The Health of Sexual and Gender Minority People with Disabilities: A Systematic Scoping Review

The Health of Sexual and Gender Minority People with Disabilities: A Systematic Scoping Review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Health of Sexual and Gender Minority People with Disabilities: A Systematic Scoping Review Amy Ball, Kelsey Hornbuckle, Sarah MacCarthy This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7660127/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 18 Mar, 2026 Read the published version in Sexuality and Disability → Version 1 posted 8 You are reading this latest preprint version Abstract Background In 2023 the NIH designated people with disabilities as a population experiencing health disparities, adding to a list that included sexual and gender minority (SGM) people. Health disparities of each group have been documented, but studies exploring their intersection are limited. Objective The objective of this systematic scoping review is to characterize current research on SGM people with disabilities in the United States, including outcomes investigated, research methodology, data sources, and methods by which researchers define and measure SGM identity and disability. Methods Eligible studies were published in English from 2014–2024 and examined the health outcomes of SGM people with disabilities in the United States. Searches of peer-reviewed literature from 3 databases (PubMed, CINHAL, and Embase) were uploaded into Covidence and screened for relevance; data from each included study were extracted for review.0 Results The final review database included 31 studies. Most were quantitative, used a national sample, and focused on structural or mental health outcomes. The ways in which disability and SGM identity were measured varied across studies, complicating efforts to draw broad conclusions. Still, studies consistently showed that those at the intersection of SGM identity and disability were more affected by violence and discrimination than either population alone. Further, gender minority people with disabilities and sexual minority women of color with disabilities had worse structural outcomes. Conclusions Future research should explore how the type and visibility of disability, specific subgroups of SGM populations, and other characteristics influence health outcomes, especially how they are influenced by stigma and discrimination. LGBT Disability Intersectionality Literature Review Heath Outcomes INTRODUCTION In 2023 the NIH designated individuals with disabilities as a population experiencing health disparities, adding this group to a list that includes sexual and gender minority (SGM) people[ 1 ]. A growing body of research suggests that individuals who identify as LGBTQ and people with disabilities experience more health inequities compared to their cisgender heterosexual counterparts not living with disabilities (Streed et al., 2021)Though the health disparities of SGM people and people with disabilities have been documented, but studies exploring their intersections are limited. Among studies that have explored disability among SGM people, several themes emerge, including barriers to health insurance and health care access, lack of cultural competence within the health system, and the cumulative toll of stigma and discrimination[ 2 ]. The themes explored by the studies included in this review are especially relevant: an expanding corpus of empirical evidence suggests that SGM individuals have higher rates of disability compared to their heterosexual cisgender counterparts[ 3 ]. The objective of this systematic scoping review was to assess the current state of research on the health outcomes of adolescents and adults in the United States who identify as a SGM person and who have a disability. Other key elements used to conceptualize the review questions included how SGM identity and disability are defined in the data and how these data are measured and collected. Especially in light of Executive Orders released January 2025 negating the roles of sex, sexual orientation and gender in health outcomes[ 4 , 5 ] in combination with efforts to minimize NIH research on health disparity populations more broadly[ 6 ], systematically documenting the scope of inequities faced by individuals living at the intersection of being SGM and living with a disability was urgently needed. METHODS This review followed the PRISMA Extension for Scoping Reviews (PRISMA-Scr)[ 7 ]. The titles and abstracts were screened using the inclusion criteria described below; if studies met the screening criteria, their full text was screened. Data were extracted from the 31 studies that passed both screening rounds. Specific data points recorded included how sexual orientation, gender identity and disability were reported; study location; methods employed; dataset used; and key results. Results were organized with attention to different core identities (e.g., difference by race and ethnicity, rurality), structural outcomes (e.g., peer victimization, discrimination, health care access, insurance status, healthcare satisfaction); physical health outcomes (e.g., overall physical health, sleep, pain, diet, physical activity, weight/BMI, chronic health conditions, sexual behaviors, substance use); and mental health outcomes (e.g., overall mental health, mental healthcare utilization, stress, anxiety depressive symptoms, suicidality, body image and self-esteem). We also noted strengths and limitations of each study and recorded any recommendations from the authors for future research directions. We performed a content analysis to identity key themes and gaps in evidence across studies. Eligibility criteria: This review was limited to studies that examined the population of individuals who identify as a sexual and gender minority and who also have a disability. Only studies focused on populations in the United States were included. Included studies were limited to work published in English between January 2014 — June 2024. No other exclusion criteria were applied. Information sources: We searched 3 databases: PubMed, CINHAL, and Embase. PubMed, a vast collection of biomedical and life science research, was our initial source. Upon recommendation from a librarian and to broaden the review’s reach, we added CINAHL, a database of research from nursing and allied health journals, and Embase, a database of research relevant to pharmacology. The lead author worked in collaboration with a reference librarian to develop the search string (see Appendix I). Results from each search were imported into Covidence and reviewed for eligibility by two reviewers. Selection of sources of evidence: We removed duplicate studies, leaving 365 studies to be screened. Two reviewers (AB and KH) screened the titles and abstracts using the inclusion and exclusion criteria described above; they removed an additional 278 studies. A full text review was conducted, eliminating an additional 56 studies. We extracted data from the 31 remaining studies. Data charting: A data-charting matrix was initially developed in Excel to collect relevant data from each included study. The matrix was designed to identify trends highlighting what subpopulations were examined by the research within the larger population of SGM people with disabilities, how these populations were defined and how identity data were collected, research methods and data sources used, outcomes studied and how they were measured, and trends in study results. The charting matrix was then rebuilt in Covidence to facilitate feedback from additional authors. Study information collected included article title and all authors, the journal in which the article was published, and methodology and data sources used. The primary population characteristics extracted for review included SGM identity and disability characteristics including descriptions of how this population was defined and measured by each study. Other population characteristics recorded were the race/ethnicity, age, and geography of each population studied. We also extracted information on subgroups within the study population; group comparisons; and results of structural, physical and mental health outcomes (See Appendix II for the full extraction form). RESULTS Excluding duplicates, 365 studies were included in the initial title and abstract screening. Of these, 278 were not eligible, leaving 87 to be screened in the full-text review. Primary reasons for exclusion included: wrong patient population (n = 37) (e.g., study population were not both SGM AND living with a disability); wrong study design (n = 12) (e.g., the study did not record any structural or health outcomes beyond the prevalence of disability within the SGM population); or wrong setting (n = 4) (e.g., the study included a population outside the United States). The 31 studies remaining after the full text screening were selected for data extraction. See Appendix III for a table detailing sources of evidence. Study Design and Data Sources The included studies used a range of study designs and data sources. The majority of studies used only quantitative methods (n = 25): a minority used mixed methods (n = 4), qualitative (n = 3), experimental (n = 1), and case study designs (n = 1). Just under half (n = 13) included studies that developed their own data set using a variety of recruitment methods. Other datasets used included The National Survey of Health and Disability, the LGBTQ National Teen Survey, Medicare insurance claims data, and other national or state level datasets. Study Population The majority of studies included in this review (n = 24) examined people with disabilities more broadly, using a population of individuals with any type and severity of disability. The remaining studies looked only at those with physical disabilities (n = 4) or at those with a specific disability (n = 3). About half (n = 15) of the studies focused on SGM individuals as a combined group. The remaining studies focused on more specific groups, including gender minority people of any sexuality (n = 6), sexual minority people of any gender (n = 5), sexual minority