Meads Catherine, Martin Adam, Grierson Jeffrey, Varney Justin
Faculty of Health, Social Care and Education, Anglia Ruskin University, Cambridge, UK.
Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
BMJ Open. 2018 Apr 17;8(4):e020776. doi: 10.1136/bmjopen-2017-020776.
Sexual minority women (SMW) experience higher chronic disease risk factors than heterosexual counterparts. However, it was unclear if these risks translate into higher physical condition rates. This systematic review evaluates cardiovascular disease (CVD), hypertension, respiratory disease and diabetes mellitus in SMW.
A protocol was registered with the Prospero database (CRD42016050299). Included were studies reporting mortality, incidence or prevalence of the above-listed conditions in SMW compared with heterosexual women. Databases (platforms) searched from 2010 to December 2016 were Medline (Ovid), Embase (Elsevier), Cumulative Index to Nursing and Allied Health Literature (Elsevier), PsycINFO (Ovid), Social Policy and Practice (Ovid), Cochrane CENTRAL (Cochrane Library), Science Citation Index (Web of Science), and CAB Abstracts (Ovid). Search terms included Medical Subject Heading (MeSH) terms and text words. Extensive additional searches were conducted in specialist academic journals and websites. Two reviewers checked study eligibility. One independently extracted data and assessed quality, checked by a second reviewer, with disagreements resolved through discussion. The Critical Appraisal Skills Programme cohort checklist was used to assess risk of bias. Meta-analysis was conducted where more than four studies reported the same outcomes, with Comprehensive Meta-Analysis software, using adjusted ORs (AORs) and random-effects models. Heterogeneity was assessed using I test.
Identified were 23 103 citations, 692 full texts screened and 16 studies included (in 18 papers). One reported mortality (from Denmark), none incidence and 15 prevalence (14 USA, 1 Australia). Same-sex cohabiting women had higher mortality rates compared with opposite-sex cohabiting women in CVD (HR=1.37 (95% CI 1.22 to 1.54)) and respiratory disease (HR=2.10 (95% CI 1.74 to 2.53)). AOR meta-analyses of seven studies showed higher asthma rates in lesbians (OR=1.44 (95% CI 1.27 to 1.64), I=0%) and bisexual women (OR=1.64 (95% CI 1.41 to 1.89), I=0%) but no differences for CVD (5 studies), hypertension (5 studies) or diabetes mellitus (7 studies).
These new health estimates require further confirmatory epidemiological studies, and investigation into potential environmental, hormonal, physiological, psychological or genetic causes. This would be supported by routine collection of sexual identity measures in population-level epidemiological surveys.
性少数群体女性（SMW）比异性恋女性面临更高的慢性病风险因素。然而，尚不清楚这些风险是否会转化为更高的身体疾病发生率。本系统评价评估了SMW中的心血管疾病（CVD）、高血压、呼吸系统疾病和糖尿病。
一项方案已在国际系统评价注册库（Prospero）数据库（CRD42016050299）中注册。纳入的研究报告了与异性恋女性相比，SMW中上述疾病的死亡率、发病率或患病率。2010年至2016年12月检索的数据库（平台）包括医学文献数据库（Ovid）、荷兰医学文摘数据库（Elsevier）、护理学与健康相关文献累积索引（Elsevier）、心理学文摘数据库（Ovid）、社会政策与实践（Ovid）、考克兰系统评价数据库（考克兰图书馆）、科学引文索引（科学网）和CAB文摘数据库（Ovid）。检索词包括医学主题词（MeSH）术语和文本词。在专业学术期刊和网站上进行了广泛的额外检索。两名评审员检查研究的纳入资格。一名评审员独立提取数据并评估质量，由另一名评审员进行核对，如有分歧通过讨论解决。使用批判性评估技能计划队列检查表评估偏倚风险。当有四项以上研究报告相同结果时，使用综合Meta分析软件，采用调整后的比值比（AOR）和随机效应模型进行Meta分析。使用I²检验评估异质性。
共识别出23103条引文，筛选了692篇全文，纳入16项研究（发表在18篇论文中）。一项研究报告了死亡率（来自丹麦），没有研究报告发病率，15项研究报告了患病率（14项来自美国，1项来自澳大利亚）。同性同居女性与异性同居女性相比，在CVD（HR=1.37（95%CI 1.22至1.54））和呼吸系统疾病（HR=2.10（95%CI 1.74至2.53））方面的死亡率更高。对七项研究的AOR Meta分析显示，女同性恋者（OR=1.44（95%CI 1.27至1.64），I²=0%）和双性恋女性（OR=1.64（95%CI 1.41至1.89），I²=0%）的哮喘发病率较高，但在CVD（5项研究）、高血压（5项研究）或糖尿病（7项研究）方面没有差异。
这些新的健康评估结果需要进一步的验证性流行病学研究，并对潜在的环境、激素、生理、心理或遗传原因进行调查。在人群水平的流行病学调查中常规收集性取向测量数据将有助于这一研究。
