LGBT health最新文献

Purpose: Our purpose was to understand the completeness of sex and gender fields in electronic health record (EHR) data and patient-level factors associated with completeness of those fields. In doing so, we aimed to inform approaches to EHR sex and gender data collection. Methods: This was a retrospective observational study using 2016-2021 deidentified EHR data from a large health care system. Our sample included adults who had an encounter at any of three hospitals within the health care system or were enrolled in the health care system's Accountable Care Organization. The sex and gender fields of interest were gender identity, sex assigned at birth (SAB), and legal sex. Patient characteristics included demographics, clinical features, and health care utilization. Results: In the final study sample (N = 3,473,123), gender identity, SAB, and legal sex (required for system registration) were missing for 75.4%, 75.8%, and 0.1% of individuals, respectively. Several demographic and clinical factors were associated with having complete gender identity and SAB. Notably, the odds of having complete gender identity and SAB were greater among individuals with an activated patient portal (odds ratio [OR] = 2.68; 95% confidence interval [CI] = 2.66-2.70) and with more outpatient visits (OR = 4.34; 95% CI = 4.29-4.38 for 5+ visits); odds of completeness were lower among those with any urgent care visits (OR = 0.80; 95% CI = 0.78-0.82). Conclusions: Missingness of sex and gender data in the EHR was high and associated with a range of patient factors. Key features associated with completeness highlight multiple opportunities for intervention with a focus on patient portal use, primary care provider reporting, and urgent care settings.

Purpose: This study aimed to uncover sexual identity development and investigate the psychiatric risks for bisexual people across mainland China, Hong Kong, and Taiwan by examining ecologically informed factors at the individual, family, and community levels. Methods: An internet-based survey was administered to 685 respondents, from June to August 2021, reached primarily through lesbian, gay, bisexual, transgender, and queer community organizations and professional networks. Participants reported their demographics, identity milestones, and psychiatric symptoms. Results: Significant birth cohort and regional differences were observed regarding bisexual identity milestones. Individuals who were older, transgender and/or nonbinary, and based in Taiwan disclosed their sexual identity more. All respondents reported clinically elevated depression and anxiety symptoms, with a majority experiencing moderately severe depression (60%) and moderate or severe anxiety (80%). Approximately half of respondents contemplated suicide in the past year. Compared with cisgender women, identifying as transgender and nonbinary assigned female at birth was significantly associated with increased depression and higher odds of suicidal ideation in the past year. Enhanced self-esteem was associated with greater well-being and decreased psychiatric symptoms. Experiencing family shame was associated with increased anxiety and depression. At the community level, living in Hong Kong was linked to lower depression and suicidal ideation compared to mainland China. The presence of an LGBT group correlated with improved psychological well-being. Conclusions: Chinese bisexual people face substantial risks for depression, anxiety, and suicidal ideation, influenced by factors including self-esteem, transgender and nonbinary gender identity, family dynamics, and community context. Significant birth cohort and regional differences in bisexual identity development exist.

Purpose: This study was conducted to understand whether health education materials made specifically for members of sexual and gender minority (SGM) groups play a pivotal role in SGM cancer survivors' care satisfaction and experiences. Methods: We identified 2250 SGM cancer survivors who completed the "OUT: National Cancer Survey," conducted by the National LGBT Cancer Network in 2020-2021, and classified participants by their self-reported satisfaction with overall cancer care. We examined care satisfaction in relation to use of SGM-tailored health education resources and factors surrounding their SGM identities, which may influence their satisfaction, including feelings of safety with care teams. Results: Regardless of satisfaction with overall care, substantial proportions of survivors reported lacking vital health education resources specific to their SGM identities in areas of mental health (69%), physical activity (91%), tobacco use cessation (89%), and alcohol consumption (86%), despite attributing value to these materials. Contextualizing SGM survivor satisfaction with care, it was notable that among SGM survivors who felt safe with members of their care team knowing their SGM identity, only 3% were less than satisfied with their overall cancer care, compared to 38% who felt unsafe. Conclusion: SGM survivors value tailored information and health education resources that incorporate their intersectional identities. More research must be done to elucidate why SGM survivors do not receive these materials, while creating spaces where they feel safe receiving care. Increased delivery of SGM-tailored materials and prioritization of SGM safety in health care may have implications for overall cancer care satisfaction among SGM survivors.

