State lesbian, gay, bisexual, transgender, and queer (LGBTQ+) policies and subjective cognitive decline in US sexual minority adults aged 45 years and older

Abstract

Background: In 2023, state legislatures across the United States introduced a record-breaking 510 anti-lesbian, gay, bisexual, transgender, and queer (LGBTQ+) bills. These anti-LGBTQ+ bills may increase chronic stress and ultimately affect their overall health, including subjective cognitive decline (SCD). Methods: Combining the 2019–2022 Behavioral Risk Factor Surveillance System (BRFSS) and 2017–2021 policy tallies, we conducted multivariable logistic regression analyses to explore the relationship between LGBTQ+ state policy environments (protective vs. restrictive) and SCD (yes vs. no) among sexual minority adults aged 45 years and older. Results: Among 10,487 sexual minority adults, 1,009 (9.9%) reported experiencing SCD. Participants from states with protective policies were less likely to report SCD than those from restrictive ones (adjusted odds ratio [AOR] = 0.63; 95% confidence interval [CI]: 0.46–0.88). Among those with SCD, individuals from protective states were more likely to discuss their cognitive issues with healthcare providers (AOR = 1.68; 95% CI: 1.04–2.72) and to receive the help they needed (AOR = 1.55; 95% CI: 1.05–2.29). Conclusions: Sexual minority adults experiencing SCD were more likely to reside in states with restrictive LGBTQ+ policies. Conversely, those with SCD living in states with protective policies were more likely to access cognitive-related care and support.