Sexual and gender minority (SGM) individuals face marked disparities in substance use. The present narrative review explores research on substance use in SGM communities using a minority stress theory lens. We define the SGM population and minority stress, and explore stresses and substance use disparities in adolescence, adulthood, and older age. Though research on this topic is beginning to highlight the relationship between stress and substance use for SGM individuals, more work is needed on older SGM populations and in translating research findings to effective interventions.

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times more inpatient admissions (22 029 [18.3%] vs 17 011 [9.3%]; P < .001), 5.2 times more home health services (7989 [6.7%] vs 2446 [1.3%]; P < .001), and 1.7 times more therapy needs (57 279 [47.7%] vs 50 329 [27.6%]; P < .001) (Table). The 39.7% of children with high-intensity neurological impairment accounted for 61.3% ($2 946 765 384) of total health care costs and had 2.4 times the per-member-per-year spending ($24 532 vs $10 205) of those with lower-severity neurological impairment (Table). Discussion | Distinguishing children with high-intensity neurological impairment from those with lower-intensity neurological impairment is important, as evidenced by their greater multimorbidity, polypharmacy, and health care use and spending. Although inherent limitations exist when using diagnostic codes, the results of this study suggest that high-intensity neurological impairment codes may allow health care systems and payers such as Medicaid to efficiently identify these medically complex children with unique, higher-intensity needs. We believe the use of high-intensity neurological impairment codes could enable the prioritization of comparative effectiveness, health outcomes, and pharmaceutical research in this vulnerable population.

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