Sexual and gender minority (SGM) individuals are at risk for several neurologic deficiencies, including autism spectrum disorder and ischemic stroke, but further research is needed, according to a review published in JAMA Neurology.
The data on neurologic health needs of SGM individuals, including those who are lesbian, gay, bisexual, transgender, and identify on the queer spectrum, are scarce. The objective of the current scoping review was to present the available data on SGM health in neurology and to identify areas of knowledge gaps.
Following a systematic search for articles published in PubMed, Embase, Web of Science, PsycINFO, CINAHL, and BIOSIS Previews, a total of 348 studies were eligible for the review, including 205 (58.9%) case reports or series.
Most studies focused on gay or bisexual cisgender men (252 articles, 72.4%), or HIV (247 articles, 71.0%). Neuroinfectious disease was the most common subject studied (200 articles, 57.5%), followed by cognitive neurology (60 articles, 17.2%), cerebrovascular disease (16 articles, 4.6%), and autism (16 articles, 4.6%). Literature on neuroinfectious disease in SGM individuals mainly focused on HIV (173 articles; 86.5%).
Of the 16 studies aimed at investigating the potential association between gender dysphoria and autism spectrum disorder, 9 studies (56.3%) reported a positive correlation.
Several studies suggested an increased risk for ischemic stroke among transgender women, but there was no evidence for this increased risk in transgender men and gender nonconforming individuals, compared with cisgender individuals. In addition, very short sleep duration was associated with an increased risk for reporting stroke among SGM individuals (adjusted odds ratio, 4.1; 95% CI, 2.2-7.6).
Studies that investigated sleep in SGM individuals reported conflicting results. Additionally, literature on headache in SGM individuals was sparse. Conclusions on other neurologic topics, including multiple sclerosis, epilepsy, or movement or neuromuscular disorders, were limited by lack of data.
A major limitation of the studied neurologic literature was the lack of data on sociodemographic factors that affect health, including race, ethnicity, socioeconomic status, and immigration or refugee status, restricting the generalizability of results to the SGM community.
“Expanding neurologic research to include broader representation of SGM identities and incorporate sociodemographic factors, like race/ethnicity and socioeconomic status, is essential. Collection of sexual orientation and gender identity in electronic health records, patient registries, and all population health surveys would be a significant step toward advancing equitable neurologic care for this underserved community,” concluded the study researchers.
Rosendale N, Wong JO, Flatt JD, Whitaker E. Sexual and gender minority health in neurology: A Scoping Review. JAMA Neurol. Published online February 22, 2021. doi:10.1001/jamaneurol.2020.5536