Purpose: This study explores the sociodemographic, insurance coverage, and substance use differences among transgender and gender diverse (TGD) individuals currently using hormone therapy (HT) and those who have an interest in future HT use. Methods: We surveyed TGD individuals in Michigan in 2018 to examine sociodemographic, health insurance, and substance use differences between those who had used HT and those who were interested but had never accessed HT using logistic regression models. Results: Respondents (N = 536) were 80.1% White and 18.0% nonbinary. About two-thirds of the participants had ever used HT (65.7%). In multivariate analyses, nonbinary participants were much more likely to be interested in future HT use than transmasculine individuals (odds ratio [OR] = 6.91), yet no significant difference between transmasculine and transfeminine individuals was found. Black participants also had higher odds of interest in future HT use (OR = 8.79). Those who did not know if they had trans-specific insurance coverage (OR = 42.39) and those who had no trans-specific insurance coverage (OR = 4.50) were more likely to be in the future interest group compared with those who reported full trans care coverage. Those with a bachelor's degree were less likely to be in the future interest group than those with some college education or an associate's degree, as were heavy marijuana users. Conclusion: Nonbinary individuals may be interested in HT but lack access, and known health care disparities around race and socioeconomic status may also impact HT access. Standard and transparent insurance coverage for gender-affirming care is sorely needed.

Fertility preservation is the process of collecting and storing oocytes, sperm, or reproductive tissue so that a person may retain their ability to have biologically related children. In instances of infertility caused by medical intervention or an underlying medical condition, this procedure is often sought by affected patient populations. U.S. Title 21 regulations have produced disparities in access, disproportionately restricting services for sexually and gender diverse subpopulations capable of producing sperm. This article examines policies contributing to these disparities, explores how these policies may translate to real-world health care delivery, and proposes policy changes that would increase equitable access to care.

Purpose: The "one-liner," commonly used in clinical communications, summarizes a patient's identity, presenting condition, medical history, and clinical findings. Imprecise, inconsistent use of gender and sex information in one-liners threatens the provision of affirming care to transgender, nonbinary, gender-expansive, and intersex patients and may exacerbate health care disparities. This study aimed to generate guidance for communicating gender and sex information in one-liners. Methods: This is an explanatory sequential, equal status mixed methods study of transgender, nonbinary, gender-expansive, and intersex people and clinicians caring for this population. Survey participants rated one-liners on a five-point Likert-type scale of appropriateness, considering affirmation and clinical utility, and provided open-ended comments. We conducted two focus groups with survey respondents to explore survey results and performed a thematic analysis of survey comments and focus group transcripts. Results: Survey respondents included 57 clinicians and 80 nonclinicians. One-liners containing patient pronouns were rated most appropriate, and appropriate patient descriptors included self-described gender identity or gender-neutral terms. In scenarios where patient sex information was not pertinent to the chief concern (CC), one-liners containing no sex information were rated most appropriate. Four themes were identified: inclusion of sex information based on relevance to the CC, accurate patient representation, influence of clinical setting, and risk of harm from inaccurate one-liners. Conclusion: This study generated data to support the appropriate use of gender and sex language in one-liners. Clinicians, educators, and trainees may use these findings to compose one-liners that are affirming and clinically useful for patients of diverse gender and sex identities.

Purpose: The human papillomavirus (HPV) causes cervicovaginal, oral, and anogenital cancer, and cervical cancer screening options include HPV testing of a clinician-collected sample. Transgender and gender diverse (TGD) people assigned female at birth (AFAB) face many barriers to preventive care, including cancer screening. Self-sampling options may increase access and participation in HPV testing and cancer screening. This study estimated the prevalence of HPV in self-collected cervicovaginal, oral, and anal samples from Midwestern TGD individuals AFAB. Methods: We recruited TGD individuals AFAB for an observational study, mailing them materials to self-collect cervicovaginal, oral, and anal samples at home. We tested samples for high-risk (HR; 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59) and other HPV genotypes (6, 11, 66, 68, 73, 90) using a polymerase chain reaction mass array test. Prevalence ratios for HPV infection at each site as a function of participant characteristics were estimated in log-binomial models. Results: Out of 137 consenting participants, 102 completed sample collection. Among those with valid tests, 8.8% (HR = 6.6%; HPV 16/18 = 3.3%) were positive for oral HPV, 30.5% (HR = 26.8%; HPV 16/18 = 9.7%) for cervicovaginal HPV, and 39.6% (HR = 33.3%; HPV 16/18 = 8.3%) for anal HPV. A larger fraction of oral (71.4%) than anal infections (50.0%) were concordant with a cervicovaginal infection of the same type. Conclusions: We detected HR cervicovaginal, oral, and anal HPV in TGD people AFAB. It is essential that we reduce barriers to cancer screening for TGD populations, such as through the development of a clinically approved self-screening HPV test.

