A recent study published in the journal Neurology reveals that LGBTQ+ adults may face a significantly higher risk of negative brain health outcomes compared to their straight cisgender counterparts. Analyzing data from over 393,000 participants, the research found that individuals within the LGBTQ+ community have a 15% increased risk of experiencing a range of serious brain health issues, including dementia, stroke, and late-life depression, which is characterized as a depressive episode diagnosed after the age of 60.
Dr. Shufan Huo, the study's lead author and a postdoctoral research fellow at Yale University School of Medicine, expressed concern over these findings, highlighting the need to focus on the unique health challenges faced by sexual and gender minorities (SGM). Dr. Huo noted, “It is concerning to see the differences in brain health between sexual gender minority individuals and cisgender straight people. At the same time, I am glad that we can raise awareness for this often overlooked group.”
The study emphasizes a shift in medical research, which has historically centered on white male patients, often neglecting the diverse needs of the broader population. Prior investigations into the health of LGBTQ+ individuals have been limited by small sample sizes and a narrow focus on specific health issues, such as HIV and substance use, rather than encompassing a wider range of health outcomes. This study aims to shed light on the pressing need for comprehensive research that addresses the overall health and well-being of sexual and gender minorities.
The recent study marks a significant advancement in research regarding LGBTQ+ health, as it is the first to gather comprehensive data on both sexual orientation and gender identity. Dr. Riccardo Manca, a research fellow in life sciences at Brunel University London, emphasized the study’s importance, noting that the diverse sample enhances its representation of the LGBTQ+ population.
The findings are expected to inform future research focusing on the heightened risks faced by various LGBTQ+ subgroups, which can help identify specific challenges they encounter. To bridge existing knowledge gaps, the authors examined participants from the All of Us Research Program, which ran from May 2017 to June 2022. Participants reported their identities, indicating whether they identified as a sexual minority—such as lesbian, gay, bisexual, or other non-straight orientations—or as a gender minority, which includes individuals who are gender diverse, transgender, or possess a gender identity differing from their assigned sex at birth.
The study specifically targeted three prominent brain health outcomes: dementia, stroke, and late-life depression. These conditions are particularly relevant as they affect various neurological, psychiatric, and cognitive functions and share overlapping risk factors. Among the 393,041 participants, who had an average age of 51, approximately 10% identified as part of sexual or gender minority groups. Notably, 97% identified as a sexual minority, while 11% identified as a gender minority, highlighting the intersections within these identities.
Dr. Shufan Huo highlighted significant differences among LGBTQ+ subgroups in a recent study, noting that individuals assigned male at birth (AMAB) exhibited higher rates of late-life depression compared to their cisgender counterparts. Conversely, sexual minority individuals assigned female at birth (AFAB) and those identifying as gender diverse showed increased rates of dementia. Additionally, transgender women were found to have a higher incidence of stroke. Huo pointed out that these disparities may stem from varying levels of societal stigma faced by each group.
Dr. Amir Ahuja, director of psychiatry at the Los Angeles LGBT Center, underscored the value of utilizing a large database to identify population-level disparities, while also cautioning that correlation does not imply causation. He emphasized the importance of focusing on these issues, particularly for transgender women, to encourage preventive care and address potential risk factors.
However, the study does have its limitations. Huo noted the absence of data regarding crucial factors such as gender-affirming hormone therapy, acknowledging that not all transgender individuals pursue this treatment. Additionally, Manca pointed out that the average age of participants was relatively young compared to the typical age at which dementia risk begins to rise, usually around 65. This highlights the need for further research to fully understand the complexities of brain health within these diverse populations.
Dr. Riccardo Manca pointed out that a recent epidemiological study from the UK found that the risk of dementia among non-heterosexual individuals was notably higher in those under 55. This suggests that cognitive decline within the LGBTQ+ community, particularly among certain subgroups, may occur earlier than what is typically observed in heterosexual populations. However, the underlying reasons for this phenomenon are not yet understood.
Experts emphasize that being part of a sexual or gender minority does not inherently lead to poorer brain health. Instead, the elevated risks are likely the result of a complex interplay of psychosocial and biological factors. Chronic stress, discrimination, and societal stigma can contribute to mental health challenges such as anxiety and depression, which in turn can negatively affect brain health. Although the study attempted to account for some aspects of substance use and economic inequality, it acknowledged that not all factors could be controlled.
Many individuals within the LGBTQ+ community face economic hardships and housing instability, which further exacerbate health outcomes, according to Dr. Amir Ahuja. Structural barriers to accessing quality healthcare are also a significant issue. Ahuja highlighted that numerous studies, including the US Trans Survey, reveal that sexual and gender minority populations are often not taken seriously by healthcare providers, and discrimination remains prevalent. This leads to a cycle where patients may avoid follow-up care, necessary tests may go unperformed, and health issues may remain unaddressed, ultimately resulting in worse health outcomes.