women (n = 4), or sexual minority men (n = 1). Measurement of Disability Among the studies included this review, 21 used some variation the yes/no question, “Do you have a disability?” Three studies included no follow-up question or other question related to disability. Of those with a follow-up question, six asked respondents to relate to a list of disability categories including physical, sensory, intellectual/developmental, psychiatric, or other. Other related questions asked the respondents to list specific disabilities (n = 1), to indicate if they used any assistive equipment (n = 1), or if they received special education in school or had an Individualized Education Program (IEP)(n = 1). Two studies asked specifically about physical disability and included follow up questions about the type, duration, severity and age at the disability’s onset. Six studies used surveys with questions that determined disability status using a variation of the six-item set of questions assessing hearing, vision, walking, cognition, self-care, and independent living that are used in the American Community Survey (ACS); one study used these questions as the sole disability measure, and the remaining five used them in addition to the binary disability question described above. The ACS questions are intended to define disability from a functional perspective[ 8 ], as opposed to defining disability by specific diagnoses or categories of disability. Additional ways in which the studies measured disability status included self-report of a specific disability (n = 1), an unspecified self-report method (n = 1) and Medicare eligibility due to disability (n = 2). Measurement of Sexual Orientation and Gender Identity Sexuality was included as a variable in 23 studies. All of the studies included a single self-report question asking participants to choose from a list of sexualities; all of the lists included some variation of straight/heterosexual, gay/homosexual/lesbian, or bisexual, typically with an option of “other” or “prefer not to answer.” Studies using data from sources specifically designed to capture the SGM population, such as the 2017 LGBTQ National Teen Survey and the 2019–2020 National Study of LGBTQ + Student Success, were more likely to include additional options such asexual, two-spirit, queer, or questioning. Twenty-two studies included gender minority people as a separate variable population. Only four of these did not use self-reported sex/gender to assess gender minority status; of those that used self-report, five did not specify the style of question used to assess gender minority status; all others used a two-part question. There was no standard question style assessing sex and gender across these studies. The most common style included seven studies that asked respondents to identify their sex/gender as male, female, and other. Those who answered “other” were asked to choose from options such as transgender, non-binary, two- spirit, gender non-conforming, genderqueer, agender, intersex, and choose not to disclose. Outcome Measures As with the measures used to define the study population, the majority (n = 27) of outcome measures used self-reported data. Outcome measures were divided into one of three categories: structural outcomes (n = 21), physical health outcomes (n = 9), and mental health outcomes (n = 18). Structural outcomes include those related to healthcare (n = 8), violence and discrimination (n = 9), and disability in the workplace (n = 4). Investigation of healthcare outcomes (e.g., insurance coverage, receipt of healthcare regularly or in the past year, and experiences with healthcare professionals) showed that SGM adults with disabilities were more likely to have unmet healthcare needs and less access to healthcare than non-SGM people without disabilities. Studies examining structural outcomes focused on violence, bullying, and experiences with discrimination; all noted a higher rate of discrimination and victimization. Substantial gender-identity discrimination stemmed from the perceived violation of gender norms, with sexual minority women and those with nonnormative gender expressions experiencing more or more severe discrimination. Five studies examined social connectedness/support or resilience as adaptions to discrimination, but both social support and individual resilience were generally noted as lower among SGM people with disabilities. Those studies that examined disability in the workplace focused on disclosure of minority status, experiences with discrimination at work, and workplace accommodations. These studies found significant variation among subgroups on several measures but generally found that women of color and transgender people with disabilities were more likely to experience discrimination and less likely to receive workplace accommodations compared to their non-SGM and able-bodied counterparts. Physical health outcomes investigated include overall physical health and quality of life (n = 7), physical activity and nutrition (n = 4), weight related outcomes (n = 3), prevalence of chronic illnesses (n = 2), pain (n = 2), sleep (n = 1), and sexual behaviors (n = 1). Each study that included a measure of general physical health showed that SGM youth and adults with disabilities had poorer general health and poorer physical quality of life. Of those studies looking at exercise, nutrition, and body weight, SGM youth and adults with disabilities reported less physical activity and greater BMI than non-SGM and able-bodied people. However, there was little investigation into differences in diet, and no analysis of how type or severity of disability impacted physical activity or BMI. In those studies that examined the prevalence of chronic illnesses, SGM adults with disabilities had a higher prevalence of most chronic illnesses when compared to SGM adults without disabilities, including lung, joint, metabolic, liver, kidney, and heart conditions. Substance use patterns were different among SGM minorities with disabilities when compared to non-SGM people without disabilities; however, there was enough variation by type of disability, type of substance, and other population characteristics to obscure general trends. Seventeen studies investigated mental health outcomes, including direct outcomes such as overall mental health (n = 5) and psychological distress (n = 3), measures of depressive symptoms (n = 6), suicidality (3), and self-esteem and body image (n = 3).They also included outcomes indicative of interaction with the healthcare system, such as prevalence of mental health diagnoses (n = 4) and use of prescribed psychotropic drugs (n = 1). Across these studies, SGM adults with disabilities reported more psychological distress, more diagnosed mental health issues, and more days of poor mental health than non SGM adults with disabilities. SGM identity and disability status were each correlated to depression and anxiety, especially in relation to discrimination. Within this intersectional population, having a more severe disability or being nonbinary contributed to a greater likelihood of depression and anxiety. In both youth and adults, SGM identity and disability contributed to suicidality, both in SGM-only and disability-only groups as well as in the intersectional population. Synthesis of results: In sum, the outcomes measured in this systematic scoping review focused heavily on structural factors. Many of these studies found significant differences in healthcare among multiply-minoritized populations (e.g., transgender women of color). Physical health outcomes received less attention, but studies documented generally worse outcomes across all categories of physical health. Studies also focused on mental health outcomes, both independently and in relation to structural factors such as discrimination and stigma. The influence of protective structural factors on mental health were explored, such as the role of community connectedness on mental health outcomes including anxiety and substance use[ 9 ]. DISCUSSION Study Design and Data Sources Most of the studies included in this review had a similar methodology. The majority were quantitative, collected cross-sectional data, and used a national-level survey sample from the National Survey on Health and Disability. A significant weakness of much of this research is inherent in these broad, nationwide datasets: most do not represent the general public. The National Survey of Health and Disability was the most commonly used dataset in this review. The authors of each study using these data note that the sample is disproportionately white and highly educated compared to the general U.S. population. This limitation is common to those datasets targeting the SGM population or those with disabilities. However, despite this limitation, the use of existing datasets covering a large population is a strength of the reviewed research. Though cross- sectional research such as this does not enable researchers to infer causal links among SGM identity, disability, and health outcomes, results based on such broad datasets are highly useful in identifying targets for policy development and future research. Mixed methods used in some studies may have contributed additional nuance to study findings. Only a minority of included studies used qualitative research methods, either alone or in conjunction with a quantitative component. The qualitative research provided context to quantitative data collection. Such research is needed to tailor future interventions to the unique needs of SGM people with disabilities. Measurement of Sexual Orientation, Gender Identity and Disability Although the research methods used in this review are rather uniform, the definitions and measures used to identify SGM minority people vary significantly, largely in how transgender individuals are identified. A minority of studies used a binary question assessing sex/at birth and current gender, limiting the number of studies accurately assessing the unique needs of transgender and gender diverse populations. In collecting information about sexual identity, most studies used a list of