Incidences and Characteristics of Repetitive Traumatic Brain Injury Between Sexual and Gender Minority Patients and Non-SGM Controls
Dafna Erana Hernandez1, Jaaie Varshney1, Derby Gill1, David Castro1, Sara Cole2, John Yue1, H. E. Hinson3, Nicole Rosendale3, Michael Diaz3
1UCSF, 2Zuckerberg San Francisco General Hospital, 3UCSF/Zuckerberg San Francisco General Hospital Department of Neurology
Objective:
To examine incidences and characteristics of repetitive traumatic brain injury (TBI) in patients who self-identified as sexual and gender minority (SGM), compared with non-SGM.
Background:
Recent evidence suggests SGM individuals are at increased risk of adverse neurological health outcomes. The impact of TBI on the SGM population remains underexplored.
Design/Methods:
Retrospective chart review of adult patients presenting with TBI to a United States Level 1 trauma center between 2019-2024. SGM patients were selected through the sexual orientation and gender identity SmartForm in Epic, and non-SGM patients were matched by year of presentation. The primary outcome was incidence of repetitive TBI, defined as a subsequent presentation for head injury within 5-years of the index TBI. Secondary outcomes were sociodemographic factors, TBI severity, and clinical outcomes.
Results:
239 SGM and 271 non-SGM patients were identified. The incidence of repetitive TBI was higher in the SGM group vs. non-SGM (39% vs. 15%, p<0.0001). SGM patients were younger (median age 44 vs. 58-years, p<0.0001) and more likely to have history of psychiatric illness (68% vs. 29%, p<0.0001) and previous TBI (i.e., prior to the index TBI of inclusion, 31% vs. 20%, p=0.005). The majority of patients (n=348, 90%) had mild TBI (Glasgow Coma Scale score 13-15) and were discharged home (n=437, 86%). SGM patients differed in injury mechanisms, with fewer ground level falls (37% vs. 48%, p=0.009), more violence/assault (21% vs. 14%, p=0.048) and motorcycle/e-scooter accidents (8% vs. 3%, p=0.013).
Conclusions:
There was a considerably higher incidence of repetitive TBI within 5-years amongst SGM patients presenting with acute TBI compared with non-SGM. History of psychiatric illness, prior TBI, and TBI mechanisms of violence/assault and motorcycle/e-scooter accidents, were significantly higher in SGM patients. These findings underscore the distinct injury profile of SGM patients, and the critical need to identify specific risk factors to mitigate subsequent injury and improve outcome.
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