LGBT health最新文献

Purpose: Sex differences in cardiac arrhythmias are well established. This study aimed to explore the prevalence of arrhythmias in transgender and nonbinary (TGNB) adults. Methods: This cross-sectional study utilized electronic medical records from a center specializing in TGNB care. Adults aged ≥18 years with ≥2 medical visits between January 1, 2010, and December 31, 2021, were categorized into self-reported gender groups: TGNB (transgender men, transgender women, nonbinary [NB]-assigned male at birth, NB-assigned female at birth), cisgender men, and cisgender women. The primary outcome was any arrhythmia using age- and race-adjusted regression models comparing transgender patients with cisgender men and cisgender women. Prevalence of arrhythmias was explored in transgender people with a gender-affirming hormone therapy (GAHT) prescription. Results: The sample included 49,862 adults, with 7121 (14%) TGNB persons. Median age was 28 years. Prevalence of arrhythmias was low (0.7-1.4% NB persons, 1.4-1.5% transgender persons). After adjustment, transgender women and transgender men had similar odds of any arrhythmia compared with cisgender men (transgender women: adjusted odds ratio [aOR] 0.89, 95% confidence interval [CI] 0.63-1.24, p = 0.52; transgender men: aOR 1.17, 95% CI 0.82-1.62, p = 0.37), but higher odds of any arrhythmia compared with cisgender women (transgender women: aOR 1.65, 95% CI 1.13-2.34, p = 0.01; transgender men: aOR 2.15, 95% CI 1.48-3.04, p < 0.001). Prevalence of arrhythmias appeared similar among transgender adults regardless of GAHT use (transgender men: 1.5% vs 1.9%, transgender women: 1.2% vs 2.1%). Conclusion: Further research examining arrhythmias in TGNB patients and across gender minority subgroups is warranted, including longitudinal studies evaluating the potential impact of GAHT.

Purpose: Lesbian, gay, bisexual, and questioning (LGBQ) high schoolers experience high prevalence of poor behavioral health, but little is known about LGBQ middle schoolers. We sought to quantify behavioral health disparities of LGBQ middle school students. Methods: Using 2021 New Mexico Middle School Youth Risk and Resiliency Survey data (N = 12,400), we estimated the size of the LGBQ middle school population and calculated adjusted risk ratios to investigate behavioral health disparities between LGBQ and heterosexual youth. Results: A quarter of the sample identified as LGBQ. These youth reported significantly more suicidal behaviors and poorer mental health than heterosexual youth. LGBQ youth were more likely to use most substances compared with heterosexual youth. Conclusion: LGBQ middle school students demonstrated high prevalence of poor behavioral health. These findings show that disparities begin earlier than previously assumed and underscore that sociocultural landscapes for sexually diverse youth remain challenging.

Purpose: Sexual minority adolescents (SMAs) have disproportionate experiences of mental health symptoms during adolescence, and minority stress contributes to mental health inequities among SMAs. Gender nonconformity (GNC) could place SMAs at higher risk for minority stress and subsequent mental health symptoms. The current study was designed to examine associations between GNC, minority stress, and psychological distress among SMAs. Method: SMAs ages 12-17 years (n = 455; mean age = 15.52 years) in the United States completed a cross-sectional online survey from February to July 2022, including measures of GNC, peer victimization, family rejection, negative expectations, negative disclosure experiences, internalized homonegativity, and psychological distress. We conducted path analysis to examine associations between GNC, minority stressors, and psychological distress, including indirect effects of GNC on psychological distress via minority stress. Results: In multivariable path analysis adjusted for demographic characteristics, GNC was associated with higher levels of peer victimization and negative expectations and lower internalized homonegativity among SMAs. Higher levels of peer victimization and negative expectations were associated with higher psychological distress. GNC was indirectly related to higher levels of psychological distress via higher peer victimization. Conclusions: The current study is the first to document associations between GNC and multiple minority stress experiences among SMAs, and GNC was indirectly related to psychological distress among SMAs via peer victimization. Although all SMAs would benefit from interventions designed to reduce peer victimization and increase their capacity to cope with minority stress, such interventions may be particularly beneficial for SMAs who are gender nonconforming.

Purpose: Inappropriate, disrespectful, or coercive health care (IDCH) is associated with patient age and sexual orientation and gender identity (SOGI) and can impact healthcare engagement and outcomes. Emerging adulthood is a critical period for establishing trust in health care, yet little is known about university students' IDCH experiences. This study assessed the IDCH prevalence and identified IDCH-SOGI associations in a university student sample. Methods: Using data from the cross-sectional IDC Survey (2021), we quantified the lifetime prevalence of 18 IDCH items in a sample of 3403 university students. Chi-squared and Kruskal-Wallis tests were used to assess bivariate associations between IDCH items and SOGI. We modeled associations between demographic characteristics and two types of provider-sexual misconduct using logistic regression. Results: Statistically significant associations between SOGI and 17 of the analyzed IDCH items were identified. Self-reported IDCH experiences were more prevalent among minoritized SOGI students than heterosexual cisgender students, including receiving inappropriate/harmful treatment and dismissive or biased provider communication. Gender minority and sexual minority cisgender male and female students had significantly higher odds of ever being touched inappropriately during an exam, compared with heterosexual cisgender males (adjusted odds ratios [95% confidence interval]: 3.07 [1.59-5.93], 2.34 [1.24-4.41], and 1.85 [1.16-2.90], respectively). SOGI was not significantly associated with experiencing a provider's sexual advances. Conclusion: University students with historically minoritized SOGIs may be particularly vulnerable to IDCH experiences; research is needed to understand differential experiences within minoritized sexual and gender subpopulations. Patient and provider education about healthcare norms and trauma-centered care could potentially reduce IDCH and its harms.

