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Huo S, Rivier CA, Clocchiatti-Tuozzo S, Renedo D, Sunmonu NA, de Havenon A, Sarpong DF, Rosendale N, Sheth KN, Falcone GJ. Brain Health Outcomes in Sexual and Gender Minority Groups: Results From the All of Us Research Program. Neurology 2024; 103:e209863. [PMID: 39321407 DOI: 10.1212/wnl.0000000000209863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2024] Open
Abstract
BACKGROUND AND OBJECTIVES 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. METHODS 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. RESULTS 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). DISCUSSION 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.
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Affiliation(s)
- Shufan Huo
- 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
| | - Cyprien A Rivier
- 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
| | - Santiago Clocchiatti-Tuozzo
- 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
| | - Daniela Renedo
- 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
| | - N Abimbola Sunmonu
- 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
| | - Adam de Havenon
- 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
| | - Daniel F Sarpong
- 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
| | - Nicole Rosendale
- 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
| | - Kevin N Sheth
- 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
| | - Guido J Falcone
- 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
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Jansen KL, Fried AL, Goetz C, Kang S. Mistrust and missed opportunities: BDSM practitioner experiences in healthcare. J Sex Med 2024:qdae125. [PMID: 39323076 DOI: 10.1093/jsxmed/qdae125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 07/16/2024] [Accepted: 09/04/2024] [Indexed: 09/27/2024]
Abstract
BACKGROUND Stigma and discrimination have been shown to be significant barriers to healthcare utilization and provider trust among sexual minority groups including BDSM and kink communities. AIM This exploratory study sought to better understand medical mistrust and experiences of discrimination in primary care settings and how these factors predict hiding kink-related injuries from healthcare providers. METHODS A total of 301 individuals who self-identified as being a member of the BDSM community and engaged in BDSM-play activities completed an online survey. OUTCOMES Participants completed measures including experiences with BDSM-play-related injuries, disclosure of BDSM activity to healthcare providers, measures addressing mistrust in in healthcare providers (such as avoidance of questions about sexual health or STI testing), and experiences with discrimination in healthcare settings because of BDSM group membership (such as perceptions of being insulted or receiving poor care). RESULTS Nearly, 40% of participants indicated at least one experience with discrimination in the healthcare system because they identified as a member of the kink community. Over 20% of participants indicated there were BDSM-related concerns they would have liked to discuss with their primary care provider but did not. Participants who hid injuries from their primary care provider had higher levels of medical mistrust and more experiences with medical discrimination than those who disclosed their injuries. A stepwise logistic regression determined that medical mistrust served as a significant predictor of hiding injuries from healthcare providers. CLINICAL IMPLICATIONS Patients who are members of the BDSM community are likely to have had negative healthcare experiences, and these experiences impact their communication with and trust in future medical encounters. STRENGTHS AND LIMITATIONS Strengths of the study include addressing diverse components of stigma in healthcare including both experiences with discrimination as well as perceptions of the medical field. Furthermore, potential direct consequences of past negative experiences such as hiding injuries from healthcare providers were examined. Given the likely impact of race, gender, and BDSM group membership on experiences with discrimination, a limitation includes the limited representations of BDSM participants from minoritized racial and ethnic groups. Furthermore, in addressing injuries, the survey did not differentiate intended or expected injuries obtained in BDSM play from unintentional or unwanted injuries. CONCLUSION Mistrust in the medical system impacts members of the BDSM community's willingness to disclose injuries to their healthcare provider.
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Affiliation(s)
- Kate L Jansen
- Department of Clinical Psychology, Midwestern University, Glendale, AZ 85308, United States
| | - Adam L Fried
- Department of Clinical Psychology, Midwestern University, Glendale, AZ 85308, United States
| | - Christianna Goetz
- Department of Clinical Psychology, Midwestern University, Glendale, AZ 85308, United States
| | - Saleenjit Kang
- Department of Clinical Psychology, Midwestern University, Glendale, AZ 85308, United States
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Thakarar K, Appa A, Abdul Mutakabbir JC, Goff A, Brown J, Tuell C, Fairfield K, Wurcel A. Frame Shift: Focusing on Harm Reduction and Shared Decision Making for People Who Use Drugs Hospitalized With Infections. Clin Infect Dis 2024; 78:e12-e26. [PMID: 38018174 PMCID: PMC11487100 DOI: 10.1093/cid/ciad664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Indexed: 11/30/2023] Open
Affiliation(s)
- Kinna Thakarar
- Tufts University School of Medicine, Boston, Massachusetts, USA
- Center for Interdisciplinary Population & Health Research, MaineHealth Institute for Research, Portland, Maine, USA
- Department of Medicine, Maine Medical Center, Portland, Maine, USA
| | - Ayesha Appa
- Division of HIV, Infectious Diseases, and Global Medicine at San Francisco General Hospital, University of California–San Francisco, San Francisco, California, USA
| | - Jacinda C Abdul Mutakabbir
- Division of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California–San Diego, La Jolla, California, USA
- Division of the Black Diaspora and African American Studies, University of California–San Diego, La Jolla, California, USA
| | - Amelia Goff
- Section of Addiction Medicine, Department of Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Jessica Brown
- Department of Care Management, Oregon Health and Science University, Portland, Oregon, USA
| | | | - Kathleen Fairfield
- Tufts University School of Medicine, Boston, Massachusetts, USA
- Center for Interdisciplinary Population & Health Research, MaineHealth Institute for Research, Portland, Maine, USA
- Department of Medicine, Maine Medical Center, Portland, Maine, USA
| | - Alysse Wurcel
- Tufts University School of Medicine, Boston, Massachusetts, USA
- Department of Medicine, Division of Geographic Medicine and Infectious Diseases, Tufts Medicine, Boston, Massachusetts, USA
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