa Department of Epidemiology, New York.
authors.forename: Dominic J
authors.initials: DJ
authors.lastname: Cirillo
authors.affiliation: Stanford Prevention Research Center, Stanford University School of Medicine, California.
authors.forename: Marcia L
authors.initials: ML
authors.lastname: Stefanick
authors.affiliation: Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System and Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle.
authors.forename: Tracy L
authors.initials: TL
authors.lastname: Simpson
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology; D001727:Bisexuality / Q000706:statistics & numerical data*; D002318:Cardiovascular Diseases / Q000401:mortality*; D016022:Case-Control Studies; D002423:Cause of Death; D003863:Depression / Q000453:epidemiology; D005260:Female; D015438:Health Behavior; D020010:Heterosexuality / Q000706:statistics & numerical data*; D018452:Homosexuality, Female / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality*; D000066550:Physical Abuse / Q000706:statistics & numerical data; D017698:Postmenopause; D016016:Proportional Hazards Models; D000067073:Psychological Trauma / Q000453:epidemiology; D000072339:Sexual and Gender Minorities / Q000706:statistics & numerical data*; D012907:Smoking / Q000453:epidemiology; D012944:Social Support; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000401:mortality*
keywords: All-cause mortality; Sexual minority; Women Veterans