Using national U.S. data about attitudes to homosexuality, Mark Hatzenbuehler, lead author of the study, developed community profiles of homophobia. Then they compared rates of suicide, homicide, and death from other causes by community, with data from 1998 to 2008.
Hatzenbuehler explained that the authors were able to examine whether mortality risk differed for LGB individuals who lived in communities that were characterized by high versus low levels of prejudice. By the end of the study, 92% of LGB respondents living in low-prejudice communities were still alive; in contrast, only 78% of the LGB respondents living in high-prejudice communities were still alive.
The authors also found that suicide, homicide/violence, and cardiovascular diseases were all substantially elevated among sexual minorities in high-prejudice communities. LGB respondents living in high-prejudice communities died of suicide on average at age 37.5, compared to age 55.7 for those living in low-prejudice communities, a striking 18-year difference. Homicide and violence-related deaths are one of the most direct links between hostile community attitudes and death, and results indicated that homicide rates were over three times more likely to occur in high-prejudice communities than in low-prejudice communities.
Of the deaths in high-prejudice communities, 25% were due to cardiovascular disease, compared to 18.6% of deaths in the low-prejudice communities. "Psychosocial stressors are strongly linked to cardiovascular risk, and this kind of stress may represent an indirect pathway through which prejudice contributes to mortality. Discrimination, prejudice, and social marginalization create several unique demands on stigmatized individuals that are stress-inducing," said Dr. Hatzenbuehler.