Bisexual males and females report poorer health than gays, lesbians and heterosexuals, according to a new study from sociologists at Rice University.

"A New Piece of the Puzzle: Sexual Orientation, Gender and Physical Health Status" will appear in an upcoming edition of Demography. The study examined the self-rated health of 10,128 sexual minorities (gay, lesbian and bisexual adults) and 405,145 heterosexual adults to see how it differed across sexual orientation.

"According to the Institute of Medicine, existing health research on the sexual minority population is sparse and typically does not make distinctions between the different types of sexual minorities," said Bridget Gorman, a professor of sociology at Rice and the study's lead author. "We developed this study both to examine the health of these different sexual minority groups and to assess how risk factors for poor health contribute to their overall health."

In addition to recording self-rated health information, the researchers analyzed the participants' lifestyle according to a number of factors that traditionally impact health, including socio-economic status (including education level, employment status, household income and access to health insurance), health behaviors (smoker or nonsmoker, drinking habits, body mass index and access to health care) and social support and well-being.

The study found that 19.5 percent of bisexual men and 18.5 percent of bisexual women rated their health as "poor or fair," the highest proportion among the groups surveyed. In contrast, only 11.9 percent of men identifying as gay and 10.6 percent of women identifying as lesbian rated their health as "poor or fair," the lowest proportion of those surveyed. Health was also rated poor by 14.5 percent of heterosexual men and 15.6 percent of heterosexual women.

Across the groups surveyed, the researchers also found that bisexual men and women are disproportionately disadvantaged on important social, economic and behavioral factors strongly associated with health and well-being. For example, bisexual men and women were the least likely of the three groups to be college-educated. (Only 26.5 percent of bisexual men and 32.1 percent of bisexual women were college graduates, compared with 55.7 percent of gay men and 57 percent of lesbian women and 37.9 percent of heterosexual men and 37.5 percent of heterosexual women).

Bisexual men and women were more likely to smoke (23.8 percent and 21.9 percent, respectively), compared with 14.9 percent of gay men, 16.6 percent of lesbian women, 11.1 percent of heterosexual men and 8.3 percent of heterosexual women.

Bisexual men and women were the most likely of the three groups to have an annual household income of less than $25,000; 39.5 percent of bisexual men and 42.1 percent of bisexual women fell into this category, compared with 22.9 percent of gay men, 25.4 percent of lesbian women, 24.8 percent of heterosexual men and 29.5 percent of heterosexual women.

"If bisexuals are minorities within the minority and experience unique and more extreme forms of discrimination, this might contribute to disparities in things like earnings, educational attainment, the propensity to smoke cigarettes and other factors that affect well-being," said Justin Denney, director of the Kinder Institute for Urban Research's Urban Health Program and an assistant professor of sociology at Rice.

Both Gorman and Denney said that the study has important implications for the study of the health of sexual minorities.

"Our study illustrates the importance of examining health status among specific sexual minority groups, and not among 'sexual minorities' in the aggregate, since the health profile of bisexual adults differs substantially from that of gay and lesbian adults," Gorman said.

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Hilary Dowdy, a graduate of Rice, and Rose Medeiros, a senior statistician at StataCorp, co-authored the study.