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

PROJECT NARRATIVE In this study, we examine the relationship between provider- and policy-level factors on cognitive decline and preventive healthcare use among midlife and older sexual and gender minority (SGM) adults. Using 2015-2019 BRFSS, we examine prevalence, severity, and receipt of informal care for subjective cognitive decline (SCD), a major risk factor for Alzheimer’s Disease, as well as estimate the association of state policies legally permitting denial of health services based on sexual orientation on preventive healthcare use. Using panel data from the NIA-funded Vanderbilt University Social Networks, Aging, and Policy Study (VUSNAPS), we test 7 provider-level attitudes and practices towards SGM patients as predictors of preventive healthcare among midlife and older SGM adults to address inequities in preventive healthcare use.