Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
Department of Biostatistics, Washington University in St. Louis, St. Louis, MO, United States.
Mult Scler Relat Disord. 2020 Jan;37:101440. doi: 10.1016/j.msard.2019.101440. Epub 2019 Oct 12.
We aimed to determine the association between gender identity and sexual orientation on health care utilization in persons with multiple sclerosis (MS), as well as satisfaction with their doctor and comfort discussing sexual health with their doctor.
We surveyed participants from the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry regarding their gender identity and sexual orientation in 2017. Participants also reported their sociodemographic characteristics, disability status, health behaviors and health care utilization, including whether any hospitalizations or emergency room (ER) visits occurred or any disease-modifying therapy (DMT) was used within the last six months. We compared the likelihood of hospitalizations, ER visits and DMT use between (i) cisgender and transgender participants; and (ii) heterosexual, homosexual, and "other sexual orientation" participants using multivariable logistic regression models adjusting for potential confounding factors.
Of the 5,604 eligible responders, 1168 (20.8%) reported their sex at birth as male and 4436 reported their sex at birth as female (79.2%). Twenty-five (0.45%) participants identified as transgender and 260 (4.6%) as non-heterosexual individuals. As compared to participants who reported their sexual orientation as heterosexual, non-heterosexual participants were younger, with an earlier age at MS symptom onset, more likely to have a post-secondary education, and more likely to be single. The frequency of any ER visits, any hospital admissions, and DMT use did not differ according to gender identity did not differ according to gender identity or sexual orientation. As compared to cisgender participants, transgender participants reported less comfort (p < 0.042) discussing sexual health with their doctor; findings were similar for non-heterosexual participants as compared to heterosexual participants. Participants reporting other sexual orientation also reported lower satisfaction (p < 0.039) with their doctor than other participants.
Gender identity and sexual orientation were not associated with differences in healthcare utilization in persons with MS. However, health care experiences and satisfaction with care may be altered by gender identity and sexual orientation.
我们旨在确定多发性硬化症（MS）患者的性别认同和性取向与医疗保健利用之间的关系，以及他们对医生的满意度和讨论性健康的舒适度。
我们在 2017 年调查了北美多发性硬化症研究委员会（NARCOMS）登记处的参与者的性别认同和性取向。参与者还报告了他们的社会人口统计学特征、残疾状况、健康行为和医疗保健利用情况，包括过去六个月内是否发生过住院或急诊（ER）就诊，或使用过任何疾病修正治疗（DMT）。我们使用多变量逻辑回归模型比较了（i）跨性别者和 transgender 参与者之间；和（ii）异性恋、同性恋和“其他性取向”参与者之间的住院、ER 就诊和 DMT 使用的可能性，调整了潜在的混杂因素。
在 5604 名合格应答者中，有 1168 名（20.8%）报告其出生时的性别为男性，4436 名报告其出生时的性别为女性（79.2%）。有 25 名（0.45%）参与者被认定为跨性别者，260 名（4.6%）为非异性恋者。与报告性取向为异性恋的参与者相比，非异性恋参与者更年轻，MS 症状发作的年龄更早，更有可能接受过高等教育，并且更有可能单身。根据性别认同，任何急诊就诊、任何住院就诊或 DMT 使用的频率没有差异；性取向也没有差异。与 cisgender 参与者相比，transgender 参与者报告与医生讨论性健康时的舒适度较低（p < 0.042）；与异性恋参与者相比，非异性恋参与者的情况也相似。报告其他性取向的参与者对医生的满意度也低于其他参与者（p < 0.039）。
性别认同和性取向与 MS 患者的医疗保健利用无差异相关。然而，性别认同和性取向可能会改变医疗保健体验和对医疗保健的满意度。
