Prevalence of 12 Common Health Conditions in Sexual and Gender Minority Participants in the All of Us Research Program

Abstract

ImportanceLimited data describe the health status of sexual or gender minority (SGM) people due to inaccurate and inconsistent ascertainment of gender identity, sex assigned at birth, and sexual orientation.ObjectiveTo evaluate whether the prevalence of 12 health conditions is higher among SGM adults in the All of Us Research Program data compared with cisgender heterosexual (non-SGM) people.Design, Setting, and ParticipantsThis cross-sectional study used data from a multidisciplinary research consortium, the All of Us Research Program, that links participant-reported survey information to electronic health records (EHR) and physical measurements. In total, 372 082 US adults recruited and enrolled at an All of Us health care provider organization or by directly visiting the enrollment website from May 31, 2017, to January 1, 2022, and were assessed for study eligibility.ExposuresSelf-identified gender identity and sexual orientation group.Main Outcomes and MeasuresTwelve health conditions were evaluated: 11 using EHR data and 1, body mass index (BMI; calculated as weight in kilograms divided by height in meters squared), using participants’ physical measurements. Logistic regression (adjusting for age, income, and employment, enrollment year, and US Census division) was used to obtain adjusted odds ratios (AORs) for the associations between each SGM group and health condition compared with a non-SGM reference group.ResultsThe analytic sample included 346 868 participants (median [IQR] age, 55 [39-68] years; 30 763 [8.9%] self-identified as SGM). Among participants with available BMI (80.2%) and EHR data (69.4%), SGM groups had higher odds of anxiety, depression, HIV diagnosis, and tobacco use disorder but lower odds of cardiovascular disease, kidney disease, diabetes, and hypertension. Estimated associations for asthma (AOR, 0.39 [95% CI, 0.24-0.63] for gender diverse people assigned male at birth; AOR, 0.51 [95% CI, 0.38-0.69] for transgender women), a BMI of 25 or higher (AOR, 1.65 [95% CI, 1.38-1.96] for transgender men), cancer (AOR, 1.15 [95% CI, 1.07-1.23] for cisgender sexual minority men; AOR, 0.88 [95% CI, 0.81-0.95] for cisgender sexual minority women), and substance use disorder (AOR, 0.35 [95% CI, 0.24-0.52] for gender diverse people assigned female at birth; AOR, 0.65 [95% CI, 0.49-0.87] for transgender men) varied substantially across SGM groups compared with non-SGM groups.Conclusions and RelevanceIn this cross-sectional analysis of data from the All of Us Research Program, SGM participants experienced health inequities that varied by group and condition. The All of Us Research Program can be a valuable resource for conducting health research focused on SGM people.

Queering genomics: How cisnormativity undermines genomic science

“… 56 These questions are incorporated into major genomics research efforts such as the All of Us study and have been used to provide baseline assessments of the demographics of the sexual and gender minority (SGM) population in this study. 57 , 58 In 2016, the NIH designated the SGM population as a health disparity population for purposes of research supported by the NIH and the Agency for Healthcare Research and Quality. 59 Later that year, the 21 st Century Cures Act, which authorized new funding for public health research at the NIH, directed the agency to increase the participation of SGM people in clinical research and to improve methodology for studying the SGM population.…”

Assessing the Health Status of Sexual and Gender Minority Adults: What We Can Learn When We Include All of Us

“…experience of minority stress: although all persons experience individual and social stress, persons who are marginalized in society experience a unique type of stress directly related to their minoritized status. 5 What is intriguing in the study by Tran et al 4 is that SGM groups had lower odds of cardiovascular disease, kidney disease, diabetes, and hypertension, all conditions that have been found to be elevated and similarly associated with minority stressors in prior studies. To date, much of the work in the SGM literature has been based on convenience samples or probability samples with poor representation and sampling methods.…”

“…An ongoing opportunity in SGM research, and health equity work writ large, is the critical importance of applying community-engaged strategies, such as the inclusion of populations of interest across the study leadership, community advisory boards, various stakeholder boards, research staff, and key personnel, with equal partnerships in study design decisions to promote and retain study participation. 7 Notably, the All of Us Research Program attempts to oversample underrepresented populations, but within Tran et al, 4 it is apparent that multiply marginalized persons (eg, SGM persons with marginalized racial and ethnic identities) are not as prevalent in the study sample, a point for further improvement recognized by the team. This can reflect multiple issues affecting the participation of SGM persons, as well as persons with marginalized racial and ethnic identities in research and research leadership, particularly if the goal is to capture the health and well-being outcomes across the breadth of diversity and inclusion of multiple marginalized SGM populations.…”

Advancing Data Collection of Sexual Orientation and Gender Identity in Cardiology

“…Multilevel action that engages collaborators and community partners at different organizational levels is needed to enhance how SOGI data are collected, ensuring accurate representation and inclusivity across LGBTQIA+ populations in cardiovascular research and clinical care. Several studies provide noteworthy examples of community-engaged research with LGBTQIA+ populations . Furthermore, clinicians and researchers can start including SOGI data collection in their research and clinical practice today to foster a more inclusive health care environment and increase LGBTQIA+ visibility.…”