Comprehensive literature review overview matrix.

Sexual and gender minority (SGM) populations experience elevated rates of negative health outcomes (e.g., suicidality) and social determinants (e.g., poverty), which have been associated with general population mortality risk. Despite evidence of disparities in threats to well-being, it remains unclear whether SGM individuals have greater risk of mortality. This systematic review synthesized evidence on mortality among studies that included information about SGM. Three independent coders examined 6,255 abstracts, full-text reviewed 107 articles, and determined that 38 met inclusion criteria: 1) contained a sexual orientation or gender identity (SOGI) measure; 2) focused on a mortality outcome; 3) provided SGM vs non-SGM (i.e., exclusively heterosexual and cisgender) or general population comparisons of mortality outcomes; 4) were peer-reviewed; and 5) were available in English. A search of included articles’ references yielded 5 additional studies (total n = 43). The authors used the NIH’s Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies to assess included studies. Mortality outcomes included all-cause (n = 27), suicide/intentional self harm (n = 23), homicide (n = 7), and causes related to drug use (n = 3). Compared to non-SGM people, 14 studies (32.6%) supported higher mortality for SGM, 28 studies (65.1%) provided partial support of higher mortality for SGM (e.g., greater mortality from one cause but not another), one study (2.3%) found no evidence of higher mortality for SGM. There was considerable heterogeneity in operational definitions of SGM populations across studies. Although mixed, findings suggest elevated mortality for SGM versus non-SGM populations. Integrating SOGI measures into mortality surveillance would enhance understanding of disparities by standardizing data collection, thereby reducing heterogeneity and increasing capacity to aggregate results (e.g., meta-analyses).

性与性别少数群体（Sexual and Gender Minority, SGM）面临着更高比例的不良健康结局（如自杀意念）与社会决定因素困境（如贫困），而这些因素均与普通人群的死亡风险相关。尽管已有证据表明该群体在福祉威胁方面存在健康不平等，但目前仍不清楚性与性别少数群体是否拥有更高的死亡风险。本系统综述对纳入性与性别少数群体相关信息的死亡结局研究进行了证据整合。三名独立编码员对6255篇摘要进行了筛查，对107篇文献进行了全文审阅，最终确定38篇符合纳入标准：①包含性取向与性别认同（Sexual Orientation and Gender Identity, SOGI）测量指标；②以死亡结局为研究终点；③提供了性与性别少数群体与非少数群体（即仅异性恋和顺性别群体）或普通人群的死亡结局对比数据；④经过同行评议；⑤为英文文献。对纳入文献的参考文献进行检索后，又补充纳入5项研究，最终总样本量为43项。本研究采用美国国立卫生研究院（National Institutes of Health, NIH）的《观察性队列与横断面研究质量评估工具》对纳入的研究进行质量评价。死亡结局涵盖全因死亡（n=27）、自杀/故意伤害性自残（n=23）、他杀（n=7）以及与药物使用相关的死亡（n=3）。与非性与性别少数群体相比，14项研究（占比32.6%）证实性与性别少数群体的死亡风险更高；28项研究（占比65.1%）仅部分支持该群体死亡风险升高（例如仅在某一类死亡原因中观察到更高风险，而非全部死因）；另有1项研究（占比2.3%）未发现性与性别少数群体存在更高死亡风险的证据。不同研究中对性与性别少数群体的操作定义存在较大异质性。尽管研究结果存在分歧，但现有证据仍提示性与性别少数群体的死亡风险高于非少数群体。将性取向与性别认同测量指标纳入死亡监测体系，可通过标准化数据收集增进对健康不平等的认知，进而减少研究异质性并提升结果聚合（如元分析）的可行性。