sexualities, inviting respondents to note all that apply; variation in this question largely correlates with the target population (e. g. datasets targeting SGM populations specifically have larger lists with lesser known identities). The questions used to identify SGM respondents vary in structure and content, likely leading to inconsistency in how accurately this population is identified across studies. The definition of disability status also varies. While many studies simply ask for self- reported disability status, several also use questions to assess functional difficulties drawn from the ACS study, and a few also ask for specific conditions and diagnoses. This variation makes it difficult to compare disability populations across studies. A combination of the ACS or similar measures of functional difficulties alongside a question of disability identity (e.g. “Do you consider yourself disabled”) is likely to capture the full disability population. However other question types may be better at capturing specific disability subpopulations. The variability in how SGM and disability populations are measured is a significant weakness of the data included in this review. Subgroups among these populations may be better defined with other question type; however, absent standardized definitions of SGM people and/or people with disabilities, efforts to draw conclusions across studies will be hindered. Outcomes Investigated The structural outcomes investigated can be broadly separated into structural, physical, and mental health outcomes. Physical health outcomes were comparatively under-investigated; they primarily included as outcomes general physical health, and to a lesser extent physical activity and sexual behavior. Mental health outcomes investigated were heavily weighted towards issues such as depression and suicidality and generalized poor mental health; issues such as substance use and other mental health issues were investigated less often. The relationship between structural outcomes and physical health outcomes was not thoroughly investigated among the studies in this review. By contrast, many studies included investigations of how structural and mental health outcomes relate to each other. This was especially true when the structural outcomes investigated were based in community connectedness, interpersonal relationships, or in institutions such as schools or workplaces. These studies heavily reference the role of stigma and discrimination, based both on disability status and gender/sexual identity, alone and in conjunction with each other or other minoritized identities. Limitations: A significant limitation of this review is that each of the databases used contained research primarily in public health and related fields. Exploration of other databases may have identified more-relevant research from other disciplines, such as sociology or social work. In addition our search only considered peer-reviewed research; we did not explore potentially relevant grey literature. Another significant limitation is the way in which the literature search defined disability. The search string for disability was not expanded as fully as the search string for SGM identity, so it is likely that there are more ways of defining disability than are shown in this review. For future review of this research, it would be prudent to develop a more detailed search string for disability, using additional disability-related search terms. It may also be useful to include terms related to specific disabilities or chronic illnesses. CONCLUSIONS This scoping review was intended to provide a summary of recent research focused on the health outcomes of SGM people living with disabilities. This population is relatively unstudied in public health research, and continuing research on this population may be threatened. In the process of conducting this review, we identified areas where application of diverse research methods may be useful, how these population may be best identified and measured, and what frameworks could inform future research questions. Larger datasets such as those included in this review are valuable in concretely identifying trends in the health of marginalized populations, especially those such as SGM individuals, who often go unrecognized or underrepresented in research in general. Future research should make every effort to include racial and ethnic minorities in numbers large enough to address the needs of these subpopulations within the larger population of SGM people with disabilities. Larger datasets representative of these groups will facilitate analysis of factors that contribute to health outcomes for SGM individuals with disabilities. Including more qualitative research on this population can add valuable nuance to the quantitative data contained in datasets such as these. To this end, exploration of research in other disciplines including the social sciences and area studies (e.g. LGBT or Disability Studies) may prove useful. As research in this population is still rather scarce, grey literature may also be a source of novel research ideas and methodology. Additionally, qualitative research can be embedded in quantitative research studies to provide context for quantitative results as was done in the studies by Blanck, Hyseni, and Wise[ 10 – 12 ]. Given the relative scarcity of research on SGM people living with disability, the ways in which each group is defined is not standardized, and most research examines broad sections of this intersectional population. More standard ways of defining and measuring these populations will help to compare results across studies. Future studies should also explore how the type and visibility of disability, specific subgroups of SGM populations (e.g., bisexual people), and other characteristics (e.g., being a racial minority or older age) exacerbate experiences with stigma and discrimination. Analysis of the role race and ethnicity was limited. Only five studies included analysis by race/ethnicity via National Survey of Health and Disability data. Across each of these studies, race was correlated with differences in the prevalence of disability and outcome results. All studies noted that people of color in general had more negative health outcomes, though with some variation with respect to social connectedness, outness (of sexuality and/or disability), discrimination, and work/school accommodations. Finally, the outcomes explored in this review are heavily weighted toward structural and mental health outcomes. This clearly highlights a gap in research on physical health outcomes, most of which focused on general health and behavioral health factors such as diet, exercise, and substance use. By contrast, those studies looking at structural and mental health outcomes were asking more complex research questions. Such research is highly relevant to a group with complex patterns of stigma and discrimination such as SGM people with disabilities. Since the initiation of this research, the implications of being designated health disparities population by NIH have changed significantly. Indeed, this administration’s dramatic restrictions imposed on NIH will significantly impact research on SGM people living with disabilities going forward. Many researchers are unclear what the path forward may be for existing funding mechanisms. However, we have the opportunity to lean on and learn from our community partners to ensure that we can find adaptive and dynamic ways to provide high quality services to all, and especially those most marginalized. Doing so will likely require innovation, or at least a re-envisioning of our research approach; however in collaboration with our community partners, we can continue to advance our ability to address the unique and crosscutting needs of SGM living with disabilities. Works included in review Blanck, P., Hyseni, F., & Altunkol Wise, F. (2020). Diversity and Inclusion in the American Legal Profession: Workplace Accommodations for Lawyers with Disabilities and Lawyers Who Identify as LGBTQ+. Journal of Occupational Rehabilitation , 30 (4), 537–564. https://doi.org/10.1007/s10926-020-09938-3 Blanck, P., Hyseni, F., & Wise, F. A. (2021). Diversity and Inclusion in the American Legal Profession: Discrimination and Bias Reported by Lawyers with Disabilities and Lawyers Who Identify as LGBTQ+. American Journal of Law & Medicine , 47 (1), 9–61. https://doi.org/10.1017/amj.2021.1 Eliason, M. J., Martinson, M., & Carabez, R. M. (2015). Disability Among Sexual Minority Women: Descriptive Data from an Invisible Population. LGBT Health , 2 (2), 113–120. https://doi.org/10.1089/lgbt.2014.0091 Ending Radical and Wasteful Government DEI Programs and Preferencing . (2025, January 29). Federal Register. https://www.federalregister.gov/documents/2025/01/29/2025-01953/ending-radical-and-wasteful-government-dei-programs-and-preferencing How Disability Data are Collected from The American Community Survey . (2021, November 21). Census. https://www.census.gov/topics/health/disability/guidance/data-collection-acs.html Hyseni, F., Myderrizi, A., & Blanck, P. (2022). Diversity and inclusion in the legal profession: Disclosure of cancer and other health conditions by lawyers with disabilities and lawyers who identify as LGBTQ +. Journal of Cancer Survivorship , 16 (1), 165–182. https://doi.org/10.1007/s11764-021-01143-2 Initial Rescissions of Harmful Executive Orders and Actions . (2025, January 28). Federal Register. https://www.federalregister.gov/documents/2025/01/28/2025-01901/initial-rescissions-of-harmful-executive-orders-and-actions Liu, M., Kadakia, K. T., Patel, V. R., & Krumholz, H. M. (2025). Characterization of Research Grant Terminations at the National Institutes of Health. JAMA . https://doi.org/10.1001/jama.2025.7707 Nakkeeran, N., & Nakkeeran, B. (2018). Disability, mental health, sexual orientation and gender identity: Understanding health inequity through experience and difference. Health Research Policy and Systems , 16 (S1), 97. https://doi.org/10.1186/s12961-018-0366-1 NIH designates people with disabilities as a population with health disparities | National Institutes of Health (NIH) . (n.d.). Retrieved July 10, 2025, from https://www.nih.gov/news-events/news-releases/nih-designates-people-disabilities-population-health-disparities Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., … Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ , n71. https://doi.org/10.1136/bmj.n71 Smith-Johnson, M. (2022). Transgender Adults Have Higher Rates Of Disability Than Their Cisgender Counterparts: Study examines rates of disability among transgender adults and cisgender adults. Health Affairs , 41 (10), 1470–1476. https://doi.org/10.1377/hlthaff.2022.00500 Streed CG Jr, Hall JP, Boyd BA, Batza K, & Kurth NK. (2021). Comparative Health Status and Characteristics of Respondents of the 2019–2020 National Survey on Health and Disability by Sexual and Gender Minority Status. LGBT Health , 8 (8), 563–568. https://doi.org/10.1089/lgbt.2021.0075 Declarations Author Contribution All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Amy Ball, Kelsey Hornbuckle, and Sarah MacCarthy. The first draft of the manuscript was written by Amy Ball, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. References NIH (2023) NIH designates people with disabilities as a population with health disparities. National Institutes of Health, NIH.gov Nakkeeran N, Nakkeeran B (Oct 9 2018) Disability, mental health, sexual orientation and gender identity: understanding health inequity through experience and difference. Health Res Policy Syst 16:97. no. Suppl 110.1186/s12961-018-0366-1 Smith-Johnson M (Oct 2022) Transgender Adults Have Higher Rates Of Disability Than Their Cisgender Counterparts. Health Aff (Millwood) 41(10):1470–1476. 10.1377/hlthaff.2022.00500 (2025) Exec. Order No. 14148, 3 C.F.R. 8237 Initial rescissions of harmful executive orders and actions. [Online] Available: https://www.federalregister.gov/documents/2025/01/28/2025-01901/initial-rescissions-of-harmful-executive-orders-and-actions (2025) Exec. Order No. 14151, 3 C.F.R. 8338 Ending radical and wasteful government DEI programs and preferencing. . [Online] Available: https://www.federalregister.gov/documents/2025/01/29/2025-01953/ending-radical-and-wasteful-government-dei-programs-and-preferencing Liu M, Kadakia KT, Patel VR, Krumholz HM (2025) Characterization of Research Grant Terminations at the National Institutes of Health. JAMA May 8. 10.1001/jama.2025.7707 Page MJ et al (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews, BMJ , vol. 372, p. n71, Mar 29 10.1136/bmj.n71 Census How Disability Data are Collected from The American Community Survey. United States Census Bureau. https://www.census.gov/topics/health/disability/guidance/data-collection-acs.html (accessed Eliason MJ, Martinson M, Carabez RM (2015) Disability Among Sexual Minority Women: Descriptive Data from an Invisible Population. LGBT health 2(2):113–120. 10.1089/lgbt.2014.0091 Blanck P, Hyseni F, Altunkol Wise F (2020) Diversity and Inclusion in the American Legal Profession: Workplace Accommodations for Lawyers with Disabilities and Lawyers Who Identify as LGBTQ. J Occup Rehabil 30(4):537–564. 10.1007/s10926-020-09938-3 Blanck P, Hyseni F, Wise FA (2021) Diversity and Inclusion in the American Legal Profession: Discrimination and Bias Reported by Lawyers with Disabilities and Lawyers Who Identify as LGBTQ. Am J Law Med 47(1):9–61. 10.1017/amj.2021.1 Hyseni F, Myderrizi A, Blanck P (2022) Diversity and inclusion in the legal profession: disclosure of cancer and other health conditions by lawyers with disabilities and lawyers who identify as LGBTQ +. J Cancer Surviv 16(1):165–182. 10.1007/s11764-021-01143-2 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 18 Mar, 2026 Read the published version in Sexuality and Disability → Version 1 posted Editorial decision: Revision requested 16 Nov, 2025 Reviews received at journal 30 Oct, 2025 Reviewers agreed at journal 07 Oct, 2025 Reviewers agreed at journal 06 Oct, 2025 Reviewers invited by journal 05 Oct, 2025 Editor assigned by journal 24 Sep, 2025 Submission checks completed at journal 24 Sep, 2025 First submitted to journal 19 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Birmingham","correspondingAuthor":false,"prefix":"","firstName":"Kelsey","middleName":"","lastName":"Hornbuckle","suffix":""},{"id":526192912,"identity":"4ea76cbb-88ea-4faa-9a7e-96e78765ec6b","order_by":2,"name":"Sarah MacCarthy","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0ElEQVRIiWNgGAWjYDADAwbmAwyMDUDWASJ1SBgwsCWQrIXHgDgt8tMOP/zwo+ZenblEzjeJnzsY5PhuJODXYnA7zViy51ixhOWM3G2SvWcYjCUJapFOMGMGekPC4EbuNgneNobEDYS0yM9O/8bM8A+kJeeZ5N82hnqCWhhu55gxM7aBtbBJA21JMCDsl5xiyd6+BMkNZ54ZW8uekTCceeYBQYdt/PDjWwK/wfHkhzff7rCR5ztOyGFwIABWKUGschDgP0CK6lEwCkbBKBhJAAA7fkbewMWVhQAAAABJRU5ErkJggg==","orcid":"","institution":"University of Alabama at Birmingham","correspondingAuthor":true,"prefix":"","firstName":"Sarah","middleName":"","lastName":"MacCarthy","suffix":""}],"badges":[],"createdAt":"2025-09-19 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05:08:48","extension":"xml","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":53783,"visible":true,"origin":"","legend":"","description":"","filename":"98530ec6417442729c8723312ad71f121structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7660127/v1/159414fce42e3638d6c11f37.xml"},{"id":93649044,"identity":"85e99227-c4de-4f3c-96e5-22af472a5127","added_by":"auto","created_at":"2025-10-16 05:16:48","extension":"html","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":60502,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7660127/v1/71d74023ea8bda0d818b2407.html"},{"id":105223444,"identity":"4bba5b8c-0f1d-44af-8648-972c40d5b230","added_by":"auto","created_at":"2026-03-23 16:06:47","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":504891,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7660127/v1/207f58a5-2785-45f7-a3b4-de455c8307b8.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Health of Sexual and Gender Minority People with Disabilities: A Systematic Scoping Review","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eIn 2023 the NIH designated individuals with disabilities as a population experiencing health disparities, adding this group to a list that includes sexual and gender minority (SGM) people[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. A growing body of research suggests that individuals who identify as LGBTQ and people with disabilities experience more health inequities compared to their cisgender heterosexual counterparts not living with disabilities (Streed et al., 2021)Though the health disparities of SGM people and people with disabilities have been documented, but studies exploring their intersections are limited.\u003c/p\u003e\u003cp\u003eAmong studies that have explored disability among SGM people, several themes emerge, including barriers to health insurance and health care access, lack of cultural competence within the health system, and the cumulative toll of stigma and discrimination[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The themes explored by the studies included in this review are especially relevant: an expanding corpus of empirical evidence suggests that SGM individuals have higher rates of disability compared to their heterosexual cisgender counterparts[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe objective of this systematic scoping review was to assess the current state of research on the health outcomes of adolescents and adults in the United States who identify as a SGM person and who have a disability. Other key elements used to conceptualize the review questions included how SGM identity and disability are defined in the data and how these data are measured and collected. Especially in light of Executive Orders released January 2025 negating the roles of sex, sexual orientation and gender in health outcomes[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] in combination with efforts to minimize NIH research on health disparity populations more broadly[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], systematically documenting the scope of inequities faced by individuals living at the intersection of being SGM and living with a disability was urgently needed.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003eThis review followed the PRISMA Extension for Scoping Reviews (PRISMA-Scr)[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The titles and abstracts were screened using the inclusion criteria described below; if studies met the screening criteria, their full text was screened. Data were extracted from the 31 studies that passed both screening rounds. Specific data points recorded included how sexual orientation, gender identity and disability were reported; study location; methods employed; dataset used; and key results. Results were organized with attention to different core identities (e.g., difference by race and ethnicity, rurality), structural outcomes (e.g., peer victimization, discrimination, health care access, insurance status, healthcare satisfaction); physical health outcomes (e.g., overall physical health, sleep, pain, diet, physical activity, weight/BMI, chronic health conditions, sexual behaviors, substance use); and mental health outcomes (e.g., overall mental health, mental healthcare utilization, stress, anxiety depressive symptoms, suicidality, body image and self-esteem). We also noted strengths and limitations of each study and recorded any recommendations from the authors for future research directions. We performed a content analysis to identity key themes and gaps in evidence across studies.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eEligibility criteria:\u003c/h2\u003e\u003cp\u003eThis review was limited to studies that examined the population of individuals who identify as a sexual and gender minority and who also have a disability. Only studies focused on populations in the United States were included. Included studies were limited to work published in English between January 2014 \u0026mdash; June 2024. No other exclusion criteria were applied.