1
|
Letter to the editor: "Incidence of prostate cancer in transgender women in the US: a large database analysis.". Prostate Cancer Prostatic Dis 2024:10.1038/s41391-024-00846-8. [PMID: 38769422 DOI: 10.1038/s41391-024-00846-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/02/2024] [Accepted: 05/09/2024] [Indexed: 05/22/2024]
|
2
|
Disparities in cancer incidence by sexual orientation. Cancer 2024. [PMID: 38733613 DOI: 10.1002/cncr.35356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/24/2024] [Accepted: 04/03/2024] [Indexed: 05/13/2024]
Abstract
INTRODUCTION Cancer risk factors are more common among sexual minority populations (e.g., lesbian, bisexual) than their heterosexual peers, yet little is known about cancer incidence across sexual orientation groups. METHODS The 1989-2017 data from the Nurses' Health Study II, a longitudinal cohort of female nurses across the United States, were analyzed (N = 101,543). Sexual orientation-related cancer disparities were quantified by comparing any cancer incidence among four sexual minority groups based on self-disclosure-(1) heterosexual with past same-sex attractions/partners/identity; (2) mostly heterosexual; (3) bisexual; and (4) lesbian women-to completely heterosexual women using age-adjusted incidence rate ratios (aIRR) calculated by the Mantel-Haenszel method. Additionally, subanalyses at 21 cancer disease sites (e.g., breast, colon/rectum) were conducted. RESULTS For all-cancer analyses, there were no statistically significant differences in cancer incidence at the 5% type I error cutoff among sexual minority groups when compared to completely heterosexual women; the aIRR was 1.17 (95% CI,0.99-1.38) among lesbian women and 0.80 (0.58-1.10) among bisexual women. For the site-specific analyses, incidences at multiple sites were significantly higher among lesbian women compared to completely heterosexual women: thyroid cancer (aIRR, 1.87 [1.03-3.41]), basal cell carcinoma (aIRR, 1.85 [1.09-3.14]), and non-Hodgkin lymphoma (aIRR, 2.13 [1.10-4.12]). CONCLUSION Lesbian women may be disproportionately burdened by cancer relative to their heterosexual peers. Sexual minority populations must be explicitly included in cancer prevention efforts. Comprehensive and standardized sexual orientation data must be systematically collected so nuanced sexual orientation-related cancer disparities can be accurately assessed for both common and rare cancers.
Collapse
|
3
|
Sexual and gender minority content in undergraduate medical education in the United States and Canada: current state and changes since 2011. BMC MEDICAL EDUCATION 2024; 24:482. [PMID: 38693525 PMCID: PMC11064371 DOI: 10.1186/s12909-024-05469-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 04/25/2024] [Indexed: 05/03/2024]
Abstract
PURPOSE To characterize current lesbian, gay, bisexual, transgender, queer, and intersex (LGBTQI +) health-related undergraduate medical education (UME) curricular content and associated changes since a 2011 study and to determine the frequency and extent of institutional instruction in 17 LGBTQI + health-related topics, strategies for increasing LGBTQI + health-related content, and faculty development opportunities. METHOD Deans of medical education (or equivalent) at 214 allopathic or osteopathic medical schools in Canada and the United States were invited to complete a 36-question, Web-based questionnaire between June 2021 and September 2022. The main outcome measured was reported hours of LGBTQI + health-related curricular content. RESULTS Of 214 schools, 100 (46.7%) responded, of which 85 (85.0%) fully completed the questionnaire. Compared to 5 median hours dedicated to LGBTQI + health-related in a 2011 study, the 2022 median reported time was 11 h (interquartile range [IQR], 6-16 h, p < 0.0001). Two UME institutions (2.4%; 95% CI, 0.0%-5.8%) reported 0 h during the pre-clerkship phase; 21 institutions (24.7%; CI, 15.5%-33.9%) reported 0 h during the clerkship phase; and 1 institution (1.2%; CI, 0%-3.5%) reported 0 h across the curriculum. Median US allopathic clerkship hours were significantly different from US osteopathic clerkship hours (4 h [IQR, 1-6 h] versus 0 h [IQR, 0-0 h]; p = 0.01). Suggested strategies to increase content included more curricular material focusing on LGBTQI + health and health disparities at 55 schools (64.7%; CI, 54.6%-74.9%), more faculty willing and able to teach LGBTQI + -related content at 49 schools (57.7%; CI, 47.1%-68.2%), and more evidence-based research on LGBTQI + health and health disparities at 24 schools (28.2%; CI, 18.7%-37.8%). CONCLUSION Compared to a 2011 study, the median reported time dedicated to LGBTQI + health-related topics in 2022 increased across US and Canadian UME institutions, but the breadth, efficacy, or quality of instruction continued to vary substantially. Despite the increased hours, this still falls short of the number of hours based on recommended LGBTQI + health competencies from the Association of American Medical Colleges. While most deans of medical education reported their institutions' coverage of LGBTQI + health as 'fair,' 'good,' or 'very good,' there continues to be a call from UME leadership to increase curricular content. This requires dedicated training for faculty and students.
Collapse
|
4
|
Gender-Affirming Hormone Therapy and Cervical Cancer Screening Rates in Transgender Men and Nonbinary People: A Cross-Sectional Study from a Boston Community Health Center. LGBT Health 2024. [PMID: 38669119 DOI: 10.1089/lgbt.2023.0418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
Purpose: Clinical monitoring for patients receiving gender-affirming hormone therapy (GAHT) has the potential to facilitate their receipt of preventive health services. We aimed to determine whether GAHT is associated with increased utilization of cervical cancer screening among transgender men (TM) and nonbinary persons assigned female at birth (NB-AFAB). Methods: We conducted a cross-sectional observational study of a single community health center in Boston. Persons of all gender identities eligible for cervical cancer screening during 2008-2019 were assessed. The outcome of interest was receipt of cervical cancer screening based on U.S. Preventive Services Task Force recommendations. We compared the proportion of persons who received cervical cancer screening by prescription of GAHT. Results: We identified 13,267 eligible persons. This cohort included 10,547 (79.5%) cisgender women, 1547 (11.7%) TM, and 1173 (8.8%) NB-AFAB persons. Among all persons eligible for cervical cancer screening, TM and NB-AFAB persons were less likely to receive screening than cisgender women (56.2% and 56.1% vs. 60.5% respectively; odds ratio [OR] = 0.84; 95% confidence interval [CI] = 0.75-0.93; OR = 0.84; 95% CI = 0.74-0.94, respectively). Among TM, those prescribed testosterone were more likely to receive cervical cancer screening than those not prescribed testosterone (57.9% vs. 48.2%, OR = 1.47; 95% CI = 1.14-1.92). Among NB-AFAB adults, those prescribed testosterone were more likely to receive cervical cancer screening than those not prescribed testosterone (61.9% vs. 51.5%, OR = 1.53; 95% CI = 1.21-1.93). Conclusions: The benefits of engagement in care to access GAHT may extend beyond the hormonal intervention to preventive health services.
