The Intersection of Sexual Orientation, Gender Identity, and Race/Ethnicity on Cardiovascular Health: a Review of the Literature and Needed Research

This review discusses the current literature about the cardiovascular health of sexual and gender minority (SGM) individuals with a particular focus on the intersection between SGM identity and race/ethnicity, describes potential contributions to observed differences, and suggests interventions to begin to improve cardiovascular health equity in this community. Research on cardiovascular health in SGM individuals predominantly focuses on individual cardiovascular health risk factors and has conflicting results. The studies assessing cardiovascular health outcomes in SGM people show mixed results and are limited by reliance on self-reported cardiovascular diagnoses. Research examining the intersectional influences of race/ethnicity and SGM identity on cardiovascular health is even more sparse, particularly in gender minority cardiovascular health. While some studies suggest disparate prevalence of cardiovascular risk factors like tobacco use, hypertension, and obesity in SGM people of color, the small number of these studies limits the interpretation of this body of research. The etiology for differential cardiovascular health is likely multifactorial, with contribution of inequitable access to appropriate healthcare, lack of SGM culturally competent clinicians, and discrimination within the healthcare system. Another potential component is the link between minority stress and physical health, a growing area of research in SGM health. Systematic research about the intersectional influences of race, ethnicity, sexual orientation, and gender identity on cardiovascular health is urgently needed. A first step could be to enable electronic health record capture of demographic characteristics that include sexual orientation and gender identity in addition to race/ethnicity. This intervention, combined with training for healthcare providers and staff, would be a powerful step toward providing more equitable cardiovascular care for this underserved community.