Purpose: Sexual and gender minoritized (SGM) populations face health disparities along the cancer care continuum, although attempts to define these disparities are limited by a lack of comprehensive sexual orientation and gender identity (SOGI) data collection. The objective of this study was to interview a diverse group of stakeholders to understand attitudes, barriers, and facilitators to inform data collection approaches in a cancer care setting. Methods: This was a qualitative study conducted from March to July 2023 with paired surveys of stakeholders including patients, caregivers, providers, and cancer registry staff. Twenty participants across these categories, including half who identified as SGM, completed surveys and interviews. Qualitative data were reduced to themes with exemplar quotations using rapid qualitative analysis methods and compared to survey data. Results: Themes revealed general support for SOGI data collection as part of holistic cancer care, and all participants acknowledged that specific SOGI-related information, particularly correct pronoun usage, was essential to inform patient-centered care. Themes revealed tensions around optimal SOGI data collection methods, mixed opinions on the relevance of sexual orientation, experiences of discrimination and discomfort related to SOGI, and limited acknowledgment of population benefits of SOGI data collection. Conclusion: Themes demonstrated overall support for SOGI data collection but also revealed several barriers, such as a lack of recognition of population benefits and experiences of discrimination and discomfort, that will need to be addressed to comprehensively collect these data. Based on diverse preferences and limitations of all methods of collection, a multimodal approach may be needed to optimize completion.

Purpose: The present study investigated associations of sexual orientation and/or gender identity-based medical mistrust and racial/ethnic-based medical mistrust, respectively, with unmet medical care need among lesbian, gay, bisexual, transgender, queer, and/or sexually or gender diverse (LGBTQ+) people of color (POC) assigned female at birth (AFAB). We also tested the interaction of the two types of medical mistrust on unmet medical care need. Methods: Participants were 266 LGBTQ+ POC AFAB. Participants completed measures of medical mistrust based on race/ethnicity and LGBTQ+ identity. Unmet medical care need was assessed using the item: "During the past 12 months, was there ever a time where you felt that you needed health care but you didn't receive it?" Multivariate logistic regression models were run with either type of medical mistrust, as well as their interaction, as the predictor and unmet medical care need as the outcome variable. Results: There were no significant main effects of either type of medical mistrust on unmet medical care need. However, there was an interaction between the two types of medical mistrust, such that associations between each type of medical mistrust and unmet medical care needs were stronger at higher levels of the other type of medical mistrust. Racial/ethnic medical mistrust was associated with a greater likelihood of unmet medical needs at high, but not low, levels of LGBTQ+ medical mistrust. Conclusions: Racial/ethnic medical mistrust and LGBTQ+ medical mistrust exacerbate each other's influence on unmet medical care need. These results underscore the need for inclusive clinical practices for LGBTQ+ POC.

Purpose: Our aim was to examine associations between transgender identity and sleep disturbance in a demographically diverse, national sample of U.S. early adolescents. Methods: We conducted a cross-sectional analysis of the Adolescent Brain Cognitive Development Study from Year 3 (2019-2021, n = 10,277, 12-13 years) to investigate the association between transgender identity and caregiver-reported measures of their adolescent's sleep, assessed by the Sleep Disturbance Scale for Children. Results: Transgender adolescents had a higher risk of overall sleep disturbance and symptoms of insomnia and excessive sleepiness. Furthermore, per caregiver report, transgender adolescents were more likely to have shorter sleep duration categories; particularly concerning is the significant risk of <5 hours of sleep for transgender adolescents compared with their cisgender peers. Conclusion: These findings indicate that transgender adolescents had worse caregiver-reported sleep outcomes compared to cisgender peers. This study highlights the need for screenings and interventions targeted at improving sleep among transgender adolescents.

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: Sexual and gender diverse (SGD) youth have been particularly vulnerable to mental health difficulties and substance use during the COVID-19 pandemic. However, estimates have varied across studies pointing to the potential for moderator variables. This meta-analytic and narrative synthesis provides estimates of the prevalence of mental health difficulties (anxiety, depression, suicidal ideation, suicide attempts) and substance use during COVID-19 among SGD youth. Methods: A comprehensive search strategy combining keywords and subject headings was designed and used across eight databases from inception to October 7, 2022. The search yielded 826 nonduplicate records of which 191 full-text articles were retrieved, evaluated, and extracted by two study authors. Data were analyzed from February 27 to March 1, 2023. Results: Using random-effects meta-analyses, 19 studies from 18 independent samples with 10,500 participants were included. Pooled prevalence rates for clinically elevated anxiety, depression, and suicidal ideation were 55.4% [95% confidence interval (CI):45.9%-64.5%], 61.8% (95% CI: 50.9%-71.7%), and 50.9% (95% CI: 42.8%-59.0%). There was no evidence of publication bias. Suicide attempts and substance use were summarized narratively with rates of suicide attempts being greater than 20% across included studies and variable reporting of substance use across substance types. No moderators explained variability across studies. Conclusion: More than 50% of SGD youth experienced clinically elevated symptoms of anxiety, depression, and suicidal ideation during the COVID-19 pandemic, compared to prepandemic estimates for both SGD and non-SGD youth. Targeted resource allocation is needed to specifically address the needs of SGD youth.

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.