Dementia risk factors among caregivers and non-caregivers by sexual and gender minority status

Background

Unpaid caregivers face elevated prevalence of Alzheimer’s disease and related dementia (ADRD) risk factors yet remain under-recognized as an at-risk population. Additionally, sexual and gender minority (SGM) adults experience discrimination at multiple levels which further negatively impact their health. This study sought to examine the individual effects of caregiving and SGM minoritization on 12 of the 14 Lancet Commission-identified ADRD risk factors, using a nationally representative US sample.

Methods

Secondary analysis of the 2023 Behavioral Risk Factor Surveillance System (BRFSS) was conducted utilizing 49,413 US adults. SGM status (n = 3,307) was based on self-reported sexual identity. Caregiver status was defined as provision of unpaid care in the past 30 days. Twelve Lancet Commission risk factors were operationalized using 14 BRFSS variables (education, depression, smoking, alcohol, hearing impairment, vision impairment, diabetes, obesity, hypertension, cardiovascular disease, physical inactivity, and loneliness). Weighted proportions and Rao-Scott chi-square tests were calculated with an alpha < =0.05.

Results

Approximately 22% of US adults were caregivers regardless of SGM status. Among SGM adults, significantly elevated prevalences comparing caregivers to non-caregivers were noted for 3 out of the 12 risk factors. Among non-SGM adults, caregivers had significantly higher prevalence of 9 out of the 12 risk factors. In comparing risk factor prevalences between SGM and non-SGM groups, the prevalences were consistently higher among SGM (both caregivers and non-caregivers) for education, depression, smoking, uncorrected vision, alcohol use, coronary heart disease, and loneliness.

Conclusions

Non-SGM adults exhibited an overall greater risk profile among caregivers relative to SGM adults; however, the overall magnitude of prevalences remained higher among SGM adults for depression, smoking, and loneliness.

Key messages

• Unpaid caregivers carry a higher burden of dementia risk factors than non-caregivers, positioning them as a critical yet overlooked prevention population.

• SGM adults show persistently higher prevalence of depression, smoking, and loneliness regardless of caregiving status, signaling compounded dementia risk.