Nocka Kristen, Montgomery Madeline C, Progovac Ana, Guss Carly E, Chan Philip A, Raifman Julia
Department of Health, Law, and Policy, Boston University School of Public Health, Boston, Massachusetts.
Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island.
J Adolesc Health. 2021 Mar;68(3):472-479. doi: 10.1016/j.jadohealth.2020.11.014. Epub 2020 Dec 24.
Structural stigma has shaped disparities across several domains of health for transgender relative to cisgender (nontransgender) adolescents in the United States. Research on transgender health has largely overlooked the role of preventive care, especially for adolescents.
We used ICD-9 and ICD-10 codes to identify transgender adolescents in the Rhode Island All Payers Claims Database (APCD) from 2011 to 2017 based on a diagnosis for gender identity disorder (GID). We evaluated differences in the use of preventive care services between transgender and cisgender adolescents. We compared the frequency of sexually transmitted infection and HIV screening and the percentage prescribed pre-exposure prophylaxis among transgender and cisgender adolescents using t-tests and chi-square tests. We used logistic regression to evaluate the association between attending regular physical exams and receiving preventive health services.
There was no significant difference in the proportion of transgender and cisgender adolescents who received regular influenza vaccinations, physical exams, and HPV vaccinations. Transgender adolescents were significantly more likely to receive regular cholesterol and BMI screenings compared to cisgender adolescents. While there was a significant positive association between having regular physical exams and receiving most preventive screenings in the cisgender population, in the transgender population, regular physical exams were only significantly positively associated with STI screening.
Transgender adolescents accessing the healthcare system received similar, if not greater, levels of preventive health services compared to their cisgender peers. Because regular physical exams were not associated with receiving most preventive services among transgender adolescents, these services may be delivered outside of primary care settings.
在美国，相对于顺性别（非跨性别）青少年，结构性耻辱感在跨性别青少年健康的多个领域造成了差异。对跨性别健康的研究很大程度上忽略了预防性保健的作用，尤其是对青少年而言。
我们使用国际疾病分类第九版（ICD - 9）和第十版（ICD - 10）编码，基于性别认同障碍（GID）的诊断，在罗德岛全支付者索赔数据库（APCD）中识别2011年至2017年期间的跨性别青少年。我们评估了跨性别青少年和顺性别青少年在预防性保健服务使用上的差异。我们使用t检验和卡方检验比较了跨性别青少年和顺性别青少年中性传播感染和艾滋病毒筛查的频率以及接受暴露前预防用药的比例。我们使用逻辑回归来评估进行定期体检与接受预防性健康服务之间的关联。
在接受定期流感疫苗接种、体检和人乳头瘤病毒（HPV）疫苗接种的跨性别青少年和顺性别青少年比例上，没有显著差异。与顺性别青少年相比，跨性别青少年接受定期胆固醇和体重指数（BMI）筛查的可能性显著更高。虽然在顺性别群体中，进行定期体检与接受大多数预防性筛查之间存在显著的正相关，但在跨性别群体中，定期体检仅与性传播感染筛查显著正相关。
与他们的顺性别同龄人相比，使用医疗保健系统的跨性别青少年接受了相似甚至更多水平的预防性健康服务。由于在跨性别青少年中，定期体检与接受大多数预防性服务无关，这些服务可能在初级保健环境之外提供。
