Impact of the LGBT+ rights on reporting cases and deaths of Mpox globally: Relationships with the LGBT+ rights index during 2022-2024 epidemics

Abstract

INTRODUCTION: The 2022-2024 mpox epidemics have been studied regarding clinical features, diagnostics, therapies, and vaccines. However, the influence of LGBT+ rights on mpox morbidity and mortality remains unexplored. METHODS: An ecological study was conducted across 106 countries, utilizing the LGBT+ rights index (LGBT-RI) per country. It was obtained from a range of sources, including the State-Sponsored Homophobia Reports produced by ILGA, among others, from Our World in Data. The study also incorporated data on cases, incidence rates, and mortality rates from the U.S. Centers for Disease Control (CDC) and the World Health Organization (WHO). The annual variation of the variables was meticulously assessed, and non-linear regression models (exponential) were conducted at Stata/MP® v.14.0. RESULTS: The non-linear regression models yielded significant findings, underscoring the importance of this study. The analysis revealed a positive relationship between LGBT-RI and reported Mpox cases (r2=0.1006; p=0.0040), indicating that countries with higher LGBT-RI had higher Mpox cases. Similarly, higher LGBT-RI values were significantly associated with higher Mpox incidence rates (cases/100,000 pop) (r2=0.5062; p<0.0001). The number of deaths notified and the Mpox mortality rate were also associated with the LGBT-RI (r2=0.0636; p=0.0328 and r2=0.1390; p=0.0005, respectively). Notably, the %CFR was not associated with LGBT-RI (r2=0.0216; p=0.3287), as expected. DISCUSSION: These findings highlight the impact of stigma and LGBT+ rights on Mpox diagnosis, management, and reporting. Despite the 2022-2024 epidemics, 88 countries, including 10 in Latin America and the Caribbean, have yet to report Mpox, underscoring the need for further studies on its epidemiology.

Keywords

• LGBT+
• Mpox
• Epidemics
• correlation
• Epidemiology
• Outbreaks