Collapse
|
5
|
Gender Eligibility Descriptions for Clinical Trials. JAMA 2024; 331:1415-1416. [PMID: 38526485 DOI: 10.1001/jama.2024.0689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
|
6
|
Gender Diversity, Disability, and Well-Being: Impact of Delayed and Foregone Care Because of COVID-19. LGBT Health 2024; 11:210-218. [PMID: 38060697 DOI: 10.1089/lgbt.2022.0385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024] Open
Abstract
Purpose: This study explored the impact of delayed and foregone care due to COVID-19 on well-being among disabled and gender diverse adults. Methods: Using data from the 2021 National Survey on Health and Disability and logistic regression modeling we assessed the impact of delayed or foregone care due to COVID-19 on well-being among disabled people (n = 1638), with comparisons between cisgender (n = 1538) and gender diverse (n = 100) people with disabilities. We report odds ratios (OR) and confidence intervals (CI). Results: Disabled people reported high rates of delayed (79.36%) and foregone (67.83%) care and subsequent negative effects on well-being (72.07%). Gender diverse disabled people were over four times more likely to have delayed any care (OR 4.45, 95% CI 1.86-10.77) and three times more likely to have foregone any care (OR 3.14, 95% CI 1.71-5.79) due to COVID-19 compared to cisgender disabled people. They were three times more likely to report any negative impact on their health and well-being because of delayed and foregone care (OR 2.78, 95% CI 1.43-5.39). Conclusion: The COVID-19 pandemic affected the health care utilization of disabled people, resulting in high rates of delayed care, foregone care, and negative impacts on well-being. These effects were intensified at the intersection of disability and marginalized gender identity, with gender diverse disabled people having higher odds of delayed and foregone care and negative effects on well-being, including physical health, mental health, pain levels, and overall level of functioning.
Collapse
|
7
|
Sexual and gender minority health-related content in geriatric fellowships. J Am Geriatr Soc 2024; 72:866-874. [PMID: 37710405 DOI: 10.1111/jgs.18563] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/25/2023] [Accepted: 07/01/2023] [Indexed: 09/16/2023]
Abstract
INTRODUCTION Despite a growing number of older lesbian, gay, bisexual transgender, and queer (LGBTQ) adults in the United States, education on care for this vulnerable population has historically been inadequate across all levels of training. This research assessed the extent of LGBTQ education in geriatric medicine fellowship curricula across the United States. METHODS We designed a survey to anonymously collect information from geriatric medicine fellowship programs on LGBTQ curricular content. Eligible participants included all 160 fellowship directors on record with the American Geriatrics Society. The survey addressed demographics of the fellowship program, current state of inclusion of LGBTQ content in didactic curricula and in clinical settings, and other available training opportunities. RESULTS Out of those contacted, 80 (50%) completed the survey. Of the programs surveyed, 60 (75%) were housed in internal medicine, 19 (24%) were in family medicine, and one was in their own department. Forty-seven fellowships (59%) reported some formal didactic session (e.g., lecture or case based), with the majority of these programs (72%) featuring 1-2 h of formal instruction. Forty-five programs (56%) reported offering no formal clinical experiences. There was less than 50% coverage for all surveyed topics in the required curriculum (range 46% for discrimination to 9% for gender affirming care). Time and lack of expertise were cited as the main barriers to content inclusion. CONCLUSIONS Curricular content regarding care for LGBTQ older adults is inadequate in geriatric medicine fellowships. Faculty development of current educators and providing standardized guidelines and curricula are steps toward addressing this deficit.
Collapse
|
8
|
The Society of General Internal Medicine's Recommendations to Improve LGBTQ + Health. J Gen Intern Med 2024; 39:323-330. [PMID: 37803097 PMCID: PMC10853142 DOI: 10.1007/s11606-023-08400-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/24/2023] [Indexed: 10/08/2023]
Abstract
Lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ +) individuals experience bias in healthcare with 1 in 6 LGBTQ + adults avoiding healthcare due to anticipated discrimination and overall report poorer health status compared to heterosexual and cisgendered peers. The Society of General Internal Medicine (SGIM) is a leading organization representing academic physicians and recognizes that significant physical and mental health inequities exist among LGBTQ + communities. As such, SGIM sees its role in improving LGBTQ + patient health through structural change, starting at the national policy level all the way to encouraging change in individual provider bias and personal actions. SGIM endorses a series of recommendations for policy priorities, research and data collection standards, and institutional policy changes as well as community engagement and individual practices to reduce bias and improve the well-being and health of LGBTQ + patients.
Collapse
|
9
|
Comparison of faculty and student perceptions of sexual and gender minority content in a preclerkship medical curriculum. BMC MEDICAL EDUCATION 2023; 23:973. [PMID: 38115000 PMCID: PMC10731801 DOI: 10.1186/s12909-023-04925-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 12/01/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Sexual and gender minority (SGM) persons experience stark health disparities. Efforts to mitigate disparities through medical education have met some success. However, evaluations have largely focused on subjective perspectives rather than objective measures. This study aimed to quantify Boston University School of Medicine's sexual and gender minority (SGM) education through surveys of course directors (CDs) and medical students regarding where SGM topics were taught in the preclerkship medical curriculum. Responses were compared to identify concordance between faculty intention and student perceptions regarding SGM education. METHODS A cross-sectional survey was distributed to preclerkship CDs and current medical students in Spring 2019 and 2021, respectively, regarding where in the mandatory preclerkship curriculum CDs deliberately taught and where first- and second-year students recalled having learned 10 SGM topic domains. RESULTS 64.3% of CDs (n = 18), 47.0% of the first-year class (n = 71), and 67.3% of the second-year class (n = 101) responded to the surveys. Results indicate that, as anticipated, deliberate SGM teaching correlates with greater student recall as students recalled topics that were reported by CDs as intentionally taught at a significantly higher rate compared to those not intentionally taught (32.0% vs. 15.3%; p < 0.01). Students most commonly recalled learning SGM-related language and terminology, which is likely partly but not entirely attributed to curricular modifications and faculty development made between distribution of the faculty and student surveys, indicating the importance of all faculty being trained in appropriate SGM terminology and concepts. Discordance between faculty intention and student recall of when topics were taught reveals opportunities to enhance the intentionality and impact of SGM teaching. CONCLUSIONS Students perceive and recall SGM content that is not listed as learning objectives, and all faculty who utilize this material in their teachings should receive foundational training and be thoughtful about how information is framed. Faculty who intentionally teach SGM topics should be explicit and direct about the conclusions they intend students to draw from their curricular content.
Collapse
|
10
|
Androgenetic alopecia in transgender and gender diverse populations: A review of therapeutics. J Am Acad Dermatol 2023; 89:774-783. [PMID: 34756934 DOI: 10.1016/j.jaad.2021.08.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 08/14/2021] [Accepted: 08/17/2021] [Indexed: 10/20/2022]
Abstract
Androgenetic alopecia (AGA) management is a significant clinical and therapeutic challenge for transgender and gender-diverse (TGD) patients. Although gender-affirming hormone therapies affect hair growth, there is little research about AGA in TGD populations. After reviewing the literature on approved treatments, off-label medication usages, and procedures for treating AGA, we present treatment options for AGA in TGD patients. The first-line treatments for any TGD patient include topical minoxidil 5% applied to the scalp once or twice daily, finasteride 1 mg oral daily, and/or low-level laser light therapy. Spironolactone 200 mg daily is also first-line for transfeminine patients. Second-line options include daily oral minoxidil dosed at 1.25 or 2.5 mg for transfeminine and transmasculine patients, respectively. Topical finasteride 0.25% monotherapy or in combination with minoxidil 2% solution are second-line options for transmasculine and transfeminine patients, respectively. Other second-line treatments for any TGD patient include oral dutasteride 0.5 mg daily, platelet-rich plasma, or hair restoration procedures. After 6-12 months of treatment, AGA severity and treatment progress should be assessed via scales not based on sex; eg, the Basic and Specific Classification or the Bouhanna scales. Dermatologists should coordinate care with the patient's primary gender-affirming clinician(s) so that shared knowledge of all medications exists across the care team.
