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A new study published in the Journal of Sex Research looked at bisexual people’s health experience in primary care in English.

“The study was part of a larger study where we used data from the General Practice Patient Survey (GPPS) from England across a few years to track whether disclosing/reporting of sexuality had changed over the years,” study author Carrie Llewellyn told us. “We found from this part of the study that reporting of being straight (heterosexual) was declining year on year and hence identifying as lesbian, gay or bisexual was increasing.”

The study used the most recently available cross sectional snapshot data from the dataset to explore whether self-reported health differed according to sexual identity. Previous studies have shown globally that there are health disadvantages to being gay, lesbian, bisexual or identifying as other minority sexual identities.

“Our research questions were deliberately non directional, meaning that we did not hypothesize what the findings would be in advance,” Llewellyn told us. “We were interested in finding out whether sexual orientation was associated with reporting long standing physical or mental health conditions, quality of life and confidence in managing one's own health.”

Researchers were also interested in looking at whether there were differences in these health outcomes according to whether people reported being gay, lesbian or bisexual.

“I have a long standing research interest in health inequalities and the health of people from minority groups,” Llewellyn told us. “This work was conducted with a research student Harry Cross who had also worked with me on some research on medical school curricula and LGBT health.”

Researchers used a large national dataset collected by Ipsos-Mori on behalf of NHS England. At the time of data collection, this was mainly a postal survey that explores patient's experiences of healthcare and their perceived health. It collects information on sexual orientation in accordance to the Office for National Statistics recommendation at that time but did not ask about gender or non-binary identities. The dataset contained data from 836,312 people of which 23,834 people reporting being either gay, lesbian or bisexual. The research team statistically adjusted for the effects of age, ethnicity, working status, and socio-economic status on health, as these could all expect to impact on health and allowed them to see the impact of sexual orientation on health outcomes.

“We found that people from gay, lesbian and bisexual groups were reporting the worse physical and mental health outcomes compared to heterosexuals,” Llewellyn told us. “LGB people reported a lack of confidence managing their own health compared to heterosexual people. Among particular groups, bisexual people were found to be particularly disadvantaged with bisexual women experiencing the poorest outcomes.”

The researchers were not entirely surprised with the study’s outcome given the literature in this area, although they had hoped that this may have changed given that more people are now able to disclose non-straight sexualities. However, there is a lack of studies looking at gay and bisexual women's health. Disproportionately the field of health research has been focused on gay men’s health and this leads to the invisibility of gay women’s experiences.

“It was surprising that bisexual women fared the worst and experienced a lack of confidence managing their own health which may stem from negative experiences with healthcare and healthcare professionals not asking the right questions,” Llewellyn told us. “We would call this a 'heteronormative' environment whereby the assumption is that women have a male partner.”

Llewellyn believes it is encouraging that some people are able to report being non-heterosexual even though the question on sexual orientation was quite blunt and did not really allow for other minority identities to be collected. The data doesn't explicitly show this but it is likely that bisexual people face or anticipate a double discrimination from both straight and gay communities and from healthcare providers. It would seem socially that there is more discrimination and prejudice directed at bisexual people which adds to stigma.

“It’s important that differences are monitored in health data so that any inequalities can be evidenced,” Llewellyn told us. “We can also try and normalize asking these questions so that people feel supported to disclose their sexuality in healthcare settings which will foster better healthcare professional -patient communication.”