Epidemiology of Traumatic Brain Injury in Sexual and Gender Minority People: A Matched Single-Trauma Center Study

Sexual and gender minority (SGM) individuals are at increased risk of adverse neurological health outcomes. Despite this, risk factors and outcomes of SGM populations after traumatic brain injury (TBI) remain poorly characterized. Our study aimed to describe the epidemiology of TBI in SGM people and to compare TBI risk factors and outcomes, including the incidence of repetitive TBI, with those of non-SGM people with TBI. We conducted a retrospective chart review of adults presenting with TBI to a level I trauma center between 2019 and 2024. SGM patients were identified through the sexual orientation and gender identity SmartForm in Epic, and non-SGM patients were matched by year of presentation. Repetitive TBI was defined as subsequent presentation for head injury within 5 years of the index TBI. Among 509 patients (SGM: n = 238, non-SGM: n = 271), SGM patients were more likely to have a history of psychiatric illness (p < 0.0001) and previous TBI (i.e., prior to the index TBI of inclusion, p = 0.006). TBI severity by Glasgow Coma Scale did not differ across groups (p > 0.05), but SGM patients differed in injury mechanisms, with fewer ground-level falls (p = 0.01) and greater violence/assault (p = 0.04). There were differences in TBI outcomes, with fewer inpatient admissions for SGM patients (p = 0.004) and lower rates of in-hospital mortality (p = 0.014). The incidence of repetitive TBI was higher in the SGM group versus non-SGM group (39% vs. 15%, p < 0.0001). SGM people had 3.1 times higher odds of repetitive TBI compared with non-SGM people (95% confidence interval: 1.8-5.4, p < 0.0001), even after adjusting for age, sex assigned at birth, underlying psychiatric diagnosis, and history of prior TBI. Our findings of a higher prevalence of comorbid psychiatric illness, prior TBI, distinct TBI mechanisms, and higher repetitive TBI incidence among SGM patients underscore a distinct injury profile and the critical need to identify the reasons for these differences to improve outcomes.