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Review
February 22, 2021

Sexual and Gender Minority Health in Neurology: A Scoping Review

Author Affiliations
  • 1Department of Neurology, University of California, San Francisco Medical Center, San Francisco
  • 2Weill Institute for Neurosciences, University of California, San Francisco
  • 3University of Colorado School of Medicine, Aurora
  • 4School of Public Health, University of Nevada, Las Vegas
  • 5Health Science Library, University of California, San Francisco
JAMA Neurol. 2021;78(6):747-754. doi:10.1001/jamaneurol.2020.5536
Key Points

Question  What is the current state of science in sexual and gender minority (SGM) health in neurology?

Findings  In this systematic scoping review of 348 studies, most were case reports or series (205 [58.9%]) and focused on sexual minority cisgender men (252 [72.4%]) or HIV (247 [70.9%]). The limited research available suggests disparities in stroke, dementia care, and autism in SGM individuals, while broader conclusions in other neurologic topics were limited by lack of data.

Meaning  More rigorous research in a broader range of neurologic topics and inclusion of more groups within the larger SGM umbrella is needed to inform equitable neurologic care for the SGM community.

Abstract

Importance  Little is known about the neurologic health needs of sexual and gender minority (SGM) individuals, and existing research indicates health care disparities for this group.

Objective  To describe the current state of science in SGM neurology and highlight areas of knowledge and gaps to guide future research.

Evidence Review  All articles published before April 12, 2020, in PubMed, Embase, Web of Science, PsycInfo, CINAHL, and BIOSIS Previews were searched using a search string encompassing SGM descriptors and neurologic disorders. A total of 8359 items were found and entered into EndNote, and 2921 duplicates were removed. A blind title and abstract review was performed followed by full-text review in duplicate, with conflicts settled through consensus, to identify 348 articles eligible for data abstraction. Articles presenting primary data about an identified adult SGM population addressing a clinical neurology topic were included. Descriptive statistics were used for abstracted variables.

Findings  Of 348 studies, 205 (58.9%) were case reports or series, 252 (72.4%) included sexual minority cisgender men, and 247 (70.9%) focused on HIV. An association was found between autism spectrum disorder and gender dysphoria in 9 of 16 studies (56.3%), and a higher risk of ischemic stroke in transgender women was shown in other studies. Literature in neuroinfectious disease, the most common topic, largely focused on HIV (173 of 200 studies [86.5%]). Findings in other neurologic topics were limited by lack of data.

Conclusions and Relevance  In this rigorous compendium of SGM neurology literature, several deficiencies were found: most studies focused on a limited breadth of neurologic pathology, included only a portion of the overall SGM community, and did not assess other aspects of sociodemographic diversity that may contribute to disparities in health care access and outcomes among SGM individuals. Expanding neurologic research to include broader representation of SGM individuals and incorporating sociodemographic factors, like race/ethnicity and socioeconomic status, are essential steps toward providing equitable neurologic care for this community.

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