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eInformation sources:\u003c/h3\u003e\n\u003cp\u003eWe searched 3 databases: PubMed, CINHAL, and Embase. PubMed, a vast collection of biomedical and life science research, was our initial source. Upon recommendation from a librarian and to broaden the review\u0026rsquo;s reach, we added CINAHL, a database of research from nursing and allied health journals, and Embase, a database of research relevant to pharmacology.\u003c/p\u003e\u003cp\u003eThe lead author worked in collaboration with a reference librarian to develop the search string (see Appendix I). Results from each search were imported into Covidence and reviewed for eligibility by two reviewers.\u003c/p\u003e\n\u003ch3\u003eSelection of sources of evidence:\u003c/h3\u003e\n\u003cp\u003eWe removed duplicate studies, leaving 365 studies to be screened. Two reviewers (AB and KH) screened the titles and abstracts using the inclusion and exclusion criteria described above; they removed an additional 278 studies. A full text review was conducted, eliminating an additional 56 studies. We extracted data from the 31 remaining studies.\u003c/p\u003e\n\u003ch3\u003eData charting:\u003c/h3\u003e\n\u003cp\u003eA data-charting matrix was initially developed in Excel to collect relevant data from each included study. The matrix was designed to identify trends highlighting what subpopulations were examined by the research within the larger population of SGM people with disabilities, how these populations were defined and how identity data were collected, research methods and data sources used, outcomes studied and how they were measured, and trends in study results. The charting matrix was then rebuilt in Covidence to facilitate feedback from additional authors.\u003c/p\u003e\u003cp\u003eStudy information collected included article title and all authors, the journal in which the article was published, and methodology and data sources used. The primary population characteristics extracted for review included SGM identity and disability characteristics including descriptions of how this population was defined and measured by each study. Other population characteristics recorded were the race/ethnicity, age, and geography of each population studied. We also extracted information on subgroups within the study population; group comparisons; and results of structural, physical and mental health outcomes (See Appendix II for the full extraction form).\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eExcluding duplicates, 365 studies were included in the initial title and abstract screening. Of these, 278 were not eligible, leaving 87 to be screened in the full-text review. Primary reasons for exclusion included: wrong patient population (n\u0026thinsp;=\u0026thinsp;37) (e.g., study population were not both SGM AND living with a disability); wrong study design (n\u0026thinsp;=\u0026thinsp;12) (e.g., the study did not record any structural or health outcomes beyond the prevalence of disability within the SGM population); or wrong setting (n\u0026thinsp;=\u0026thinsp;4) (e.g., the study included a population outside the United States). The 31 studies remaining after the full text screening were selected for data extraction. See Appendix III for a table detailing sources of evidence.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eStudy Design and Data Sources\u003c/h2\u003e\u003cp\u003eThe included studies used a range of study designs and data sources. The majority of studies used only quantitative methods (n\u0026thinsp;=\u0026thinsp;25): a minority used mixed methods (n\u0026thinsp;=\u0026thinsp;4), qualitative (n\u0026thinsp;=\u0026thinsp;3), experimental (n\u0026thinsp;=\u0026thinsp;1), and case study designs (n\u0026thinsp;=\u0026thinsp;1). Just under half (n\u0026thinsp;=\u0026thinsp;13) included studies that developed their own data set using a variety of recruitment methods. Other datasets used included The National Survey of Health and Disability, the LGBTQ National Teen Survey, Medicare insurance claims data, and other national or state level datasets.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eStudy Population\u003c/h3\u003e\n\u003cp\u003eThe majority of studies included in this review (n\u0026thinsp;=\u0026thinsp;24) examined people with disabilities more broadly, using a population of individuals with any type and severity of disability. The remaining studies looked only at those with physical disabilities (n\u0026thinsp;=\u0026thinsp;4) or at those with a specific disability (n\u0026thinsp;=\u0026thinsp;3). About half (n\u0026thinsp;=\u0026thinsp;15) of the studies focused on SGM individuals as a combined group. The remaining studies focused on more specific groups, including gender minority people of any sexuality (n\u0026thinsp;=\u0026thinsp;6), sexual minority people of any gender (n\u0026thinsp;=\u0026thinsp;5), sexual minority women (n\u0026thinsp;=\u0026thinsp;4), or sexual minority men (n\u0026thinsp;=\u0026thinsp;1).\u003c/p\u003e\n\u003ch3\u003eMeasurement of Disability\u003c/h3\u003e\n\u003cp\u003eAmong the studies included this review, 21 used some variation the yes/no question, \u0026ldquo;Do you have a disability?\u0026rdquo; Three studies included no follow-up question or other question related to disability. Of those with a follow-up question, six asked respondents to relate to a list of disability categories including physical, sensory, intellectual/developmental, psychiatric, or other. Other related questions asked the respondents to list specific disabilities (n\u0026thinsp;=\u0026thinsp;1), to indicate if they used any assistive equipment (n\u0026thinsp;=\u0026thinsp;1), or if they received special education in school or had an Individualized Education Program (IEP)(n\u0026thinsp;=\u0026thinsp;1). Two studies asked specifically about physical disability and included follow up questions about the type, duration, severity and age at the disability\u0026rsquo;s onset.\u003c/p\u003e\u003cp\u003eSix studies used surveys with questions that determined disability status using a variation of the six-item set of questions assessing hearing, vision, walking, cognition, self-care, and independent living that are used in the American Community Survey (ACS); one study used these questions as the sole disability measure, and the remaining five used them in addition to the binary disability question described above. The ACS questions are intended to define disability from a functional perspective[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], as opposed to defining disability by specific diagnoses or categories of disability.\u003c/p\u003e\u003cp\u003eAdditional ways in which the studies measured disability status included self-report of a specific disability (n\u0026thinsp;=\u0026thinsp;1), an unspecified self-report method (n\u0026thinsp;=\u0026thinsp;1) and Medicare eligibility due to disability (n\u0026thinsp;=\u0026thinsp;2).\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eMeasurement of Sexual Orientation and Gender Identity\u003c/h2\u003e\u003cp\u003eSexuality was included as a variable in 23 studies. All of the studies included a single self-report question asking participants to choose from a list of sexualities; all of the lists included some variation of straight/heterosexual, gay/homosexual/lesbian, or bisexual, typically with an option of \u0026ldquo;other\u0026rdquo; or \u0026ldquo;prefer not to answer.\u0026rdquo; Studies using data from sources specifically designed to capture the SGM population, such as the 2017 LGBTQ National Teen Survey and the 2019\u0026ndash;2020 National Study of LGBTQ\u0026thinsp;+\u0026thinsp;Student Success, were more likely to include additional options such asexual, two-spirit, queer, or questioning.\u003c/p\u003e\u003cp\u003eTwenty-two studies included gender minority people as a separate variable population. Only four of these did not use self-reported sex/gender to assess gender minority status; of those that used self-report, five did not specify the style of question used to assess gender minority status; all others used a two-part question. There was no standard question style assessing sex and gender across these studies. The most common style included seven studies that asked respondents to identify their sex/gender as male, female, and other. Those who answered \u0026ldquo;other\u0026rdquo; were asked to choose from options such as transgender, non-binary, two- spirit, gender non-conforming, genderqueer, agender, intersex, and choose not to disclose.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eOutcome Measures\u003c/h2\u003e\u003cp\u003eAs with the measures used to define the study population, the majority (n\u0026thinsp;=\u0026thinsp;27) of outcome measures used self-reported data. Outcome measures were divided into one of three categories: structural outcomes (n\u0026thinsp;=\u0026thinsp;21), physical health outcomes (n\u0026thinsp;=\u0026thinsp;9), and mental health outcomes (n\u0026thinsp;=\u0026thinsp;18).\u003c/p\u003e\u003cp\u003eStructural outcomes include those related to healthcare (n\u0026thinsp;=\u0026thinsp;8), violence and discrimination (n\u0026thinsp;=\u0026thinsp;9), and disability in the workplace (n\u0026thinsp;=\u0026thinsp;4). Investigation of healthcare outcomes (e.g., insurance coverage, receipt of healthcare regularly or in the past year, and experiences with healthcare professionals) showed that SGM adults with disabilities were more likely to have unmet healthcare needs and less access to healthcare than non-SGM people without disabilities. Studies examining structural outcomes focused on violence, bullying, and experiences with discrimination; all noted a higher rate of discrimination and victimization. Substantial gender-identity discrimination stemmed from the perceived violation of gender norms, with sexual minority women and those with nonnormative gender expressions experiencing more or more severe discrimination. Five studies examined social connectedness/support or resilience as adaptions to discrimination, but both social support and individual resilience were generally noted as lower among SGM people with disabilities. Those studies that examined disability in the workplace focused on disclosure of minority status, experiences with discrimination at work, and workplace accommodations. These studies found significant variation among subgroups on several measures but generally found that women of color and transgender people with disabilities were more likely to experience discrimination and less likely to receive workplace accommodations compared to their non-SGM and able-bodied counterparts.