# Multi-Level Determinants of Sexual and Gender Minority Aging

> **NIH NIH R36** · VANDERBILT UNIVERSITY · 2024 · $51,650

## Abstract

Project Abstract
There are over 20 million sexual and gender minority (SGM) adults in the United States. SGM adults experience
significant health inequities such as higher risk for Alzheimer’s Disease and related dementias (ADRD), higher
prevalence and severity of chronic health conditions, and higher risk for multiple cancers. SGM discrimination
likely accelerates aging, disrupts use of preventive care, and creates barriers to health systems when they are
sick. The overall objective is to understand the relationship between provider- and policy-level factors to improve
aging and health outcomes of midlife and older SGM adults. In Specific Aim 1, we will estimate population-level
prevalence of subjective cognitive decline (SCD), severity of SCD, and receipt of informal care for SCD-related
impairments using data from the 2015-2019 Behavioral Risk Factor Surveillance System (BRFSS). This is the
largest probability sample of sexual minority (SM) adults available and all analyses will be stratified by sex and
sexual orientation for the first time in public health research. We hypothesize that SM adults will report higher
SCD prevalence and ADRD risk, but lower access to informal care provided by a spouse or family member. In
Specific Aim 2, we will examine the relationship between 7 provider-level attitudes and practices towards SGM
patients and preventive healthcare use (e.g., receiving colorectal cancer screenings, flu vaccinations) and level
of cognitive impairment. This aim leverages novel panel data on midlife and older SGM adults from the NIA-
funded Vanderbilt University Social Networks, Aging, and Policy Study (VUSNAPS). In Specific Aim 3, we will
estimate the association of state policies legally permitting denial of health services based on sexual orientation
and rates of preventive healthcare use, health status, and health behaviors among SM adults. In this aim, we
will use BRFSS data and a difference-in-differences design to compare SM adults in states with and without
legal denial policies. Results have significant implications for midlife and older SGM adults — an NIA priority
population. By using the largest probability sample of SM adults available, we are able to stratify by sex and
sexual orientation. These nuanced findings may inform policies regarding long-term supports and services to
meet the needs of sub-populations with both SCD-related impairments and elevated risk for ADRD. Additionally,
we use novel panel data on SGM midlife and older adults to identify provider-level predictors of preventive care.
Research insights may inform larger scale interventions to improve attitudes and practices with SGM patients at
the health system-level.

## Key facts

- **NIH application ID:** 10899675
- **Project number:** 5R36AG083386-02
- **Recipient organization:** VANDERBILT UNIVERSITY
- **Principal Investigator:** Nathaniel M Tran
- **Activity code:** R36 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $51,650
- **Award type:** 5
- **Project period:** 2023-08-15 → 2025-12-10

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10899675

## Citation

> US National Institutes of Health, RePORTER application 10899675, Multi-Level Determinants of Sexual and Gender Minority Aging (5R36AG083386-02). Retrieved via AI Analytics 2026-05-27 from https://api.ai-analytics.org/grant/nih/10899675. Licensed CC0.

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