American scientists have suggested that people identifying as a sexual or gender minority (LGBTQ+) have a higher likelihood of adverse brain health outcomes, according to cross-sectional data.
Among nearly 400 000 participants in the All of Us research programme, sexual and gender minority persons had higher odds of a composite outcome of stroke, dementia, and late-life depression than others (OR 1.15, 95% CI 1.08-1.22), reported Dr Guido Falcone of Yale School of Medicine and co-authors in Neurology.
They wrote that as a group, sexual and gender minority persons had significantly higher odds of late-life depression (OR 1.27, 95% CI 1.17-1.38).
The group trended toward higher odds of dementia (OR 1.14, 95% CI 1.00-1.29), which was significantly elevated among gender-diverse participants (assigned female at birth OR 1.94 95% CI 1.06-3.56; assigned male at birth OR 2.57, 95% CI 1.25-5.30).
Stroke risk was not higher for the overall group, but it was for transgender women (OR 1.68, 95% CI 1.04-2.70).
This study highlights brain health disparities in sexual and gender minority populations, a group that has been historically under-represented in neurological research, co-author Dr Shufan Huo, PhD, also of Yale, told MedPage Today.
“Understanding the unique risks that sexual and gender minority individuals face can help shape more inclusive care and interventions, ultimately improving outcomes for these communities.”
Huo added that it was concerning how little is known about the health disparities faced by LGBTQ+ people.
Few studies have extensively examined neurologic health in these communities.
“These findings indicating higher odds of dementia among sexual and gender minorities make a significant public health concern,” said Jason Flatt, PhD, MPH, of the University of Nevada, Las Vegas, who wasn’t involved with the research.
‘Many under-represented sexual and gender minority groups face adverse social determinants of health, like economic insecurity, discrimination, lower likelihood of having a caregiver, and reduced access to dementia care, including diagnosis and treatment,” he said.
Falcone and co-authors culled data from the NIH’s All of Us research programme, a US population-based study. Baseline questionnaires identified sexual minority (lesbian, gay, bisexual, or diverse sexual orientation) and gender minority (gender-diverse or transgender) participants.
Data were collected from 2017 to 2022.
The primary outcome was a composite of stroke, dementia, and late-life depression – whichever occurred first – from electronic health record data and self-reports. Late-life depression was defined as a depressive episode first diagnosed at or after 60.
“The bidirectional relationship between late-life depression and dementia, along with the well-described occurrences of post-stroke depression and post-stroke dementia, further complicates distinguishing between these conditions,” the researchers wrote.
Overall, 393,041 people were included in the analysis. Of those, 39 632 people (10%) were categorised as sexual and gender minority participants.
Mean age was 51, and about 62% of participants were assigned female sex at birth. The prevalence of cardiovascular risk factors was lower in the sexual and gender minority group, but the prevalence of smoking, substance use disorder, and HIV infection was higher.
The prevalence of the composite brain health outcome was 5.4% throughout the study, including 11 553 cases of late-life depression, 6 605 cases of stroke, and 2 933 cases of dementia.
The study had several limitations, the researchers acknowledged. It was cross-sectional and subject to unmeasured confounders. It did not assess variables like gender-affirming hormone therapy in transgender persons, which may have influenced some outcomes.
“We have no evidence that being a sexual or gender minority directly causes worse brain health,” Huo said. “Based on what is known, there is no reason to believe that this is the case.
“However, research has shown the effect of external factors like stigma, discrimination, and lack of access to adequate healthcare on many health issues. These systemic challenges increase stress and other risk factors that can affect brain health outcomes, for example, through neuro-inflammation, rather than the individual’s gender or sexuality being a direct cause.”
Study details
Brain Health Outcomes in Sexual and Gender Minority Groups: Results From the All of Us Research Programme
Shufan Huo, Cyprien Rivier, Santiago Clocchiatti-Tuozzo et al.
Published in Neurology on 25 September 2024
Abstract
Background and Objectives
Sexual and gender minority (SGM) groups have been historically underrepresented in neurologic research, and their brain health disparities are unknown. We aim to evaluate whether SGM persons are at higher risk of adverse brain health outcomes compared with cisgender straight (non-SGM) individuals.
Methods
We conducted a cross-sectional study in the All of Us Research Programme, a US population-based study, including all participants with information on gender identity and sexual orientation. We used baseline questionnaires to identify sexual minority (lesbian, gay, bisexual, diverse sexual orientation; non-straight sexual orientation) and gender minority (gender diverse and transgender; gender identity different from sex assigned at birth) participants. The primary outcome was a composite of stroke, dementia, and late-life depression, assessed using electronic health record data and self-report. Secondarily, we evaluated each disease separately. Furthermore, we evaluated all subgroups of gender and sexual minorities stratified by sex assigned at birth. We used multivariable logistic regression (adjusted for age, sex assigned at birth, race/ethnicity, cardiovascular risk factors, other relevant comorbidities, and neighbourhood deprivation index) to assess the relationship between SGM groups and the outcomes.
Results
Of 413,457 US adults enrolled between May 31, 2017, and June 30, 2022, we included 393,041 participants with available information on sexual orientation and gender identity (mean age 51 [SD 17] years), of whom 39,632 (10%) belonged to SGM groups. Of them, 38,528 (97%) belonged to a sexual minority and 4,431 (11%) to a gender minority. Compared with non-SGM, SGM persons had 15% higher odds of the brain health composite outcome (odds ratio [OR] 1.15, 95% CI 1.08–1.22). In secondary analyses, these results persisted across sexual and gender minorities separately (all 95% CIs > 1). Assessing individual diseases, all SGM groups had higher odds of dementia (SGM vs non-SGM: OR 1.14, 95% CI 1.00–1.29) and late-life depression (SGM vs non-SGM: OR 1.27, 95% CI 1.17–1.38) and transgender women had higher odds of stroke (OR 1.68, 95% CI 1.04–2.70).
Discussion
In a large US population study, SGM persons had higher odds of adverse brain health outcomes. Further research should explore structural causes of inequity to advance inclusive and diverse neurologic care.
NHI All of Us progamme (Open access)
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