LGBTQ+ individuals might encounter heightened risk of subpar brain health, potentially as a consequence of 'minority stress'.
A significant analysis involving over 393,000 grown-up individuals, published on Wednesday in "the journal Neurology", revealed a 15% boosted risk of an integrated brain health result – which includes dementia, stroke and late-life depression – identified as a depressive episode initial diagnosed at or after age 60.
"It's concerning to observe the discrepancies in brain health between sexual orientation and gender minority (SGM) individuals and cisgender straight people," commented lead study author Dr. Shufan Huo, a postdoctoral research fellow in the department of neurology at the Yale University School of Medicine, via email. "At the same time, I'm glad we can draw focus to this frequently disregarded group. Traditionally, medicine has centered around white, male patients, yet now we understand that this approach doesn't sufficiently address the needs of our broad population."
Preceding investigations on the wellbeing of these groups, with limited quantities, usually feature small sample sizes, lack more specific classes of sexuality or gender identity, and disproportionately prioritize themes such as HIV, hormone use, substance use disorder, and mental health, the analysts indicated.
The latest research "is pivotal because it's the first of its kind to gather detailed information on sexual orientation and gender identity," agreed Dr. Riccardo Manca, a research fellow in the department of life sciences at Brunel University London, who wasn’t engaged in the study. "Such a wide extent of diversity in the sample renders it more representative of the LGBTQ+ population."
The results might encourage future explorations focusing on heightened risks of negative consequences in LGBTQ+ subgroups to comprehend the particular challenges for each, Huo suggested.
Investigating brain health among assorted populaces
To bridge the knowledge loss, the experts analyzed individuals enrolled in the United States-based All of Us Research Program between May 2017 and June 2022. Participants disclosed whether they identified as a sexual minority — lesbian, gay, bisexual, diverse sexual orientation or non-straight sexual orientation — and/or as a gender minority, defined as gender diverse, transgender or a gender identity varied from the sex designated at birth.
The experts incorporated only dementia, stroke and late-life depression in their list of brain health results given that these are some of the most preeminent conditions affecting neurological, psychiatric and cognitive aspects of the brain. The ailments are also interrelated and share common risk factors.
From the 393,041 adults with an average age of 51, approximately 10% belonged to sexual or gender minority teams. Of that subset, 97% self-identified as a sexual minority and 11% as a gender minority, although these two groups were not mutually exclusive.
"Distinctive findings were the differences between the subgroups," Huo mentioned. "People designated male at birth (AMAB) had higher rates of late-life depression (in contrast to the cisgender population), while sexual minority people designated female at birth (AFAB) and gender diverse people had higher rates of dementia.
"Transgender women had higher rates of stroke," Huo explained. "These findings show that every group has special risk profiles, such as due to differences in societal stigma."
Comprehending disparities within the LGBTQ+ community
The research's utilization of a comprehensive database to determine population-level correlations is beneficial for highlighting specific disparities, agreed Dr. Amir Ahuja, director of psychiatry at the Los Angeles LGBT Center, who wasn't engaged in the study.
However, "correlation does not mean causation, and we do not know why these disparities exist," he added via email. "What this does do is enable us to focus on this issue in particular, and message to transgender women in order to boost preventive care and reduce their risk factors prematurely."
One "major limitation" is the absence of data on essential factors such as gender-affirming hormone therapy, Huo stated, although not every transgender person opts for this form of treatment.
The average age of the participants was also "very young" in comparison with the age beyond which dementia risk usually intensifies, which is 65, Manca indicated.
"Intriguingly, a recent epidemiological study from the UK demonstrated that dementia risk among non-heterosexual people was higher only in individuals more youthful than 55 years of age," Manca added. "This implies that decline in brain functions in the LGBTQ+ community, or at least in certain sub-groups within it, may happen sooner than predicted in the heterosexual population. However, the underlying causes behind this impact remain unclear."
There's no data suggesting that being a sexual or gender minority alone leads to worse brain health. The increased risks likely stem from a mix of psychosocial and biological factors, Huo declared – chronic stress, discrimination, and stigma can result in mental health conditions such as depression and anxiety, which in turn can worsen brain health.
Inequalities in health care access
The analysts did try to control for some substance use and economic disparity but couldn't account for all of it. Numerous individuals who self-identify as a sexual or gender minority are low-income and disproportionately houseless, which can result in worse health outcomes, Ahuja suggested.
Structural inequities in access to health care also likely contribute, experts stated.
"We cannot disregard the factors of the healthcare system itself," Ahuja said. "Numerous studies, including the (US Trans Survey), frequently reveal that SGM populations are not always taken seriously by healthcare providers, and outright discrimination is prevalent. This results in patients not adhering to recommendations and evaluations not being performed, and issues not being addressed, which can also cause worse outcomes."
Actively fostering beneficial routines might shield your cognitive wellbeing, professionals suggest. These practices involve keeping physically active, abandoning smoking, collaborating with educated healthcare professionals, and controlling stress and heart health challenges. Additionally, fostering uplifting and significant relationships is crucial, and this is significantly important for LGBTQ+ individuals who frequently depend on their chosen family for support, as Manca pointed out.
Nevertheless, specialists stated, tackling broader challenges like inclusive health care and decreasing discrimination is vital for enduring advancements in health outcomes and preventing individuals from having to face these challenges alone.
In light of the discussed research, promoting wellness and prioritizing health is essential for the LGBTQ+ community, given the increased risks associated with mental health conditions and brain health issues. Addressing structural inequities in healthcare access and fostering inclusivity can significantly contribute to improving health outcomes for this frequently disregarded group.
