Sexual orientation-related disparities in employment, health insurance, healthcare access and health-related quality of life: a cohort study of US male and female adolescents and young adults.
Sexual orientation-related disparities in employment, health insurance, healthcare access and health-related quality of life: a cohort study of US male and female adolescents and young adults.
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DOI：
10.1136/bmjopen-2017-020418
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发表时间：
2018-07-26
期刊：
影响因子：
2.9
通讯作者：
Austin SB
中科院分区：
文献类型：
--
作者：
Charlton BM;Gordon AR;Reisner SL;Sarda V;Samnaliev M;Austin SB
调查性取向在就业和医疗保健方面的差异，包括对与健康相关的生活质量(HRQL)的潜在贡献。Growing Up Today Study是一项总部位于美国的纵向队列研究，始于1996年；主要由白人和中高级社会经济职位的参与者组成。9914名受试者在最近一次随访问卷中年龄在18-32岁之间。2013年，参与者报告了他们在过去一年中是否失业、没有保险或缺乏医疗保健服务(常规体检)。参与者完成了EQ-5D-5L，这是一种经过验证的HRQL偏好加权测量。在调整了潜在的混杂因素后，我们使用性别分层的对数二项式模型来计算性取向与就业、医疗保险和医疗保健机会的关联，同时检查这些变量是否减弱了与性取向相关的HRQL差异。性少数民族女性和男性失业和没有保险的可能性大约是他们各自的异性恋同龄人的两倍。例如，未参保的双性恋女性的风险比(95%CI)为3.76(2.42比5.85)，以异性恋男性为主的失业女性的风险比为1.82(1.30比2.54)。不同性取向组间的常规体检没有差异(p>；0.05)。在EQ-5D-5L的五个维度(活动能力、自我照顾、日常活动、疼痛/不适和焦虑/抑郁)上，所有的性少数亚组的HRQL都比异性恋者差(P<；0.05)。控制就业和医疗保险并没有实质上减少现有的与性取向相关的HRQL差异。关于就业和医疗保健中与性取向有关的差异的研究往往局限于不同性别和同性成年夫妇同居之间的比较，而忽略了性少数群体(例如，双性恋者和女同性恋者)、非同居人口和年轻人之间的比较。人们对与性取向相关的HRQL差异知之甚少，包括就业和医疗保健的潜在贡献。目前的研究证明，在就业、医疗保险和各种HRQL维度上的差异在性少数亚群、非同居夫妇和处于中高级社会经济地位的家庭中的青年中普遍存在。
To investigate sexual orientation-related disparities in employment and healthcare, including potential contributions to health-related quality of life (HRQL). Growing Up Today Study, a USA-based longitudinal cohort that began in 1996; predominantly composed of participants who are white and of middle-to-high socioeconomic positions. 9914 participants 18–32 years old at the most recent follow-up questionnaire. In 2013, participants reported if, in the last year, they had been unemployed, uninsured or lacked healthcare access (routine physical exam). Participants completed the EQ-5D-5L, a validated, preference-weighted measurement of HRQL. After adjusting for potential confounders, we used sex-stratified, log-binomial models to calculate the association of sexual orientation with employment, health insurance and healthcare access, while examining if these variables attenuated the sexual orientation-related HRQL disparities. Sexual minority women and men were about twice as likely as their respective heterosexual counterparts to have been unemployed and uninsured. For example, the risk ratio (95% CI) of uninsured bisexual women was 3.76 (2.42 to 5.85) and of unemployed mostly heterosexual men was 1.82 (1.30 to 2.54). Routine physical examination was not different across sexual orientation groups (p>0.05). All sexual minority subgroups had worse HRQL than heterosexuals (p<0.05) across the five EQ-5D-5L dimensions (mobility, self-care, usual activities, pain/discomfort and anxiety/depression). Controlling for employment and health insurance did not substantially attenuate the existing sexual orientation-related HRQL disparities. Research on sexual orientation-related disparities in employment and healthcare has often been limited to comparisons between cohabitating different-sex and same-sex adult couples, overlooking sexual minority subgroups (eg, bisexuals vs lesbians), non-cohabitating populations and young people. Less is known about sexual orientation-related disparities in HRQL including potential contributions from employment and healthcare. The current study documents that disparities in employment, health insurance and various HRQL dimensions are pervasive across sexual minority subgroups, non-cohabitating couples and youth in families of middle-to-high socioeconomic positions.
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