Collapse
|
11
|
Research Considerations in Digestive and Liver Disease in Transgender and Gender-Diverse Populations. Gastroenterology 2023; 165:523-528.e1. [PMID: 37599011 DOI: 10.1053/j.gastro.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
|
12
|
Research Considerations in Digestive and Liver Disease in Transgender and Gender-Diverse Populations. Clin Gastroenterol Hepatol 2023; 21:2443-2449.e2. [PMID: 37625866 DOI: 10.1016/j.cgh.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Indexed: 08/27/2023]
|
13
|
Cardiovascular Disease Risk Estimation for Transgender and Gender-Diverse Patients: Cross-Sectional Analysis of Baseline Data From the LITE Plus Cohort Study. AJPM FOCUS 2023; 2:100096. [PMID: 37790660 PMCID: PMC10546528 DOI: 10.1016/j.focus.2023.100096] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Introduction Approximately 2% of the U.S. population identifies as transgender, and transgender people experience disproportionate rates of cardiovascular disease mortality. However, widely used cardiovascular disease risk estimators have not been validated in this population. This study sought to determine the impact on statin therapy recommendations using 3 different approaches to operationalizing sex in the American Health Association/American College of Cardiology Pooled Cohort Equation Risk Estimator. Methods This is a cross-sectional analysis of baseline clinical data from LITE Plus, a prospective cohort study of Black and/or Latina transgender women with HIV. Data were collected from October 2020 to June 2022 and used to calculate Pooled Cohort Equation scores. Results The 102 participants had a mean age of 43 years. A total of 88% were Black, and 18% were Latina. A total of 79% were taking gender-affirming hormones. The average Pooled Cohort Equation risk score was 6% when sex assigned at birth was used and statins would be recommended for the 31% with Pooled Cohort Equation >7.5%. The average risk score was 4%, and 18% met the criteria for statin initiation when current gender was used; the mean risk score was 5%, and 22% met the criteria for statin initiation when current hormone therapy was used. Conclusions Average Pooled Cohort Equation risk scores vary substantially depending on the approach to operationalizing the sex variable, suggesting that widely used cardiovascular risk estimators may be unreliable predictors of cardiovascular disease risk in transgender populations. Collection of sex, gender, and hormone use in longitudinal studies of cardiovascular health is needed to address this important limitation of current risk estimators.
Collapse
|
14
|
Sexual and Gender Minority Refugees - Preparing Clinicians for the International Anti-LGBTQI+ Crisis. N Engl J Med 2023; 389:778-781. [PMID: 37632467 DOI: 10.1056/nejmp2305401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/28/2023]
|
15
|
Survey assessment of HIV pre-exposure prophylaxis availability in student health services in New England colleges and universities. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023:1-4. [PMID: 37463515 PMCID: PMC10836149 DOI: 10.1080/07448481.2023.2232465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 04/24/2023] [Accepted: 06/26/2023] [Indexed: 07/20/2023]
Abstract
Objective: To determine HIV pre-exposure prophylaxis (PrEP) availability at student health services (SHS) in New England. Methods: We conducted an electronic survey of medical directors of SHS at New England colleges and universities. We measured the availability and volume of PrEP prescribing, barriers and facilitators to prescribing and provider knowledge. Results: Of 143 institutions surveyed, 39% completed questionnaires; 75% were private and 93% were 4 years. Thirty-six percent of institutions did not offer PrEP. Those offering PrEP started a mean of 2.0 per 1000 students/year. PrEP was available at more schools with higher vs. lower endowments (100 vs. 38%, p = 0.002), 4- vs. 2-year programs (68 vs. 0%, p = 0.042), and private vs. public schools (73 vs. 38%, p = 0.043). Conclusions: PrEP was not available at one in three New England SHS and prescribing rates at institutions that offered PrEP were low. Interventions are needed to improve PrEP access.
Collapse
|
16
|
Assessing the Health Status of Sexual and Gender Minority Adults: What We Can Learn When We Include All of Us. JAMA Netw Open 2023; 6:e2324948. [PMID: 37523189 DOI: 10.1001/jamanetworkopen.2023.24948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/01/2023] Open
|
17
|
Validation of an administrative algorithm for transgender and gender diverse persons against self-report data in electronic health records. J Am Med Inform Assoc 2023; 30:1047-1055. [PMID: 36921287 PMCID: PMC10198536 DOI: 10.1093/jamia/ocad039] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 02/19/2023] [Accepted: 02/25/2023] [Indexed: 03/17/2023] Open
Abstract
OBJECTIVE To adapt and validate an algorithm to ascertain transgender and gender diverse (TGD) patients within electronic health record (EHR) data. METHODS Using a previously unvalidated algorithm of identifying TGD persons within administrative claims data in a multistep, hierarchical process, we validated this algorithm in an EHR data set with self-reported gender identity. RESULTS Within an EHR data set of 52 746 adults with self-reported gender identity (gold standard) a previously unvalidated algorithm to identify TGD persons via TGD-related diagnosis and procedure codes, and gender-affirming hormone therapy prescription data had a sensitivity of 87.3% (95% confidence interval [CI] 86.4-88.2), specificity of 98.7% (95% CI 98.6-98.8), positive predictive value (PPV) of 88.7% (95% CI 87.9-89.4), and negative predictive value (NPV) of 98.5% (95% CI 98.4-98.6). The area under the curve (AUC) was 0.930 (95% CI 0.925-0.935). Steps to further categorize patients as presumably TGD men versus women based on prescription data performed well: sensitivity of 97.6%, specificity of 92.7%, PPV of 93.2%, and NPV of 97.4%. The AUC was 0.95 (95% CI 0.94-0.96). CONCLUSIONS In the absence of self-reported gender identity data, an algorithm to identify TGD patients in administrative data using TGD-related diagnosis and procedure codes, and gender-affirming hormone prescriptions performs well.
Collapse
|
18
|
Sexual Minority Status Disparities in Life's Essential 8 and Life's Simple 7 Cardiovascular Health Scores: A French Nationwide Population-Based Study. J Am Heart Assoc 2023:e028429. [PMID: 37195318 PMCID: PMC10382002 DOI: 10.1161/jaha.122.028429] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Background A higher burden of cardiovascular disease risk factors has been reported in sexual minority populations. Primordial prevention may therefore be a relevant preventative strategy. The study's objectives are to estimate the associations of Life's Essential 8 (LE8) and Life's Simple 7 (LS7) cardiovascular health scores with sexual minority status. Methods and Results The CONSTANCES is a nationwide French epidemiological cohort study that recruited randomly selected participants older than 18 years in 21 cities. Sexual minority status was based on self-reported lifetime sexual behavior and categorized as lesbian, gay, bisexual, or heterosexual. The LE8 score includes nicotine exposure, diet, physical activity, body mass index, sleep health, blood glucose, blood pressure, and blood lipids. The previous LS7 score included 7 metrics without sleep health. The study included 169 434 cardiovascular disease-free adults (53.64% women; mean age, 45.99 years). Among 90 879 women, 555 were lesbian, 3149 were bisexual, and 84 363 were heterosexual. Among 78 555 men, 2421 were gay, 2748 were bisexual, and 70 994 were heterosexual. Overall, 2812 women and 2392 men declined to answer. In multivariable mixed effects linear regression models, lesbian (β=-0.95 [95% CI, -1.89 to -0.02]) and bisexual (β=-0.78 [95% CI, -1.18 to -0.38]) women had a lower LE8 cardiovascular health score compared with heterosexual women. Conversely, gay (β=2.72 [95% CI, 2.25-3.19]) and bisexual (β=0.83 [95% CI, 0.39-1.27]) men had a higher LE8 cardiovascular health score compared with heterosexual men. The findings were consistent, although of smaller magnitudes for the LS7 score. Conclusions Cardiovascular health disparities exist in sexual minority adults, particularly lesbian and bisexual women, who may represent a priority population for primordial cardiovascular disease prevention.