\u003c/p\u003e\u003cp\u003ePhysical health outcomes investigated include overall physical health and quality of life (n\u0026thinsp;=\u0026thinsp;7), physical activity and nutrition (n\u0026thinsp;=\u0026thinsp;4), weight related outcomes (n\u0026thinsp;=\u0026thinsp;3), prevalence of chronic illnesses (n\u0026thinsp;=\u0026thinsp;2), pain (n\u0026thinsp;=\u0026thinsp;2), sleep (n\u0026thinsp;=\u0026thinsp;1), and sexual behaviors (n\u0026thinsp;=\u0026thinsp;1). Each study that included a measure of general physical health showed that SGM youth and adults with disabilities had poorer general health and poorer physical quality of life. Of those studies looking at exercise, nutrition, and body weight, SGM youth and adults with disabilities reported less physical activity and greater BMI than non-SGM and able-bodied people. However, there was little investigation into differences in diet, and no analysis of how type or severity of disability impacted physical activity or BMI. In those studies that examined the prevalence of chronic illnesses, SGM adults with disabilities had a higher prevalence of most chronic illnesses when compared to SGM adults without disabilities, including lung, joint, metabolic, liver, kidney, and heart conditions. Substance use patterns were different among SGM minorities with disabilities when compared to non-SGM people without disabilities; however, there was enough variation by type of disability, type of substance, and other population characteristics to obscure general trends.\u003c/p\u003e\u003cp\u003eSeventeen studies investigated mental health outcomes, including direct outcomes such as overall mental health (n\u0026thinsp;=\u0026thinsp;5) and psychological distress (n\u0026thinsp;=\u0026thinsp;3), measures of depressive symptoms (n\u0026thinsp;=\u0026thinsp;6), suicidality (3), and self-esteem and body image (n\u0026thinsp;=\u0026thinsp;3).They also included outcomes indicative of interaction with the healthcare system, such as prevalence of mental health diagnoses (n\u0026thinsp;=\u0026thinsp;4) and use of prescribed psychotropic drugs (n\u0026thinsp;=\u0026thinsp;1). Across these studies, SGM adults with disabilities reported more psychological distress, more diagnosed mental health issues, and more days of poor mental health than non SGM adults with disabilities. SGM identity and disability status were each correlated to depression and anxiety, especially in relation to discrimination. Within this intersectional population, having a more severe disability or being nonbinary contributed to a greater likelihood of depression and anxiety. In both youth and adults, SGM identity and disability contributed to suicidality, both in SGM-only and disability-only groups as well as in the intersectional population.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eSynthesis of results:\u003c/h2\u003e\u003cp\u003e In sum, the outcomes measured in this systematic scoping review focused heavily on structural factors. Many of these studies found significant differences in healthcare among multiply-minoritized populations (e.g., transgender women of color). Physical health outcomes received less attention, but studies documented generally worse outcomes across all categories of physical health. Studies also focused on mental health outcomes, both independently and in relation to structural factors such as discrimination and stigma. The influence of protective structural factors on mental health were explored, such as the role of community connectedness on mental health outcomes including anxiety and substance use[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eStudy Design and Data Sources\u003c/h2\u003e\u003cp\u003eMost of the studies included in this review had a similar methodology. The majority were quantitative, collected cross-sectional data, and used a national-level survey sample from the National Survey on Health and Disability. A significant weakness of much of this research is inherent in these broad, nationwide datasets: most do not represent the general public. The National Survey of Health and Disability was the most commonly used dataset in this review. The authors of each study using these data note that the sample is disproportionately white and highly educated compared to the general U.S. population. This limitation is common to those datasets targeting the SGM population or those with disabilities. However, despite this limitation, the use of existing datasets covering a large population is a strength of the reviewed research. Though cross- sectional research such as this does not enable researchers to infer causal links among SGM identity, disability, and health outcomes, results based on such broad datasets are highly useful in identifying targets for policy development and future research.\u003c/p\u003e\u003cp\u003eMixed methods used in some studies may have contributed additional nuance to study findings. Only a minority of included studies used qualitative research methods, either alone or in conjunction with a quantitative component. The qualitative research provided context to quantitative data collection. Such research is needed to tailor future interventions to the unique needs of SGM people with disabilities.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eMeasurement of Sexual Orientation, Gender Identity and Disability\u003c/h2\u003e\u003cp\u003eAlthough the research methods used in this review are rather uniform, the definitions and measures used to identify SGM minority people vary significantly, largely in how transgender individuals are identified. A minority of studies used a binary question assessing sex/at birth and current gender, limiting the number of studies accurately assessing the unique needs of transgender and gender diverse populations. In collecting information about sexual identity, most studies used a list of sexualities, inviting respondents to note all that apply; variation in this question largely correlates with the target population (e. g. datasets targeting SGM populations specifically have larger lists with lesser known identities). The questions used to identify SGM respondents vary in structure and content, likely leading to inconsistency in how accurately this population is identified across studies.\u003c/p\u003e\u003cp\u003eThe definition of disability status also varies. While many studies simply ask for self- reported disability status, several also use questions to assess functional difficulties drawn from the ACS study, and a few also ask for specific conditions and diagnoses. This variation makes it difficult to compare disability populations across studies. A combination of the ACS or similar measures of functional difficulties alongside a question of disability identity (e.g. \u0026ldquo;Do you consider yourself disabled\u0026rdquo;) is likely to capture the full disability population. However other question types may be better at capturing specific disability subpopulations. The variability in how SGM and disability populations are measured is a significant weakness of the data included in this review. Subgroups among these populations may be better defined with other question type; however, absent standardized definitions of SGM people and/or people with disabilities, efforts to draw conclusions across studies will be hindered.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eOutcomes Investigated\u003c/h2\u003e\u003cp\u003eThe structural outcomes investigated can be broadly separated into structural, physical, and mental health outcomes. Physical health outcomes were comparatively under-investigated; they primarily included as outcomes general physical health, and to a lesser extent physical activity and sexual behavior. Mental health outcomes investigated were heavily weighted towards issues such as depression and suicidality and generalized poor mental health; issues such as substance use and other mental health issues were investigated less often.\u003c/p\u003e\u003cp\u003eThe relationship between structural outcomes and physical health outcomes was not thoroughly investigated among the studies in this review. By contrast, many studies included investigations of how structural and mental health outcomes relate to each other. This was especially true when the structural outcomes investigated were based in community connectedness, interpersonal relationships, or in institutions such as schools or workplaces. These studies heavily reference the role of stigma and discrimination, based both on disability status and gender/sexual identity, alone and in conjunction with each other or other minoritized identities.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003eLimitations:\u003c/h2\u003e\u003cp\u003eA significant limitation of this review is that each of the databases used contained research primarily in public health and related fields. Exploration of other databases may have identified more-relevant research from other disciplines, such as sociology or social work. In addition our search only considered peer-reviewed research; we did not explore potentially relevant grey literature.\u003c/p\u003e\u003cp\u003eAnother significant limitation is the way in which the literature search defined disability. The search string for disability was not expanded as fully as the search string for SGM identity, so it is likely that there are more ways of defining disability than are shown in this review. For future review of this research, it would be prudent to develop a more detailed search string for disability, using additional disability-related search terms. It may also be useful to include terms related to specific disabilities or chronic illnesses.