A new study suggests that LGBTQ+ individuals may face a higher risk of adverse brain health outcomes. LGBTQ+ people are 14% more likely to develop dementia and 27% more likely to experience late-life depression. Transgender women face a 68% higher risk of stroke compared to cisgender people. The study highlights the need for research into LGBTQ+ health disparities.
Studies show that gender and sexual orientation minority groups (known as SGMs), which include LGBTQ+ people, often face disadvantages when it comes to neurological health and overall well-being, and have historically been underrepresented in brain health research.
Previous studies on the health of these groups, of which there are few, have often had small sample sizes, lacked more specific categories of sexuality or gender identity, and overemphasized topics such as HIV, hormone use, substance use disorder, and mental health.
To understand whether LGBTQ+ people are at increased risk for specific neurological conditions, such as stroke, dementia, and depression in later life, researchers at the University of California, Berkeley, conducted an in-depth analysis as part of the All of Us Research Program between May 2017 and June 2022.
The program is a large U.S. health study that collects data from hundreds of thousands of participants, including information on gender identity and sexual orientation. The results were published in the journal Neurology.
In this study, scientists identified participants as sexual minorities (lesbian, gay, bisexual, and other non-heterosexual sexual orientations) and gender minorities (people whose gender identity differs from their sex assigned at birth, including transgender and non-binary people).
They assessed the prevalence of three major neurological conditions: stroke, dementia, and depression in later life using questionnaires and medical records. Each condition was analyzed individually and as a combined “adverse brain health” outcome.
The analysis included 393,000 adults with an average age of 51, of whom 39,632 people (or 10%) identified as belonging to an SGM group. Of these, 97% identified as sexual minorities, while 11% were gender minorities.
When comparing these groups to cisgender and heterosexual participants, they found that LGBTQ+ individuals were 15% more likely to develop adverse brain health conditions.
A total of 21,091 people had a neurological condition. Of these, 11,553 people had late-life depression, 6,605 people had strokes, and 2,933 people had dementia.
After adjusting for factors that could affect the risk of these three neurological conditions, such as age, smoking, or high blood pressure, the researchers found that LGBTQ+ people were 15% more likely to develop negative brain health outcomes from these conditions when compared to people who identified as cisgender and heterosexual.
The researchers also found that LGBTQ+ people had a higher risk of dementia and depression in later life, 14% and 27% respectively, than people who were cisgender and heterosexual.
When analyzing the data for stroke risk, the researchers found an increased risk only for transgender women, who were 68% more likely to have a stroke than cisgender people.
A limitation of the study was that it did not examine the causes and mechanisms behind the inequalities faced by LGBTQ+ people. For example, the study did not look at gender-affirming hormone therapy in transgender people, which could play a role in increasing stroke risk in transgender women.
This study confirms that LGBTQ+ people are more likely to experience neurological and mental health problems as they age, highlighting the importance of including these groups in future research to identify specific causes, including structural and social factors, that may contribute to these disparities.
This study “is important because it is the first of its kind to collect detailed information on sexual orientation and gender identity,” said Dr. Riccardo Manca, a researcher in the Department of Biological Sciences at Brunel University London, who was involved in the study.
The findings can help inform future studies that investigate the increased risk of negative outcomes in LGBTQ+ subgroups to understand the unique challenges they face. It also underscores the need to develop neurological and mental health care that is inclusive and tailored to the needs of the LGBTQ+ community, promoting more equitable support that is sensitive to the specificities of each group.
READ MORE:
Brain Health Outcomes in Sexual and Gender Minority Groups: Results From the All of Us Research Program
Huo S, et al.
Neurology. October 22, 2024.
Abstract:
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. We conducted a cross-sectional study in the All of Us Research Program, 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; nonstraight 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 neighborhood deprivation index) to assess the relationship between SGM groups and the outcomes. 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). 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.
Comments