Collapse
|
19
|
Caring for LGBTQ+ Older Adults at Home. J Gen Intern Med 2023; 38:1538-1540. [PMID: 36763203 PMCID: PMC10160310 DOI: 10.1007/s11606-023-08064-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 01/27/2023] [Indexed: 02/11/2023]
|
20
|
Improving the cardiovascular health care of transgender and non-binary persons. Nat Rev Cardiol 2023; 20:367-368. [PMID: 37041344 DOI: 10.1038/s41569-023-00871-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
|
21
|
Differences in Ideal Cardiovascular Health Between Sexual Minority and Heterosexual Adults. JAMA Cardiol 2023; 8:335-346. [PMID: 36811854 PMCID: PMC9947804 DOI: 10.1001/jamacardio.2022.5660] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 12/23/2022] [Indexed: 02/24/2023]
Abstract
Importance Research on the cardiovascular health (CVH) of sexual minority adults has primarily examined differences in the prevalence of individual CVH metrics rather than comprehensive measures, which has limited development of behavioral interventions. Objective To investigate sexual identity differences in CVH, measured using the American Heart Association's revised measure of ideal CVH, among adults in the US. Design, Setting, and Participants This cross-sectional study analyzed population-based data from the National Health and Nutrition Examination Survey (NHANES; 2007-2016) in June 2022. Participants included noninstitutional adults aged 18 to 59 years. We excluded individuals who were pregnant at the time of their interview and those with a history of atherosclerotic cardiovascular disease or heart failure. Exposures Self-identified sexual identity categorized as heterosexual, gay/lesbian, bisexual, or something else. Main Outcomes and Measures The main outcome was ideal CVH (assessed using questionnaire, dietary, and physical examination data). Participants received a score from 0 to 100 for each CVH metric, with higher scores indicating a more favorable CVH profile. An unweighted average was calculated to determine cumulative CVH (range, 0-100), which was recoded as low, moderate, or high. Sex-stratified regression models were performed to examine sexual identity differences in CVH metrics, disease awareness, and medication use. Results The sample included 12 180 participants (mean [SD] age, 39.6 [11.7] years; 6147 male individuals [50.5%]). Lesbian (B = -17.21; 95% CI, -31.98 to -2.44) and bisexual (B = -13.76; 95% CI, -20.54 to -6.99) female individuals had less favorable nicotine scores than heterosexual female individuals. Bisexual female individuals had less favorable body mass index scores (B = -7.47; 95% CI, -12.89 to -1.97) and lower cumulative ideal CVH scores (B = -2.59; 95% CI, -4.84 to -0.33) than heterosexual female individuals. Compared with heterosexual male individuals, gay male individuals had less favorable nicotine scores (B = -11.43; 95% CI, -21.87 to -0.99) but more favorable diet (B = 9.65; 95% CI, 2.38-16.92), body mass index (B = 9.75; 95% CI, 1.25-18.25), and glycemic status scores (B = 5.28; 95% CI, 0.59-9.97). Bisexual male individuals were twice as likely as heterosexual male individuals to report a diagnosis of hypertension (adjusted odds ratio [aOR], 1.98; 95% CI, 1.10-3.56) and use of antihypertensive medication (aOR, 2.20; 95% CI, 1.12-4.32). No differences in CVH were found between participants who reported their sexual identity as something else and heterosexual participants. Conclusion and Relevance Results of this cross-sectional study suggest that bisexual female individuals had worse cumulative CVH scores than heterosexual female individuals, whereas gay male individuals generally had better CVH than heterosexual male individuals. There is a need for tailored interventions to improve the CVH of sexual minority adults, particularly bisexual female individuals. Future longitudinal research is needed to examine factors that might contribute to CVH disparities among bisexual female individuals.
Collapse
|
22
|
Assessing and Addressing the Risk of Venous Thromboembolism Across the Spectrum of Gender Affirming Care: A Review. Endocr Pract 2023; 29:272-278. [PMID: 36539066 PMCID: PMC10081942 DOI: 10.1016/j.eprac.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 12/01/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Accumulating evidence demonstrates that gender affirming hormone therapy (GAHT) improves mental health outcomes in transgender persons. Data specific to the risks associated with GAHT for transgender persons continue to emerge, allowing for improvements in understanding, predicting, and mitigating adverse outcomes while informing discussion about desired effects. Of particular concern is the risk of venous thromboembolism (VTE) in the context of both longitudinal GAHT and the perioperative setting. Combining what is known about the risk of VTE in cisgender individuals on hormone therapy (HT) with the evidence for transgender persons receiving HT allows for an informed approach to assess underlying risk and improve care in the transgender community. OBSERVATIONS Hormone formulation, dosing, route, and duration of therapy can impact thromboembolic risk, with transdermal estrogen formulations having the lowest risk. There are no existing risk scores for VTE that consider HT as a possible risk factor. Risk assessment for recurrent VTE and bleeding tendencies using current scores may be helpful when assessing individual risk. Gender affirming surgeries present unique perioperative concerns, and certain procedures include a high likelihood that patients will be on exogenous estrogens at the time of surgery, potentially increasing thromboembolic risk. CONCLUSIONS AND RELEVANCE Withholding GAHT due to potential adverse events may cause negative impacts for individual patients. Providers should be knowledgeable about the management of HT in transgender individuals of all ages, as well as in the perioperative setting, to avoid periods in which transgender individuals are off GAHT. Treatment decisions for both anticoagulation and HT should be individualized and tailored to patients' overall goals and desired outcomes, given that the physical and mental health benefits of gender affirming care may outweigh the risk of VTE.
