From the Department of Neurology (S.H., C.A.R., S.C.-T., D.R., N.A.S., A.d.H., K.N.S., G.J.F.), Yale Center for Brain and Mind Health (S.H., C.A.R., S.C.-T., D.R., A.d.H., K.N.S., G.J.F.), Department of Internal Medicine (S.C.-T.), Department of Neurosurgery (D.R.), and Office of Health Equity Research (D.F.S.), Yale University School of Medicine, New Haven, CT; and Weill Institute for Neurosciences (N.R.), Department of Neurology, University of California San Francisco.
Neurology. 2024 Oct 22;103(8):e209863. doi: 10.1212/WNL.0000000000209863. Epub 2024 Sep 25.
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.
性少数群体（SGM）和跨性别群体在神经科学研究中历来代表性不足，其大脑健康的差异也不为人知。我们旨在评估 SGM 人群与顺性别异性恋者（非 SGM）相比，是否有更高的不良大脑健康结果风险。
我们在全美人种研究计划（All of Us Research Program）中进行了一项横断面研究，该研究是一项基于美国人口的研究，包括所有有性别认同和性取向信息的参与者。我们使用基线问卷确定性少数群体（女同性恋、男同性恋、双性恋、多样化的性取向；非异性恋性取向）和性别少数群体（性别多样化和跨性别；性别认同与出生时分配的性别不同）参与者。主要结局是使用电子健康记录数据和自我报告评估的中风、痴呆和晚年抑郁的综合结果。其次，我们分别评估了每种疾病。此外，我们还评估了按出生时分配的性别分层的所有性别和性少数群体亚组。我们使用多变量逻辑回归（调整年龄、出生时分配的性别、种族/民族、心血管危险因素、其他相关合并症和邻里剥夺指数）来评估 SGM 群体与结局之间的关系。
在 2017 年 5 月 31 日至 2022 年 6 月 30 日期间招募的 413457 名美国成年人中，我们纳入了 393041 名有性取向和性别认同信息的参与者（平均年龄 51 [17] 岁），其中 39632 名（10%）属于 SGM 群体。其中，38528 名（97%）属于性少数群体，4431 名（11%）属于性别少数群体。与非 SGM 相比，SGM 人群出现大脑健康综合结局的几率高 15%（比值比 [OR] 1.15，95%CI 1.08-1.22）。在二级分析中，这些结果在单独的性少数群体和性别少数群体中均保持一致（所有 95%CI>1）。评估个别疾病时，所有 SGM 群体患痴呆症（SGM 与非 SGM：OR 1.14，95%CI 1.00-1.29）和晚年抑郁症（SGM 与非 SGM：OR 1.27，95%CI 1.17-1.38）的几率更高，跨性别女性患中风的几率更高（OR 1.68，95%CI 1.04-2.70）。
在一项大型美国人群研究中，SGM 人群出现不良大脑健康结局的几率更高。进一步的研究应探索造成不平等的结构性原因，以推进包容和多样化的神经科护理。
