Assessment of Health Conditions and Health Service Use Among Transgender Patients in Canada
Assessment of Health Conditions and Health Service Use Among Transgender Patients in Canada
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DOI：
10.1001/jamanetworkopen.2020.15036
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发表时间：
2020-08-28
影响因子：
13.8
通讯作者：
Kurdyak, Paul
中科院分区：
文献类型：
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作者：
Abramovich, Alex;de Oliveira, Claire;Kurdyak, Paul
跨性别者经历耻辱，歧视和社会经济劣势，导致无数不良的健康结果和高疾病负担率;然而，跨性别健康仍然是一个研究不足的领域。目的比较跨性别人群与普通人群的社会人口学特征、健康状况和卫生服务利用模式。设计，设置，和参与者这项横断面研究的2085跨性别者从3个大城市在安大略，加拿大，比较的特点和卫生服务的使用跨性别者与一般人口在该省。跨性别者是通过从4个门诊社区和医院诊所获得的数据确定的，这些数据与2012年1月至2016年12月期间的卫生行政数据相关联。分析了2018年10月至2020年5月期间的数据。个人年龄匹配1：5的一般安大略人口（10425人）的随机5%的样本。主要结果和措施社会人口学变量，卫生服务的使用，和变性人和普通人群的慢性疾病进行了比较。结果本研究纳入了2085名跨性别者的样本，平均（SD）年龄为30.40（12.81）岁; 771名（37.0%）被确定为跨性别女性。与10425名顺性对照组相比，（最低收入五分位数：625 [30.0%] vs 2197 [21.1%]; P < .001），并经历慢性身心健康状况，包括较高的哮喘发病率（489 [23.5%] vs 2034 [19.5%]; P < .001），糖尿病（115 [5.5%] vs 352 [3.4%]; P < .001），慢性阻塞性肺病（51 [2.4%] vs 156 [1.5%]; P < .001）和HIV（34 [1.6%] vs 12 [0.1%]; P < .001）。跨性别人群中合并慢性健康状况的比例高于顺性别人群（702 [33.7%] vs 2941 [28.2%]; P < .001）。与普通人群相比，跨性别者也有更高的医疗服务使用率，特别是在精神健康和自我伤害方面，包括2012年1月至2016年12月期间的平均（SD）精神科医生就诊次数（8.25 [23.13] vs 0.93 [9.57];标准化差异，5.84）。结论和相关性本研究发现，与顺性别个体相比，跨性别个体的精神和身体共病率更高，健康服务使用率更高。进一步的研究应该探索这些发现的原因。照顾跨性别者的临床医生应该意识到心理健康问题和自我伤害的高潜力。问题社会人口学特征，慢性病，和卫生服务利用轨迹之间的跨性别者与一般人群相比有何不同？结果-这一横断面研究确定和链接的卫生行政数据为2085变性人在加拿大安大略，发现变性人更有可能生活在低收入社区，经历慢性健康状况，并有较高的卫生服务使用比一般人群。意义本研究表明，有必要提高能力，以确定跨性别的个人在行政卫生data.This横断面研究的基础上的因素，他们的高发病率的疾病burners.This确定和链接和卫生行政数据在加拿大安大略省，比较社会人口学特征和医疗保健使用的跨性别的个人与一般人口的省。
Importance Transgender individuals experience stigma, discrimination, and socioeconomic disadvantages, leading to a myriad of poor health outcomes and high rates of disease burden; however, transgender health continues to be an understudied area. Objective To examine sociodemographic characteristics, health conditions, and health service utilization patterns among transgender individuals compared with the general population. Design, Setting, and Participants This cross-sectional study of 2085 transgender individuals from 3 large cities in Ontario, Canada, compared characteristics and health service use among transgender individuals with the general population in the province. Transgender individuals were identified through data obtained from 4 outpatient community and hospital clinics, which were linked with health administrative data between January 2012 and December 2016. Data were analyzed between October 2018 and May 2020. Individuals were age-matched 1:5 to a random 5% sample of the general Ontario population (10425 individuals). Main Outcomes and Measures Sociodemographic variables, health service use, and chronic conditions among transgender individuals and the general population were compared. Results This study included a sample of 2085 transgender individuals with a mean (SD) age of 30.40 (12.81) years; 771 (37.0%) identified as transgender women. Compared with 10425 cisgender controls, trangender individuals were more likely to live in lower-income neighborhoods (lowest-income quintile: 625 [30.0%] vs 2197 [21.1%]; P < .001) and experience chronic physical and mental health conditions, including higher rates of asthma (489 [23.5%] vs 2034 [19.5%]; P < .001), diabetes (115 [5.5%] vs 352 [3.4%]; P < .001), chronic obstructive pulmonary disease (51 [2.4%] vs 156 [1.5%]; P < .001), and HIV (34 [1.6%] vs 12 [0.1%]; P < .001). Comorbid chronic health conditions were higher among the transgender population compared with the cisgender population (702 [33.7%] vs 2941 [28.2%]; P < .001). Transgender individuals also had higher health service use compared with the general population, particularly for mental health and self-harm, including mean (SD) number of psychiatrist visits between January 2012 and December 2016 (8.25 [23.13] vs 0.93 [9.57]; standardized difference, 5.84). Conclusions and Relevance This study found higher rates of mental and physical comorbidities and higher health service use among transgender individuals compared with cisgender individuals. Further research should explore reasons for these findings. Clinicians caring for transgender individuals should be aware of the high potential for mental health issues and self-harm.Question How do sociodemographic characteristics, chronic conditions, and health service utilization trajectories differ among transgender individuals compared with the general population? Findings This cross-sectional study identified and linked health administrative data for 2085 transgender individuals in Ontario, Canada, and found that transgender individuals are more likely to live in lower-income neighborhoods, experience chronic health conditions, and have higher health service use than the general population. Meaning This study demonstrates the need to improve the capacity to identify transgender individuals in administrative health data to understand the factors underlying their high rates of disease burden.This cross-sectional study draws from identified and linked and health administrative data in Ontario, Canada, to compare the sociodemographic characteristics and health care use of transgender individuals with the general population of the province.