Collapse
|
23
|
Including sexual orientation and gender identity data to advance nephrology care. Nat Rev Nephrol 2023; 19:355-356. [PMID: 37002366 PMCID: PMC10064956 DOI: 10.1038/s41581-023-00712-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
|
24
|
A103 DESIGNING QUALITATIVE RESEARCH FOR UNDERSTANDING THE EXPERIENCES OF TRANGENDER AND GENDER DIVERSE PERSONS WITH GASTROINTESTINAL DISEASE OR SEEKING GASTROINTESTINAL CARE. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991378 DOI: 10.1093/jcag/gwac036.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background Transgender and gender diverse (TGD) people make up approximately 1% of the population, with 2.1% of Generation Z adults (born 1997-2003) identifying as TGD. As a marginalized population, TGD people have been shown to have poorer access to health care services and report worse health-related outcomes. While the health care disparities faced by TGD people need to be addressed by Medicine broadly, TGD people may face unique barriers in gastrointestinal (GI) care. To date, there has been no systematic assessment of the GI health care needs of TGD people. With the aging of Generation Z, GI care providers will increasingly be responsible for the care of TGD people, and it is important to understand their needs and experiences to ensure they receive appropriate and sensitive care. Purpose Recognizing the absence of literature on the issues faced by TGD people with GI disease or seeking care for GI issues, we plan to use qualitative research methodology to aggregate and analyze narrative experiences of TGD people of diverse backgrounds, identities and experiences. Our research will focus on TGD people’s interactions with GI care providers, and on the experience of being a TGD person with GI disease or having sought evaluation of GI symptoms. Method We will use a qualitative approach to gain a broad understanding of the experiences and perceptions of TGD people with: 1) established GI diseases, in particular IBD and DGBIs (disorders of gut-brain interaction), and 2) GI symptoms or concerns requiring GI investigations. We will use snowball sampling to reach out to TGD people in Canada and the US, with the aim of achieving diverse representation across gender identity, surgical status, age, race/ethnicity, and socioeconomic status. Participants will sit for semi-structured interviews to elicit narratives about their beliefs and experiences while living with GI disease and/or seeking care for GI issues. Interview transcripts will be subjected to objective and researcher-guided thematic analysis to identify commonalities and disparities in experiences and points-of-view. Result(s) Our proposed presentation will highlight our process in designing and initiating this project. We believe our methods and approach to this work is an important discussion and will help shape next steps in this field. We may also present some of the early results of our semi-structured interviews. Conclusion(s) This work will provide a foundation to guide further research into the process and outcomes of care for TGD people with GI disease and undergoing GI evaluations and will provide a framework to develop best practices for GI care providers pertaining to the care of TGD people. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared
Collapse
|
25
|
Assessing and Addressing the Well-being of Lesbian, Gay, Bisexual, Transgender, and Gender Nonconforming Younger Adults in China. JAMA Netw Open 2023; 6:e232299. [PMID: 36961470 DOI: 10.1001/jamanetworkopen.2023.2299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/25/2023] Open
|
26
|
Abstract P189: Sexual Minority Status Disparities in Life’s Simple 7 and Life’s Essential 8 Cardiovascular Health Scores, a French Nationwide Population-Based Study. Circulation 2023. [DOI: 10.1161/circ.147.suppl_1.p189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
A higher burden of cardiovascular disease risk factors has been reported in sexual minority populations (SM), such as lesbian, gay, bisexual, and non-heterosexual, compared to heterosexual populations. Therefore, primordial prevention, i.e., preventing risk factor onset in the first place, may be a relevant preventative strategy in this population. This study aimed to quantify the associations of SM status in each sex with Life’s Simple 7 (LS7) and Life’s Essential 8 (LE8) cardiovascular health (CVH) scores. The CONSTANCES study is a multicentric study that recruited randomly selected adults in 24 health examination centers in 21 cities in the French European territory. Sexual minority status was based on self-reported lifetime sexual behavior and categorized as lesbian, gay, bisexual, or heterosexual. The study included 169,434 CVD-free participants (53.64% women, mean age: 46.00 years). Among 90879 women, 555 were lesbian, 3149 bisexual, and 84363 heterosexual. Among 78555 men, 2421 were gay, 2748 bisexual, and 70994 heterosexual. Overall, 2812 women and 2392 men declined to answer. In women, the prevalence of high LS7 scores (12-14) ranged from 9.00% (declined to answer) to 12.38% (bisexual), whereas in men, it ranged from 4.06% (declined to answer) to 9.17% (gay). In multivariate analyses (Table 1), lesbian and bisexual women had lower LS7 score compared to heterosexual women. However, this was observed only among those who had never been pregnant (p for interaction <0.05). Conversely, gay and bisexual men living in urban areas had higher LS7 score compared to heterosexual men, while those living in rural areas had lower LS7 score than their heterosexual counterparts (p for interaction <0.05). Findings were consistent when using the LE8 score but with stronger effect sizes (Table 1). This study supports the presence of CVH disparities in sexual minority adults and may help identify vulnerable populations for prioritizing primordial CVD prevention.
Collapse
|
27
|
Beyond Sex-Based Medicine in Cardiovascular Health Research and Practice. Circulation 2023; 147:529-531. [PMID: 36780385 PMCID: PMC9936622 DOI: 10.1161/circulationaha.122.063156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
|
28
|
On, With, By-Advancing Transgender Health Research and Clinical Practice. Health Equity 2023; 7:161-165. [PMID: 36895704 PMCID: PMC9989508 DOI: 10.1089/heq.2022.0146] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2023] [Indexed: 03/06/2023] Open
Abstract
To advance the fields of transgender health research and clinical care and center trans-led scholarship, there must be an acknowledgment of the consolidated power in cisgender hands and the subsequent need to redistribute such power to trans experts and burgeoning trans leaders. To redress the social structures that cause harm and limit opportunities for trans persons to lead, current cisgender leaders can take actions including deferring opportunities to trans persons to ensure a redistribution of power and resources to trans experts. This article presents necessary steps to recruit, collaborate, and elevate trans experts.
Collapse
|
29
|
Advancing undergraduate medical education regarding the care of transgender and gender Diverse persons and communities. PERSPECTIVES ON MEDICAL EDUCATION 2022; 11:306-308. [PMID: 36435909 PMCID: PMC9743931 DOI: 10.1007/s40037-022-00732-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/31/2022] [Indexed: 06/16/2023]
|
30
|
Gender and Sexual Diverse Health Education: A Needs Assessment Among Internal Medicine Residents. LGBT Health 2022; 9:589-594. [PMID: 35905057 DOI: 10.1089/lgbt.2022.0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Purpose: The purpose of this study was to assess perception of competency and comfort level of internal medicine (IM) residents in caring for gender and sexual diverse (GSD) patients, and to identify residents' preferred educational modalities and perceived facilitators and barriers to GSD curriculum implementation. Methods: A survey was distributed among IM residents during a mandatory didactic session between November 9 and December 18, 2020. Categorical variables were analyzed using Fisher's exact test. Open-ended questions were analyzed using content and theme analysis. Results: Of 138 residents, 89 (64%) completed the survey. Residents had varying levels of comfort and perceived competence. Small group (n = 61, 69%) and case-based learning (n = 58, 66%) formats were preferred. Content and theme analysis resulted in four major themes on facilitators and three major themes on barriers to GSD curricular implementation. Conclusion: This study provides unique insight to facilitate implementation of a learner-centered and developmentally appropriate curricular approach to GSD health education.
