Sex, gender, and medical data

BackgroundEpidemiological evidence for specific long-term conditions is required to inform best practices regarding the substantial health inequalities experienced by sexual minority individuals compared with heterosexual peers.AimTo describe inequalities in long-term conditions among sexual minority (lesbian, gay, and bisexual [LGB]) adults.Design & settingCross-sectional analysis of 1 341 339 nationally representative survey responses from the English GP Patient Survey (GPPS).MethodStratifying by sex, the weighted prevalence and covariate-adjusted association of 15 long-term conditions were calculated, comparing sexual minority and heterosexual adults, considering variation by sexual orientation and variation in sexual orientation inequalities by deprivation, ethnic group, region, and age.ResultsAfter adjusting for deprivation, ethnic group, region, and age, 13 long-term conditions (all except cancer and hypertension) were more prevalent among sexual minority women than their heterosexual peers, with the largest inequalities for mental health problems (odds ratio [OR] 2.8, 95% confidence interval [CI] = 2.7 to 3.0), neurological conditions (OR 1.7, 95% CI = 1.5 to 1.8), dementia (OR 1.6, 95% CI = 1.3 to 1.9), and back problems (OR 1.4, 95% CI = 1.3 to 1.5). It was found that nine long-term conditions were also more prevalent among sexual minority men including mental health problems (OR 2.3, 95% CI = 2.2 to 2.4), 'all other conditions' (OR 1.8, 95% CI = 1.7 to 1.8), neurological conditions (OR 1.5, 95% CI = 1.4 to 1.6), and kidney or liver disease (OR 1.4, 95% CI = 1.3 to 1.5); inequalities were often largest for bisexual adults. Inequalities did not vary significantly by deprivation, ethnic group, or region except for mental health problems. Inequalities in multimorbidity were highest at younger ages; for example, LGB women aged 18–24 years had multimorbidity at the same level (approximately 20%) as heterosexual women aged 45–54 years.ConclusionSexual minority adults, especially bisexual adults, are at elevated risk for many long-term conditions and multimorbidity; this risk spans socioeconomic status and ethnic group, representing a significant healthcare challenge.

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“… 14 Collection of gender identity in the 2021 census may provide opportunities to address this evidence gap. 15 …”

Section: Discussionmentioning

confidence: 99%

Long-term conditions among sexual minority adults in England: evidence from a cross-sectional analysis of responses to the English GP Patient Survey

et al. 2021

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“…Long-term patient outcomes are uncertain, partly due to high losses to follow up. The precision of cohort and linkage studies may be affected by sex and gender marker changes [ 34 ], and the issuing of new NHS numbers where gender can be changed from the sex marker assigned at birth [ 35 ]. In the UK, patients can request new NHS numbers at any point in their transition process.…”

Section: Introductionmentioning

confidence: 99%

Care of Transgender Patients: A General Practice Quality Improvement Approach

Boyd¹,

Hackett

Bewley

2022

Healthcare

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Primary care must ensure high quality lifelong care is offered to trans and gender minority patients who are known to have poor health and adverse healthcare experiences. This quality improvement project aimed to interrogate and audit the data of trans and gender minority patients in one primary care population in England. A new data collection instrument was created examining pathways of care, assessments and interventions undertaken, monitoring, and complications. General practitioners identified a sample from the patient population and then performed an audit to examine against an established standard of care. No appropriate primary care audit standard was found. There was inconsistency between multiple UK gender identity clinics’ (GIC) individual recommended schedules of care and between specialty guidelines. Using an international, secondary care, evidence-informed guideline, it appeared that up to two-thirds of patients did not receive all recommended monitoring standards, largely due to inconsistencies between GIC and international guidance. It is imperative that an evidence-based primary care guideline is devised alongside measurable standards. Given the findings of long waits, high rates of medical complexity, and some undesired treatment outcomes (including a fifth of patients stopping hormones of whom more than half cited regret or detransition experiences), this small but population-based quality improvement approach should be replicated and expanded upon at scale.

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“…Sex (a reproductive category), gender (a societal role), and gender identity (an inner sense of self) are not synonymous ( 2 , 3 ). Sex is salient to reproduction, as there are only two gametes and pubertal pathways to adulthood and gamete production, and only one gamete producing body type that becomes pregnant ( 2 ).…”

Section: Introductionmentioning

confidence: 99%