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Abstract
Objective To systematically review all published and unpublished evidence on the impact of the COVID-19 pandemic on the health and well-being of UK sexual and gender minority (LGBT+; lesbian, gay, bisexual, transgender, non-binary, intersex and queer) people.
Methods Any relevant studies with or without comparator were included, with outcomes of: COVID-19 incidence, hospitalisation rates, illness severity, death rates, other health and well-being. Six databases (platforms) were searched—CINAHL Plus (Ovid), Cochrane Central (Cochrane Library), Medline (Ovid), Embase (Ovid), Science Citation Index (Web of Science) and Scopus between 2019 and 2020 in December 2020, using synonyms for sexual and gender minorities and COVID-19 search terms. Data extraction and quality assessment (using the relevant Joanna Briggs checklist) were in duplicate with differences resolved through discussion. Results were tabulated and synthesis was through narrative description.
Results No published research was found on any outcomes. Eleven grey literature reports found to be of low quality were included, mostly conducted by small LGBT+ charities. Only four had heterosexual/cisgender comparators. Mental health and well-being, health behaviours, safety, social connectedness and access to routine healthcare all showed poorer or worse outcomes than comparators.
Conclusions Lack of research gives significant concern, given pre-existing health inequities. Social and structural factors may have contributed to poorer outcomes (mental health, well-being and access to healthcare). Paucity of evidence is driven by lack of routinely collected sexual orientation and gender identity data, possibly resulting from institutional homophobia/transphobia which needs to be addressed. Men are more at risk of serious illness from COVID-19 than women, so using data from trans women and men might have started to answer questions around whether higher rates were due to sex hormone or chromosomal effects. Routine data collection on sexual orientation and gender identity is required to examine the extent to which COVID-19 is widening pre-existing health inequalities.
PROSPERO registration number CRD42020224304.
- COVID-19
- epidemiology
- infectious diseases
- public health
Data availability statement
Data sharing not applicable as no datasets generated and/or analysed for this study. This is a systematic review so data sharing not relevant.
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Data availability statement
Data sharing not applicable as no datasets generated and/or analysed for this study. This is a systematic review so data sharing not relevant.
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Footnotes
Contributors CM developed the original idea with discussions with LGBT activists and researchers. CM did the searches, HJL did double citation checking with CM and also looked on Google for additional studies. VJM conducted the systematic review double data extraction with CM. CM wrote the initial draft of the manuscript and all authors edited it.
Funding VJM is funded by the National Institute for Health Research (NIHR) School for Public Health Research (SPHR) (grant reference number PD-SPH-2015). The NIHR SPHR is a partnership between the Universities of Sheffield; Bristol; Cambridge; Imperial; and University College London; The London School for Hygiene and Tropical Medicine (LSHTM); LiLac–a collaboration between the Universities of Liverpool and Lancaster; and Fuse–the Centre for Translational Research in Public Health, a collaboration between Newcastle, Durham, Northumbria, Sunderland and Teesside Universities.
Disclaimer The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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