Collapse
|
31
|
Prevalence of HIV Preexposure Prophylaxis Prescribing Among Persons With Commercial Insurance and Likely Injection Drug Use. JAMA Netw Open 2022; 5:e2221346. [PMID: 35819784 PMCID: PMC9277489 DOI: 10.1001/jamanetworkopen.2022.21346] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 03/21/2022] [Indexed: 11/26/2022] Open
Abstract
Importance Although HIV preexposure prophylaxis (PrEP) implementation among persons who inject drugs has been inadequate, national HIV monitoring programs do not include data on PrEP, and specific trends in PrEP use are not well understood. Objective To estimate HIV PrEP uptake among commercially insured persons with opioid or stimulant use disorder by injection drug use (IDU) status. Design, Setting, and Participants This cross-sectional study used deidentified data from the MarketScan Commercial Claims and Encounters Database to identify a sample of 547 709 commercially insured persons without HIV but with opioid and/or stimulant use disorder, including 110 592 with evidence of IDU between January 1, 2010, and December 31, 2019. Data were analyzed from November 1, 2020, to July 1, 2021. Exposures Persons with opioid and/or stimulant use disorder and evidence of IDU were identified through claims data. Main Outcomes and Measures The outcome was receipt of tenofovir disoproxil fumarate and emtricitabine for PrEP as identified from filled pharmacy claims. Multivariable logistic regression was used to assess the association of demographic and clinical characteristics with receipt of PrEP. Results The study cohort included 211 609 (28.6%) females and 336 100 (61.4%) males with a combined mean (SD) age of 34.8 (13.1) years, including 110 592 individuals with evidence of IDU. During the study period, 508 (0.09%) persons with opioid and/or stimulant use disorder, including 170 (0.15%) with evidence of IDU, received PrEP. Receipt of PrEP increased from 0.001 to 0.243 per 100 person-years from 2010 through 2019 among the entire cohort and from 0.000 to 0.295 per 100 person-years among those with IDU. In multivariable analysis, PrEP use was more likely among males (adjusted odds ratio [aOR] 8.72; 95% CI, 6.39-11.89), persons with evidence of IDU (aOR, 1.47; 95% CI, 1.21-1.79), and persons with evidence of sexual risk indications for PrEP (aOR, 23.68; 95% CI, 19.57-28.66). Conclusions and Relevance In this cross-sectional study of commercially insured persons with opioid and/or stimulant use disorder, HIV PrEP delivery remained low, including among those with evidence of IDU. PrEP should be consistently offered alongside substance use disorder treatment and other harm reduction and HIV prevention services.
Collapse
|
32
|
Health Communication and Sexual Orientation, Gender Identity, and Expression. Med Clin North Am 2022; 106:589-600. [PMID: 35725226 PMCID: PMC9219031 DOI: 10.1016/j.mcna.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The purpose of this article is to provide guidance on completing a thorough, competent, and culturally appropriate health history with details specific to the care of lesbian, gay, bisexual, transgender, queer, intersex, and asexual (LGBTQIA) persons and communities.
Collapse
|
33
|
Safety and Predictors of Sexual Minority Youth Carrying Weapons. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP8724-NP8746. [PMID: 33289455 PMCID: PMC8184859 DOI: 10.1177/0886260520978183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Prior research has revealed sexual minority youth are more likely to carry weapons both outside of and within school. However, to date, no study has examined the degree to which bullying and harassment is associated with weapon carrying among sexual minority youth. We utilized the Youth Risk Behavior Survey to examine the prevalence and likelihood of carrying weapons by sexual identity, adjusting for adverse experiences. From the Youth Risk Behavior Survey 2009-2015, we examined self-report of adverse experiences (e.g., being bullied, skipping school due to fear for personal safety) and performed Logistic regressions to estimate the odds of carrying a weapon and were adjusted to include demographics and adverse experiences. When surveyed by sexual identity, 14.0% of heterosexual, 21.8% of gay/lesbian, 18.5% of bisexual, and 17.4% of "not sure" students reported carrying a weapon in the past 30 days. Odds of carrying a weapon were significantly increased for youth who skipped school due to feeling unsafe at school, had ever been threatened with a weapon in the past year, and had ever been in a physical fight. Compared to heterosexual female peers, sexual minority women had increased odds of carrying a weapon. Pediatricians should recognize that experiencing bullying and feeling unsafe are associated with weapon carrying, particularly among sexual minorities. Pediatricians and professionals who work with youth should recognize that reported experiences of bullying may not be the most salient indicator of risk for weapon carrying among all youth, and that other fears of or experiences with bullying are crucial to screen for among sexual minorities in particular.
Collapse
|
34
|
A Novel Curriculum Assessment Tool, Based on AAMC Competencies, to Improve Medical Education About Sexual and Gender Minority Populations. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:524-528. [PMID: 34108379 DOI: 10.1097/acm.0000000000004203] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PROBLEM Medical education aspires to mitigate bias in future professionals by providing robust curricula that include perspectives of and practices for caring for sexual and gender minority (SGM) populations; however, implementation of these ideals remains challenging. Medical school leaders motivated to improve curricula on caring for SGM populations must survey their school's current curricula to identify strengths and opportunities for improvement. In 2014, the Association of American Medical Colleges (AAMC) published 30 SGM competencies that curricula should address. Here the authors describe the development of a tool to efficiently assess whether an undergraduate medical education (UME) curriculum adequately incorporates the AAMC-recommended SGM competencies. APPROACH In 2018, Boston University School of Medicine (BUSM) convened a group of faculty and students with experience and expertise regarding SGM health. The group distilled the 30 AAMC competencies into 12 SGM topic areas that should be addressed in any UME curriculum, and they developed a curriculum assessment tool to evaluate the presence and timing of these topic areas in the BUSM curriculum. This tool was distributed to all course and clerkship directors responsible for the required UME curriculum at BUSM to investigate where these topic areas are addressed (May-June 2019). OUTCOMES The curriculum assessment tool identified several strengths in the preclerkship and clerkship curricula, including faculty willingness and enthusiasm to include SGM content. The assessment tool also revealed that some SGM topic areas are underrepresented in the BUSM curriculum, particularly during clerkships. NEXT STEPS The curriculum assessment tool described here is a straightforward, standardized instrument to map SGM topic areas within any UME curriculum. It is designed to be comprehensible by individuals who are not familiar with SGM health. The tool minimizes barriers to medical curricular change by providing a mechanism to assess and understand how SGM health is incorporated into existing curricula.
Collapse
|
35
|
Gender Identity, Disability, and Unmet Healthcare Needs among Disabled People Living in the Community in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052588. [PMID: 35270279 PMCID: PMC8909748 DOI: 10.3390/ijerph19052588] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 02/14/2022] [Accepted: 02/16/2022] [Indexed: 12/10/2022]
Abstract
Disabled adults and transgender people in the United States face multiple compounding and marginalizing forces that result in unmet healthcare needs. Yet, gender identity among disabled people has not been explored, especially beyond binary categories of gender. Using cross-sectional survey data, we explored the rates of disability types and the odds of unmet healthcare needs among transgender people with disabilities compared to cisgender people with disabilities. The rates of disability type were similar between transgender and cisgender participants with two significant differences. Fewer transgender participants identified physical or mobility disability as their main disability compared to cisgender participants (12.31%/8 vs. 27.68/581, p < 0.01), and more transgender participants selected developmental disability as their main disability compared to cisgender participants (13.85%/9 vs. 3.67%/77, p < 0.001). After adjusting for sociodemographic characteristics, the odds of disabled transgender participants reporting an unmet need were higher for every unmet need except for preventative services.
