Page 76 - AN-2-4

Advanced Neurologyurology
Advanced Ne Sexual behavior and multiple sclerosis

Individuals who engage in same-sex sexual behavior 9,589 females with same-sex behavior and 64,409 males and
are a unique subset of the general population, with known 137,450 females with opposite-sex behavior. Our control
health disparities relating to stigma and discrimination [9,10] . cohort consisted of 711,077 adults without documented
In addition, they also have unique healthcare needs that may high-risk sexual behavior. Full characteristics for the
impact MS care, such as use of pre-exposure prophylaxis cohorts, including age, race, ethnicity, other diagnoses
medications in men who have sex with men . Other such as infectious mononucleosis, and laboratory values
[11]
unique factors, such as monkeypox vaccination, are also for EBV antibody, are tabulated in Table 1.
greatly increased in this population . Research into the The risk of MS was significantly higher for individuals
[12]
current gap of knowledge regarding the ways in which MS engaging in same-sex behavior compared to individuals
differs in this unique subpopulation could hold potential
implications for future treatment. As a first step, we sought engaging in opposite-sex behavior. Males engaging in same-
to investigate the association between orientation of sexual sex behavior had a 2.80-fold higher risk of MS diagnosis
behavior and MS risk. (95% confidence interval [CI]: 1.66 – 4.73) and females
engaging in same-sex behavior had a 2.30-fold higher risk
2. Methods (95% CI: 1.65 – 3.20) of MS diagnosis (Figure 1). There was
no significant risk difference between adults engaging in
We collected aggregate, de-identified data from the TriNetX any form of high-risk sexual behavior compared to adults
research database. TriNetX is a health information database not engaging in high-risk sexual behavior (P = 0.41).
with over 85 million unique patient records. We obtained Table 2 contains information on cohort size and number of
data from the past 20 years ranging from April 3, 2002, patients with the outcome of interest.
to April 3, 2022, at 58 large health-care organizations.
Subject inclusion and exclusion criteria were defined using 4. Discussion
International Classification of Diseases (ICD) codes. We
created an investigative cohort defined by the presence of Our study found a significant association between same-
same-sex high-risk sexual behavior (ICD-10: Z72.52) and/or sex sexual behavior and the lifetime risk of MS. The
bisexual high-risk sexual behavior (ICD10: Z72.53) and the association was prominent in both male and female
absence of opposite-sex high-risk sexual behavior (ICD-10: patients, indicating a need for targeted research in this
Z72.51) . A comparator cohort was created, defined by the understudied area. Importantly, the lifetime risk of
[13]
presence of opposite-sex high-risk sexual behavior (ICD- MS in this population was found to be over twice that
10: Z72.51) and the absence of same-sex high-risk sexual of individuals engaging only in opposite-sex sexual
behavior (ICD-10: Z72.52, Z72.53). Finally, a third control encounters. The risk for males was nearly 3 times higher
cohort was created from patients who participated in any (OR: 2.80, 95% CI: 1.66 – 4.73) whereas the risk for females
virtual visit encounter in the TrinetX database and lacked was 2.3 times higher (OR: 2.30, 95% CI: 1.65 – 3.20). These
any previous history of high-risk sexual behavior (ICD-10: ratios were calculated after adjusting for age, sex, race, and
Z72.5). All patients were 18 years or older. The data were ethnicity, in addition to the recently identified risk factor
extracted from TriNetX on April 3, 2022. of EBV seropositivity, which had a notably low prevalence
The two investigative cohorts were stratified by sex; in our study population. This allowed the impact of sexual
males with exclusively same-sex behavior were compared behavior on MS to be isolated as much as possible. This
to males with opposite-sex behavior. We balanced cohorts finding invokes the need for further inquiry into MS in this
based on age, sex, race, ethnicity, infectious mononucleosis, unique population.
and EBV seropositivity using the TriNetX software, which One theory for this increased risk could lie in an
uses nearest-neighbor matching with a difference between increased level of stress experienced by these individuals,
propensity scores less than or equal to 0.1. After matching, notably during their adolescent years. Youths engaging
we investigated the outcome of lifetime diagnosis of MS in same-sex behavior but identifying as heterosexual
(ICD-10: G35). Rates of diagnosis were used to calculate risk experience higher rates of bullying and suicidality ,
[14]
ratio and odds ratio [OR]. Significance for this study was set which are types of adverse childhood experiences .
[15]
at P < 0.05. This study only utilized aggregated, deidentified Adverse childhood experiences are known to be linked
patient data and thus was exempted from review by the to increased neuroinflammation, increased autoimmune
Colorado Multiple Institutional Review Board (COMIRB). diseases, and earlier age of MS diagnosis, which could be
a contributing factor to the large association we found .
[16]
3. Results Youths who engage in same-sex behavior and identify as
We identified 234,022 adults with high-risk sexual LGBTQ+ also experience higher rates of adverse childhood
behavior. Of these patients, we identified 13,595 males and experiences . Future research could investigate the
[17]

Volume 2 Issue 4 (2023) 2 https://doi.org/10.36922/an.1383