Background Older lesbian, gay and bisexual (LGB) people were born at a time same sex activity between men was a criminal offence, and where social and legislative conditions permitted discrimination against sexual minorities across a spectrum of domains. Minority Stress Theory posits that LGBT people are at an elevated risk for poorer health because of their exposure to social stress related to prejudice and stigma. Modelling the health and care trajectories of lesbian, gay and bisexual (LGB) is essential to identify inequalities and support needs, yet because of the small sample of LGB people in any one survey, current evidence relies on studies that have poor generalisability and low power. This study assesses the magnitude of health and care inequalities among older LGB people across ten outcomes, informed by evidence on the health trajectories and distinct history of LGB people in the UK.

Methods A systematic review was conducted of representative data sources on older LGB and heterosexual people’s health and care status in the UK. Individual Participant Data (IPD) meta-analysis was employed to synthesise data. To account for the intricacies of individual datasets, the analysis employed a two-stage approach where an odds ratio (OR) and standard error was calculated for each dataset individually, before being meta-analysed through DerSimonian and Laird random effects models.

Results Our largest model incorporated data from 25 different datasets and provided an unparalleled sample size (over 2,500 LGB men and women) to measure the magnitude of sexuality-based health inequalities in later life. We find that among men aged 50 and over, being gay, bisexual or having another non-heterosexual orientation is associated with an increased risk of reporting a long-term illness and limitations due to health or illness. Indicators of mental health also suggest that gay and bisexual men are more likely to report low life satisfaction and substantially more likely to have attempted suicide over their life time (Adjusted Odds Ratio: 2.29; 95% Confidence Interval: 1.19–4.42). We find that among women, differences in health are apparent with regards to self-rated health as well as with engagement with risky health behaviours with higher levels of smoking and frequent alcohol consumption.

Conclusion The findings corroborate the minority stress theory, but they also generate new questions for researchers around when and why these inequalities emerge.