Collapse
|
36
|
Intersectionality and cancer survivorship: Sexual orientation and racial/ethnic differences in physical and mental health outcomes among female and male cancer survivors. Cancer 2022; 128:284-291. [PMID: 34499367 PMCID: PMC8738152 DOI: 10.1002/cncr.33915] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Because of concerns about sexual minorities' poor cancer survivorship, this study compared cancer survivors' health outcomes in relation to multiple intersecting social positions, namely gender, sexual orientation, and race/ethnicity. METHODS This secondary data analysis used 2014-2019 Behavior Risk Factor Surveillance Survey data. The survey respondents consisted of 40,482 heterosexual and sexual minority men and 69,302 heterosexual and sexual minority women who identified as White, Black, or Hispanic. Logistic regression models compared White, Black, and Hispanic male and female cancer survivors' health status, depression, and health-related quality of life by sexual orientation. Models were adjusted for sociodemographic characteristics and access to care. RESULTS Mental health findings showed consistency, with sexual minority male and female cancer survivors having 2 to 3 times greater odds of depression and/or poor mental health among White, Black, and Hispanic survivors. Among White women, sexual minorities reported greater odds of fair or poor health, poor physical health, and poor activity days, whereas White sexual minority men showed similar odds in comparison with their heterosexual counterparts. Among Black and Hispanic sexual minority men and women, differences in the odds of fair or poor health, poor physical health, and poor activity days in comparison with their heterosexual counterparts were mostly explained by sociodemographic and access-to-care factors. CONCLUSIONS Physical and mental health outcomes vary in relation to sexual orientation and race/ethnicity among both female and male cancer survivors. Clinicians, researchers, and health care administrators must better understand and address the unique needs of cancer survivors in relation to multiple axes of social inequality to advance cancer equity.
Collapse
|
37
|
Cardiovascular Disease in a Population-Based Sample of Transgender and Cisgender Adults. Am J Prev Med 2021; 61:804-811. [PMID: 34364725 PMCID: PMC8608688 DOI: 10.1016/j.amepre.2021.05.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/25/2021] [Accepted: 05/09/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Existing data on cardiovascular disease among transgender people are inconsistent and are derived from nonrepresentative samples or population-based data sets that do not include transgender-specific risk factors such as gender-affirming hormone use and gender minority stressors. A nationally representative sample of cisgender and transgender adults aged ≥40 years was used to assess the prevalence and correlates of smoking, select cardiovascular disease conditions, and venous thromboembolism. METHODS Participants were recruited from 2016 to 2018, with analysis conducted in December 2020 with 114 transgender and 964 cisgender individuals. Sample weights and multiple imputations were used for all estimates except for descriptive statistics. Logistic regression models estimated the ORs and 95% CIs expressing the relationship between each outcome variable and a set of independent variables. Each model controlled for race and age. RESULTS No meaningful differences between cisgender and transgender participants were found in smoking or cardiovascular disease conditions. However, there was an increased odds of venous thromboembolism among transgender women compared with those among cisgender women. Transgender people had greater odds of discrimination, psychological distress, and adverse childhood experiences. These stressors were associated with increased odds of a cardiovascular condition, and everyday discrimination and adverse childhood experiences were associated with increased odds of smoking. Discrimination and psychological distress were associated with venous thromboembolism. CONCLUSIONS Transgender people face disparities in cardiovascular disease risk. This study provides support for the gender minority stress model as a framework for understanding cardiovascular disease disparities. Future research with larger samples and adjudicated outcomes is needed to advance the field.
Collapse
|
38
|
Impact of the COVID-19 pandemic on transgender and gender diverse health care. Lancet Diabetes Endocrinol 2021; 9:729-731. [PMID: 34570996 PMCID: PMC8463012 DOI: 10.1016/s2213-8587(21)00266-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/10/2021] [Accepted: 09/10/2021] [Indexed: 01/20/2023]
|
39
|
Comparative Health Status and Characteristics of Respondents of the 2019-2020 National Survey on Health and Disability by Sexual and Gender Minority Status. LGBT Health 2021; 8:563-568. [PMID: 34448601 DOI: 10.1089/lgbt.2021.0075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: We examined the health of sexual and gender minority (SGM) adults with disabilities compared with their non-SGM peers. Methods: The National Survey on Health and Disability is an internet-based survey fielded October 2019 through January 2020. We performed bivariate analyses to compare sociodemographic factors, disability type, and health behaviors between SGM and non-SGM adults. We estimated logistic regression models for dichotomous and count outcomes. Results: After adjustment, SGM adults with disabilities were more likely to report diminished measures of health status. Conclusion: SGM adults with disabilities in the United States experience disparities in self-reported health status compared with non-SGM peers.
Collapse
|
40
|
Cardiovascular health concerns in sexual and gender minority populations. Nat Rev Cardiol 2021; 18:227-228. [PMID: 33510362 DOI: 10.1038/s41569-021-00518-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
41
|
Assessing and Addressing Cardiovascular Health in People Who Are Transgender and Gender Diverse: A Scientific Statement From the American Heart Association. Circulation 2021; 144:e136-e148. [PMID: 34235936 DOI: 10.1161/cir.0000000000001003] [Citation(s) in RCA: 100] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
There is growing evidence that people who are transgender and gender diverse (TGD) are impacted by disparities across a variety of cardiovascular risk factors compared with their peers who are cisgender. Prior literature has characterized disparities in cardiovascular morbidity and mortality as a result of a higher prevalence of health risk behaviors. Mounting research has revealed that cardiovascular risk factors at the individual level likely do not fully account for increased risk in cardiovascular health disparities among people who are TGD. Excess cardiovascular morbidity and mortality is hypothesized to be driven in part by psychosocial stressors across the lifespan at multiple levels, including structural violence (eg, discrimination, affordable housing, access to health care). This American Heart Association scientific statement reviews the existing literature on the cardiovascular health of people who are TGD. When applicable, the effects of gender-affirming hormone use on individual cardiovascular risk factors are also reviewed. Informed by a conceptual model building on minority stress theory, this statement identifies research gaps and provides suggestions for improving cardiovascular research and clinical care for people who are TGD, including the role of resilience-promoting factors. Advancing the cardiovascular health of people who are TGD requires a multifaceted approach that integrates best practices into research, health promotion, and cardiovascular care for this understudied population.
Collapse
|
42
|
Abstract
For years, physicians have debated how best to care for children with differences in sex development (DSD, also termed intersex). Stories of suffering of adults who underwent early surgical intervention for DSD have led many health organizations to call for deferral of unnecessary procedures. While some have instituted full deferral of cosmetic procedures, standard of care remains an interdisciplinary team approach informed by parents' wishes. As the medical community hesitates to institute full deferral, citing absence of long-term data, legislation restricting early procedures is mounting. This article highlights recent data from the DSD-LIFE Study and considers whether and to what extent they support deferral.
Collapse
|
43
|
The Health Care of Adults with Differences in Sex Development or Intersex Traits Is Changing: Time to Prepare Clinicians and Health Systems. LGBT Health 2021; 8:439-443. [PMID: 34191611 DOI: 10.1089/lgbt.2021.0018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Historically, the majority of differences in sex development or intersex trait (dsd/I)-specific medical care has been provided by pediatric clinicians, leading to a dearth of adult clinicians qualified to care for this vulnerable population, and pediatricians reticent to transition patients to adult care. Recent changes in routine care of children and infants with dsd/I, including reconsidering the role of early genital surgeries, highlight the critical need to address the gaps in adult dsd/I health care. In this perspective, we describe three key educational and research approaches that can be implemented to build competency to care for adults with dsd/I and improve care across the lifespan.