Purpose: Transgender and gender diverse (TGD) youth in North American clinical reports are predominantly White with relatively high socioeconomic status suggesting that access to gender-affirming care is inequitable. This study examined whether socioeconomic and social determinant of health discrepancies exist between a clinical population of TGD youth and surrounding communities. Methods: Patient postal codes were used to link the Ontario Marginalization Index (ON-MARG) to a clinic-based TGD youth cohort (n = 298). Using ON-MARG, each patient was assigned a quintile score from 1 (least marginalized) to 5 (most marginalized) on four marginalization measures. Mean quintile scores were compared to background populations. Census-based Toronto neighborhood-level data on ethnic diversity and educational status were also examined. Neighborhoods were categorized as highly represented, less represented, or unrepresented based on representation in the clinic cohort. One-way analysis of covariance was used to determine associations between neighborhood-level variables and the degree of neighborhood representation. Results: ON-MARG data demonstrated that clinic patients hailed from areas with more individuals having paid employment. Patients from Toronto and surrounding areas came, in general, from communities with fewer recent immigrants and visible minorities. Highly represented Toronto neighborhoods had smaller proportions of visible minorities and immigrants compared with less and unrepresented neighborhoods. Educational status, represented by adults with bachelor's degrees, was lower among unrepresented neighborhoods. Conclusion: TGD youth seen in clinic, particularly those from Toronto, are disproportionally White and socioeconomically advantaged. Further research is needed to better understand the underrepresentation of racialized and low-socioeconomic status youth and to inform strategies to improve access to care.

Purpose: In the past 2 years, nearly all 50 states have debated bills seeking to ban minors' access to gender-affirming medical interventions, with many being passed into law. This study documents gender-diverse youths' (GDY) and their caregivers' experiences as they grapple with how such laws impact their families. Methods: Sixteen GDY and 16 caregivers participating in a longitudinal study of the impact of gender-affirming care on GDYs' well-being were interviewed about how the legal and social discourse was impacting them and their families. When interviewed, some participants had completed only the initial intake, others had completed the intake and an initial medical consultation, and a few had recently started gender-affirming hormones. Thematic analysis was used to identify common threads in the youths' and caregivers' experiences. Results: Four main themes were identified: Direct effects of losing access to gender-affirming medical interventions, reflecting how losing access to care would impact well-being; growing hostility toward the gender-diverse community, noting increasing social negativity; personal and social upheaval, reflecting the many aspects of families' lives affected; and galvanization into social action, documenting drives to effect social change. Conclusion: Laws banning gender-affirming medical interventions impact GDY and their families beyond limiting access to medical care. They increase the social stressors, cause social network disruptions, increase hostility toward the gender-diverse community, and lead some GDY and caregivers to engage more politically to protect their community. Gender-affirming health care providers need to recognize how the social and political environment impact GDY and their families to provide high-quality, person-centered care.

Purpose: The purpose of this analysis is to: 1) describe the most common mental health diagnoses in the emergency department (ED) and inpatient hospital settings among transgender and gender diverse (TGD) youth vs. matched controls and 2) evaluate if a gender-affirming hormone therapy (GAHT) or gonadotropin-releasing hormone agonist (GnRHa) prescription decreased the risk of suicidality within these settings. Methods: Using the PEDSnet dataset (years 2009-2019), TGD youth aged 8-18 (n = 3414, with a median age at last visit of 16.2 [14.4, 17.7] years, were propensity-score matched to controls (n = 13,628, age 16.6 [14.2, 18.3] years). Relative risks of the most common mental health diagnoses within ED and inpatient settings were calculated for TGD youth compared with controls. Recurrent time-to-event analysis was used to examine whether GAHT or GnRHa attenuated the risk of suicidality among subsamples of TGD youth. Results: TGD youth had a higher relative risk (95% confidence interval [CI]) of mental health diagnoses and suicidality in the ED (5.46 [4.71-6.33]) and inpatient settings (6.61 [5.28-8.28]) than matched controls. TGD youth prescribed GAHT had a 43.6% lower risk of suicidality (hazard ratio [HR] = 0.564 [95% CI 0.36-0.89]) compared with those never prescribed GAHT during our study period or before GAHT initiation. TGD youth who were prescribed GnRHa therapy had a nonstatistically significant reduction in ED or inpatient suicidality diagnoses compared with those never prescribed GnRHa (HR = 0.79 [0.47-1.31]). Conclusion: Although risk of mental health diagnoses and suicidality in ED and inpatient settings was high among TGD youth, a GAHT prescription was associated with a significant reduction in suicidality risk.