\u003c/p\u003e\u003c/div\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003e This scoping review was intended to provide a summary of recent research focused on the health outcomes of SGM people living with disabilities. This population is relatively unstudied in public health research, and continuing research on this population may be threatened. In the process of conducting this review, we identified areas where application of diverse research methods may be useful, how these population may be best identified and measured, and what frameworks could inform future research questions.\u003c/p\u003e\u003cp\u003eLarger datasets such as those included in this review are valuable in concretely identifying trends in the health of marginalized populations, especially those such as SGM individuals, who often go unrecognized or underrepresented in research in general. Future research should make every effort to include racial and ethnic minorities in numbers large enough to address the needs of these subpopulations within the larger population of SGM people with disabilities. Larger datasets representative of these groups will facilitate analysis of factors that contribute to health outcomes for SGM individuals with disabilities.\u003c/p\u003e\u003cp\u003eIncluding more qualitative research on this population can add valuable nuance to the quantitative data contained in datasets such as these. To this end, exploration of research in other disciplines including the social sciences and area studies (e.g. LGBT or Disability Studies) may prove useful. As research in this population is still rather scarce, grey literature may also be a source of novel research ideas and methodology. Additionally, qualitative research can be embedded in quantitative research studies to provide context for quantitative results as was done in the studies by Blanck, Hyseni, and Wise[\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eGiven the relative scarcity of research on SGM people living with disability, the ways in which each group is defined is not standardized, and most research examines broad sections of this intersectional population. More standard ways of defining and measuring these populations will help to compare results across studies. Future studies should also explore how the type and visibility of disability, specific subgroups of SGM populations (e.g., bisexual people), and other characteristics (e.g., being a racial minority or older age) exacerbate experiences with stigma and discrimination.\u003c/p\u003e\u003cp\u003eAnalysis of the role race and ethnicity was limited. Only five studies included analysis by race/ethnicity via National Survey of Health and Disability data. Across each of these studies, race was correlated with differences in the prevalence of disability and outcome results. All studies noted that people of color in general had more negative health outcomes, though with some variation with respect to social connectedness, outness (of sexuality and/or disability), discrimination, and work/school accommodations.\u003c/p\u003e\u003cp\u003eFinally, the outcomes explored in this review are heavily weighted toward structural and mental health outcomes. This clearly highlights a gap in research on physical health outcomes, most of which focused on general health and behavioral health factors such as diet, exercise, and substance use. By contrast, those studies looking at structural and mental health outcomes were asking more complex research questions. Such research is highly relevant to a group with complex patterns of stigma and discrimination such as SGM people with disabilities.\u003c/p\u003e\u003cp\u003eSince the initiation of this research, the implications of being designated health disparities population by NIH have changed significantly. Indeed, this administration\u0026rsquo;s dramatic restrictions imposed on NIH will significantly impact research on SGM people living with disabilities going forward. Many researchers are unclear what the path forward may be for existing funding mechanisms. However, we have the opportunity to lean on and learn from our community partners to ensure that we can find adaptive and dynamic ways to provide high quality services to all, and especially those most marginalized. Doing so will likely require innovation, or at least a re-envisioning of our research approach; however in collaboration with our community partners, we can continue to advance our ability to address the unique and crosscutting needs of SGM living with disabilities.\u003c/p\u003e\u003cp\u003eWorks included in review\u003c/p\u003e\u003cp\u003eBlanck, P., Hyseni, F., \u0026amp; Altunkol Wise, F. (2020). Diversity and Inclusion in the American Legal Profession: Workplace Accommodations for Lawyers with Disabilities and Lawyers Who Identify as LGBTQ+. \u003cem\u003eJournal of Occupational Rehabilitation\u003c/em\u003e, \u003cem\u003e30\u003c/em\u003e(4), 537\u0026ndash;564. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s10926-020-09938-3\u003c/span\u003e\u003cspan address=\"10.1007/s10926-020-09938-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\u003cp\u003eBlanck, P., Hyseni, F., \u0026amp; Wise, F. A. (2021). Diversity and Inclusion in the American Legal Profession: Discrimination and Bias Reported by Lawyers with Disabilities and Lawyers Who Identify as LGBTQ+. \u003cem\u003eAmerican Journal of Law \u0026amp; Medicine\u003c/em\u003e, \u003cem\u003e47\u003c/em\u003e(1), 9\u0026ndash;61. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1017/amj.2021.1\u003c/span\u003e\u003cspan address=\"10.1017/amj.2021.1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\u003cp\u003eEliason, M. J., Martinson, M., \u0026amp; Carabez, R. M. (2015). Disability Among Sexual Minority Women: Descriptive Data from an Invisible Population. \u003cem\u003eLGBT Health\u003c/em\u003e, \u003cem\u003e2\u003c/em\u003e(2), 113\u0026ndash;120. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1089/lgbt.2014.0091\u003c/span\u003e\u003cspan address=\"10.1089/lgbt.2014.0091\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eEnding Radical and Wasteful Government DEI Programs and Preferencing\u003c/em\u003e. (2025, January 29). Federal Register. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.federalregister.gov/documents/2025/01/29/2025-01953/ending-radical-and-wasteful-government-dei-programs-and-preferencing\u003c/span\u003e\u003cspan address=\"https://www.federalregister.gov/documents/2025/01/29/2025-01953/ending-radical-and-wasteful-government-dei-programs-and-preferencing\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eHow Disability Data are Collected from The American Community Survey\u003c/em\u003e. (2021, November 21). Census. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.census.gov/topics/health/disability/guidance/data-collection-acs.html\u003c/span\u003e\u003cspan address=\"https://www.census.gov/topics/health/disability/guidance/data-collection-acs.html\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\u003cp\u003eHyseni, F., Myderrizi, A., \u0026amp; Blanck, P. (2022). Diversity and inclusion in the legal profession: Disclosure of cancer and other health conditions by lawyers with disabilities and lawyers who identify as LGBTQ +. \u003cem\u003eJournal of Cancer Survivorship\u003c/em\u003e, \u003cem\u003e16\u003c/em\u003e(1), 165\u0026ndash;182. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s11764-021-01143-2\u003c/span\u003e\u003cspan address=\"10.1007/s11764-021-01143-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eInitial Rescissions of Harmful Executive Orders and Actions\u003c/em\u003e. (2025, January 28). Federal Register. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.federalregister.gov/documents/2025/01/28/2025-01901/initial-rescissions-of-harmful-executive-orders-and-actions\u003c/span\u003e\u003cspan address=\"https://www.federalregister.gov/documents/2025/01/28/2025-01901/initial-rescissions-of-harmful-executive-orders-and-actions\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\u003cp\u003eLiu, M., Kadakia, K. T., Patel, V. R., \u0026amp; Krumholz, H. M. (2025). Characterization of Research Grant Terminations at the National Institutes of Health. \u003cem\u003eJAMA\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1001/jama.2025.7707\u003c/span\u003e\u003cspan address=\"10.1001/jama.2025.7707\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\u003cp\u003eNakkeeran, N., \u0026amp; Nakkeeran, B. (2018). Disability, mental health, sexual orientation and gender identity: Understanding health inequity through experience and difference. \u003cem\u003eHealth Research Policy and Systems\u003c/em\u003e, \u003cem\u003e16\u003c/em\u003e(S1), 97. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12961-018-0366-1\u003c/span\u003e\u003cspan address=\"10.1186/s12961-018-0366-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eNIH designates people with disabilities as a population with health disparities | National Institutes of Health (NIH)\u003c/em\u003e. (n.d.). Retrieved July 10, 2025, from \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.nih.gov/news-events/news-releases/nih-designates-people-disabilities-population-health-disparities\u003c/span\u003e\u003cspan address=\"https://www.nih.gov/news-events/news-releases/nih-designates-people-disabilities-population-health-disparities\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\u003cp\u003ePage, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hr\u0026oacute;bjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., \u0026hellip; Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. \u003cem\u003eBMJ\u003c/em\u003e, n71. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1136/bmj.n71\u003c/span\u003e\u003cspan address=\"10.1136/bmj.n71\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\u003cp\u003eSmith-Johnson, M. (2022). Transgender Adults Have Higher Rates Of Disability Than Their Cisgender Counterparts: Study examines rates of disability among transgender adults and cisgender adults. \u003cem\u003eHealth Affairs\u003c/em\u003e, \u003cem\u003e41\u003c/em\u003e(10), 1470\u0026ndash;1476. