Brain Health Outcomes in Sexual and Gender Minority Groups
Shufan Huo1, Cyprien Rivier1, Santiago Clocchiatti-Tuozzo2, Daniela Renedo1, N. Abimbola Sunmonu3, Adam De Havenon1, Kevin Sheth4, Guido Falcone5
1Yale University, 2Yale University, Department of Neurology, 3Yale Neurology, 4Yale UniversityDivision of Neuro and Critical Care, 5Yale School of Medicine
Objective:

We evaluated whether sexual and gender minority (SGM) persons are at higher risk of adverse brain health outcomes compared to cisgender heterosexual (non-SGM) individuals.

Background:

Mounting evidence shows that SGM groups experience health disparities, but research on brain health status of this underrepresented group is very limited.

Design/Methods:

We conducted a cross-sectional study in the All of Us Research Program, a population study focused on health disparities enrolling 1 million Americans. We used baseline questionnaires to identify participants from sexual minorities (non-straight e.g., gay, lesbian, bisexual) and gender minorities (gender identity different from sex assigned at birth). We further divided gender minorities into gender diverse (e.g., non-binary) and transgender. The primary outcome was a composite of stroke, dementia, and late-life depression. Secondarily, we evaluated SGM subgroups and diseases separately. We used multivariable logistic regression (adjusted to age, ethnicity, cardiovascular risk factors, social status) to assess the relationship between SGM groups and brain health outcomes.

Results:

We included 393,041 participants (mean age 51, female sex at birth 62%), of whom 39,632 (10%) belonged to SGM groups. Of these, 4,431 (1%) belonged to a gender minority (2,212 [50%] gender diverse, 2,219 [50%] transgender) and 38,528 (10%) to a sexual minority. Compared to non-SGM, SGM individuals had 19% higher odds of the brain health composite outcome (OR 1.19, 95%CI 1.13-1.25). These results persisted across all SGM subgroups (p<0.05). Assessing individual diseases, all SGM groups had higher odds of late-life depression (SGM vs. non-SGM: 1.26, 1.17-1.34), all SGM except transgender persons had higher odds of dementia (SGM vs. non-SGM: 1.27, 1.15-1.39), and gender minority groups had higher odds of stroke (1.32, 1.03-1.61).

Conclusions:

In a large US population study, SGM individuals had higher odds of adverse brain health outcomes. Further research should explore structural causes of inequity to advance inclusive and diverse neurological care.

10.1212/WNL.0000000000205825