Collapse
|
44
|
Meeting the Patient Care, Education, and Research Missions: Academic Medical Centers Must Comprehensively Address Sexual and Gender Minority Health. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:822-827. [PMID: 32852319 DOI: 10.1097/acm.0000000000003703] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
While sociopolitical advances have improved the rights of sexual and gender minorities (i.e., lesbian, gay, bisexual, transgender, queer [LGBTQ+] persons), they continue to face a health system that discriminates against them and does not provide competent, comprehensive care. Despite calls for advancing research, there remains limited sexual and gender minority health research funding, mentorship, and institutional support. Academic medical centers are best suited to systematically tackle disparities and improve care for all sexual and gender minority people through their tripartite missions of patient care, education, and research. In this article, the authors outline discrimination experienced by LGBTQ+ persons and highlight the unique disparities they experience across access and outcomes. The authors posit that by systematically improving clinical care of, incorporating education and training about, and research with LGBTQ+ people into their core missions, academic medical centers can dramatically change the health care landscape. Academic medical centers can eliminate health disparities, expand necessary research endeavors about sexual and gender minorities, and prepare the health care workforce to address the unique needs of these overlooked populations.
Collapse
|
45
|
Sexual Orientation Change Efforts, Depressive Symptoms, and Suicidality Among Lesbian, Gay, and Bisexual Adults: A Cross-Sectional Study in South Korea. LGBT Health 2021; 8:427-432. [PMID: 34061676 DOI: 10.1089/lgbt.2020.0501] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: We examined the association of sexual orientation change efforts (SOCE) with past-week depressive symptoms and past 12-month suicidal ideation and suicide attempts among Korean lesbian, gay, and bisexual adults. Methods: A cross-sectional study of 2168 participants was used. Lifetime SOCE was classified as "never experienced," "been advised but not undergone SOCE," and "undergone SOCE." Results: Participants who had undergone SOCE showed 1.44- and 2.35-times higher prevalence of suicidal ideation and suicide attempts than those without such practices. Significant associations were also observed between having advice on SOCE alone and all mental health indicators. Conclusion: Strict legal sanctions that prohibit SOCE are required in Korea.
Collapse
|
46
|
Pilot study of senior care organization staff knowledge about sexual and gender minority older adults. J Am Geriatr Soc 2021; 69:E17-E19. [PMID: 34019696 DOI: 10.1111/jgs.17229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 04/08/2021] [Accepted: 04/19/2021] [Indexed: 11/30/2022]
|
47
|
Health Care Satisfaction in Relation to Gender Identity: Behavioral Risk Factor Surveillance Survey, 20 States (2014-2018). Med Care 2021; 59:312-318. [PMID: 33492048 PMCID: PMC9260670 DOI: 10.1097/mlr.0000000000001508] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Health care satisfaction is a key component of patient-centered care. Prior research on transgender populations has been based on convenience samples, and/or grouped all gender minorities into a single category. OBJECTIVE The objective of this study was to quantify differences in health care satisfaction among transgender men, transgender women, gender nonconforming, and cisgender adults in a diverse multistate sample. RESEARCH DESIGN Cross-sectional analysis of 2014-2018 Behavioral Risk Factor Surveillance System data from 20 states, using multivariable logistic models. SUBJECTS We identified 167,468 transgender men, transgender women, gender-nonconforming people, cisgender women, and cisgender men and compared past year health care satisfaction across these groups. RESULTS Transgender men and women had the highest prevalence of being "not at all satisfied" with the health care they received (14.6% and 8.6%, respectively), and gender-nonconforming people had the lowest prevalence of being "very satisfied" with their health care (55.7%). After adjustment for sociodemographic characteristics, transgender men were more likely to report being "not at all satisfied" with health care than cisgender men (odds ratio: 4.45, 95% confidence interval: 1.72-11.5) and cisgender women (odds ratio: 3.40, 95% confidence interval: 1.31-8.80). CONCLUSIONS Findings indicate that transgender and gender-nonconforming adults report considerably less health care satisfaction relative to their cisgender peers. Interventions to address factors driving these differences are needed.
Collapse
|
48
|
Ensuring That LGBTQI+ People Count - Collecting Data on Sexual Orientation, Gender Identity, and Intersex Status. N Engl J Med 2021; 384:1184-1186. [PMID: 33793150 DOI: 10.1056/nejmp2032447] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
49
|
Association of Coming Out as Lesbian, Gay, and Bisexual+ and Risk of Cigarette Smoking in a Nationally Representative Sample of Youth and Young Adults. JAMA Pediatr 2021; 175:56-63. [PMID: 33104174 PMCID: PMC7589064 DOI: 10.1001/jamapediatrics.2020.3565] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/23/2020] [Indexed: 01/05/2023]
Abstract
Importance Coming out as lesbian, gay, bisexual, or other identities besides heterosexual (LGB+) may represent a susceptible period for cigarette smoking initiation in youth and young adults. Objective To assess whether young people who change their sexual identity have higher risk of cigarette smoking initiation and current smoking compared with those with consistent sexual identities. Design, Setting, and Participants This cohort study used data from the nationally representative Population Assessment of Tobacco and Health study (wave 1, 2013-2014; wave 2, 2014-2015; wave 3, 2015-2016; wave 4, 2016-2018). Youth and young adults aged 14 to 29 years who were never smokers at wave 1 were included in this study. Analysis began October 2018 and ended June 2020. Exposures Consistent sexual identity (consistently heterosexual, consistently LGB+) vs changing sexual identity (coming out as LGB+, other LGB+ patterns) based on 4 waves of sexual identity data. Identities were further classified by distinguishing between bisexual and lesbian, gay, and other nonheterosexual identities. Main Outcomes and Measures Smoking initiation and current cigarette smoking at wave 4. Results Among 7843 individuals who never smoked at wave 1, 6991 (90.7%) reported a consistent sexual identity, and 852 (9.3%) changed sexual identity across waves. The mean (SE) baseline age of participants who reported consistent heterosexuality was 20.1 (0.8) years; consistently LGB+, 20.0 (3.7) years; coming out as LGB+, 18.0 (2.9) years, and other LGB+ pattern, 20.3 (3.8) years. A total of 14.1% (weighted) initiated smoking, and 6.3% were current smokers at wave 4. Compared with consistently heterosexual identities, coming out as LGB+ (23% vs 13%; odds ratio [OR], 1.72; 95% CI, 1.34-2.20), consistently LGB+ identities (17% vs 13%; OR, 1.45; 95% CI, 1.03-2.04), and other LGB+ patterns (17% vs 13%; OR, 1.47; 95% CI, 1.04-2.08) were positively associated with smoking initiation by wave 4. Compared with consistently heterosexual identities, ORs for smoking initiation were 2.24 (28% vs 13%; 95% CI, 1.72-2.92) for coming out as bisexual, 1.99 (23% vs 13%; 95% CI, 1.20-3.29) for consistently LGB+ with change to/from bisexual, and 2.20 (23% vs 13%; 95% CI, 1.40-3.46) for other LGB+ patterns with change to/from bisexual identity. Current smoking estimates were similar to those for smoking initiation. Conclusions and Relevance Compared with consistently heterosexual identities, changing sexual identity over follow-up was associated with smoking initiation and current smoking. The risk associated with changing sexual identities was concentrated among participants coming out as bisexual or reporting other changes in their identity to/from being bisexual. More research is needed on mechanisms underlying the association between changing sexual identity and smoking initiation to inform tailored prevention programs and tobacco regulations.
Collapse
|
50
|
Correction: Documenting Social Media Engagement as Scholarship: A New Model for Assessing Academic Accomplishment for the Health Professions. J Med Internet Res 2020; 22:e26225. [PMID: 33315581 PMCID: PMC7769691 DOI: 10.2196/26225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 12/08/2020] [Indexed: 11/13/2022] Open
|