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1377/hlthaff.2022.00500\u003c/span\u003e\u003cspan address=\"10.1377/hlthaff.2022.00500\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\u003cp\u003eStreed CG Jr, Hall JP, Boyd BA, Batza K, \u0026amp; Kurth NK. (2021). Comparative Health Status and Characteristics of Respondents of the 2019\u0026ndash;2020 National Survey on Health and Disability by Sexual and Gender Minority Status. \u003cem\u003eLGBT Health\u003c/em\u003e, \u003cem\u003e8\u003c/em\u003e(8), 563\u0026ndash;568. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1089/lgbt.2021.0075\u003c/span\u003e\u003cspan address=\"10.1089/lgbt.2021.0075\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Amy Ball, Kelsey Hornbuckle, and Sarah MacCarthy. The first draft of the manuscript was written by Amy Ball, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eNIH (2023) NIH designates people with disabilities as a population with health disparities. National Institutes of Health, NIH.gov\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNakkeeran N, Nakkeeran B (Oct 9 2018) Disability, mental health, sexual orientation and gender identity: understanding health inequity through experience and difference. Health Res Policy Syst 16:97. no. Suppl 110.1186/s12961-018-0366-1\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSmith-Johnson M (Oct 2022) Transgender Adults Have Higher Rates Of Disability Than Their Cisgender Counterparts. Health Aff (Millwood) 41(10):1470\u0026ndash;1476. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1377/hlthaff.2022.00500\u003c/span\u003e\u003cspan address=\"10.1377/hlthaff.2022.00500\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e(2025) \u003cem\u003eExec. Order No. 14148, 3 C.F.R. 8237 Initial rescissions of harmful executive orders and actions.\u003c/em\u003e [Online] Available: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.federalregister.gov/documents/2025/01/28/2025-01901/initial-rescissions-of-harmful-executive-orders-and-actions\u003c/span\u003e\u003cspan address=\"https://www.federalregister.gov/documents/2025/01/28/2025-01901/initial-rescissions-of-harmful-executive-orders-and-actions\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e(2025) \u003cem\u003eExec. Order No. 14151, 3 C.F.R. 8338 Ending radical and wasteful government DEI programs and preferencing.\u003c/em\u003e. [Online] Available: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.federalregister.gov/documents/2025/01/29/2025-01953/ending-radical-and-wasteful-government-dei-programs-and-preferencing\u003c/span\u003e\u003cspan address=\"https://www.federalregister.gov/documents/2025/01/29/2025-01953/ending-radical-and-wasteful-government-dei-programs-and-preferencing\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLiu M, Kadakia KT, Patel VR, Krumholz HM (2025) Characterization of Research Grant Terminations at the National Institutes of Health. JAMA May 8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1001/jama.2025.7707\u003c/span\u003e\u003cspan address=\"10.1001/jama.2025.7707\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePage MJ et al (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews, \u003cem\u003eBMJ\u003c/em\u003e, vol. 372, p. n71, Mar 29 \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/bmj.n71\u003c/span\u003e\u003cspan address=\"10.1136/bmj.n71\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCensus How Disability Data are Collected from The American Community Survey. United States Census Bureau. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.census.gov/topics/health/disability/guidance/data-collection-acs.html\u003c/span\u003e\u003cspan address=\"https://www.census.gov/topics/health/disability/guidance/data-collection-acs.html\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (accessed\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEliason MJ, Martinson M, Carabez RM (2015) Disability Among Sexual Minority Women: Descriptive Data from an Invisible Population. LGBT health 2(2):113\u0026ndash;120. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1089/lgbt.2014.0091\u003c/span\u003e\u003cspan address=\"10.1089/lgbt.2014.0091\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBlanck P, Hyseni F, Altunkol Wise F (2020) Diversity and Inclusion in the American Legal Profession: Workplace Accommodations for Lawyers with Disabilities and Lawyers Who Identify as LGBTQ. J Occup Rehabil 30(4):537\u0026ndash;564. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s10926-020-09938-3\u003c/span\u003e\u003cspan address=\"10.1007/s10926-020-09938-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBlanck P, Hyseni F, Wise FA (2021) Diversity and Inclusion in the American Legal Profession: Discrimination and Bias Reported by Lawyers with Disabilities and Lawyers Who Identify as LGBTQ. Am J Law Med 47(1):9\u0026ndash;61. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1017/amj.2021.1\u003c/span\u003e\u003cspan address=\"10.1017/amj.2021.1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHyseni F, Myderrizi A, Blanck P (2022) Diversity and inclusion in the legal profession: disclosure of cancer and other health conditions by lawyers with disabilities and lawyers who identify as LGBTQ +. J Cancer Surviv 16(1):165\u0026ndash;182. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s11764-021-01143-2\u003c/span\u003e\u003cspan address=\"10.1007/s11764-021-01143-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"sexuality-and-disability","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"sedi","sideBox":"Learn more about [Sexuality and Disability](http://link.springer.com/journal/11195)","snPcode":"11195","submissionUrl":"https://submission.springernature.com/new-submission/11195/3","title":"Sexuality and Disability","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"LGBT, Disability, Intersectionality, Literature Review, Heath Outcomes","lastPublishedDoi":"10.21203/rs.3.rs-7660127/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7660127/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eIn 2023 the NIH designated people with disabilities as a population experiencing health disparities, adding to a list that included sexual and gender minority (SGM) people. Health disparities of each group have been documented, but studies exploring their intersection are limited.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003e The objective of this systematic scoping review is to characterize current research on SGM people with disabilities in the United States, including outcomes investigated, research methodology, data sources, and methods by which researchers define and measure SGM identity and disability.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eEligible studies were published in English from 2014\u0026ndash;2024 and examined the health outcomes of SGM people with disabilities in the United States. Searches of peer-reviewed literature from 3 databases (PubMed, CINHAL, and Embase) were uploaded into Covidence and screened for relevance; data from each included study were extracted for review.0\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe final review database included 31 studies. Most were quantitative, used a national sample, and focused on structural or mental health outcomes. The ways in which disability and SGM identity were measured varied across studies, complicating efforts to draw broad conclusions. Still, studies consistently showed that those at the intersection of SGM identity and disability were more affected by violence and discrimination than either population alone. Further, gender minority people with disabilities and sexual minority women of color with disabilities had worse structural outcomes.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eFuture research should explore how the type and visibility of disability, specific subgroups of SGM populations, and other characteristics influence health outcomes, especially how they are influenced by stigma and discrimination.\u003c/p\u003e","manuscriptTitle":"The Health of Sexual and Gender Minority People with Disabilities: A Systematic Scoping Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-16 05:08:43","doi":"10.21203/rs.3.rs-7660127/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-16T21:38:35+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-31T01:52:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"225701277688266510052225686697133762638","date":"2025-10-07T21:50:14+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"143615448440071185317751724392084888192","date":"2025-10-06T17:37:32+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-05T21:44:48+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-24T07:42:41+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-24T07:42:13+00:00","index":"","fulltext":""},{"type":"submitted","content":"Sexuality and Disability","date":"2025-09-19T15:45:06+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"sexuality-and-disability","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"sedi","sideBox":"Learn more about [Sexuality and Disability](http://link.springer.com/journal/11195)","snPcode":"11195","submissionUrl":"https://submission.springernature.com/new-submission/11195/3","title":"Sexuality and Disability","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"e041b6e2-1922-4e9d-a238-5751bab1e349","owner":[],"postedDate":"October 16th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-03-23T16:03:21+00:00","versionOfRecord":{"articleIdentity":"rs-7660127","link":"https://doi.org/10.1007/s11195-026-09937-x","journal":{"identity":"sexuality-and-disability","isVorOnly":false,"title":"Sexuality and Disability"},"publishedOn":"2026-03-18 15:57:37","publishedOnDateReadable":"March 18th, 2026"},"versionCreatedAt":"2025-10-16 05:08:43","video":"","vorDoi":"10.1007/s11195-026-09937-x","vorDoiUrl":"https://doi.org/10.1007/s11195-026-09937-x","workflowStages":[]},"version":"v1","identity":"rs-7660127","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7660127","identity":"rs-7660127","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}