Pediatrics, Boston Children's Hospital, Boston, Massachusetts.
Division of Endocrinology, Diabetes & Hypertension, Brigham and Women's Hospital, Boston, Massachusetts.
JAMA Netw Open. 2021 Oct 1;4(10):e2124647. doi: 10.1001/jamanetworkopen.2021.24647.
In the United States, adolescents who are lesbian, gay, or bisexual (LGB) face disparities across physical and mental health outcomes compared with non-LGB youth, yet few studies have looked at patterns of health care utilization by sexual orientation.
To compare health care utilization indicators for LGB and non-LGB youth.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study analyzed wave 3 data from Healthy Passages, a longitudinal observational study of diverse public school students in Birmingham, Alabama; Houston, Texas; and Los Angeles County, California. Multivariable logistic regression models tested sexual-orientation differences in the past 12-month health care utilization measures, controlling for youth age, gender, race and ethnicity, household education, income, and marital status. Data collection began in 2010 when students were in the 5th grade (mean [SE] age, 11.13 [0.01] years) (wave 1) and continued 2 years later (wave 2, 7th grade) and 5 years later (wave 3, 10th grade). Permission to be contacted was provided for 6663 children, and 5147 (77%) participated in audio computer-assisted self-administered interviews. This study included 4256 youth (640 LGB, 3616 non-LGB) who completed interviews at wave 1 and wave 3 and answered key items used in this analysis. Analyses were completed in June 2021.
Sexual orientation (LGB vs non-LGB).
Health care utilization and communication difficulty with a physician in the past 12 months.
Among 4256 youths included in the study at baseline in 5th grade (wave 1), 2171 (48.9%) were female; 1502 (44.5%) were Hispanic or Latino; 1479 (28.9%) were Black; the mean (SE) age was 11.19 (0.03) years; and 640 (14.5%) were LGB at wave 3. Compared with non-LGB youth, a higher proportion of LGB youth reported not receiving needed medical care in the last 12 months (adjusted odds ratio [aOR], 1.68; 95% CI,1.38-2.05), most commonly for sexually transmitted infections, contraception, and substance use. LGB youth more frequently reported difficulty communicating with their physician (aOR, 1.71; 95% CI, 1.27-2.30) than non-LGB youth.
This study's results found that health care utilization differs by sexual orientation for youth. These findings suggest that clinician training is needed to address the health care needs of LGB youth. Routinely capturing sexual orientation data might enable tracking of health care utilization indicators for LGB youth.
在美国，与非 LGB 青年相比，同性恋、双性恋或无性恋（LGB）的青少年在身心健康结果方面存在差异，但很少有研究关注性取向对医疗保健利用模式的影响。
比较 LGB 和非 LGB 青年的医疗保健利用指标。
设计、地点和参与者：这项队列研究分析了来自 Healthy Passages 的第 3 波数据，这是一项对阿拉巴马州伯明翰、德克萨斯州休斯顿和加利福尼亚州洛杉矶县不同公立学校学生进行的纵向观察研究。多变量逻辑回归模型测试了过去 12 个月医疗保健利用指标中的性取向差异，控制了青年年龄、性别、种族和民族、家庭教育、收入和婚姻状况。数据收集始于 2010 年，当时学生处于 5 年级（平均[SE]年龄 11.13[0.01]岁）（第 1 波），并在 2 年后（第 2 波，7 年级）和 5 年后（第 3 波，10 年级）继续进行。为 6663 名儿童提供了联系许可，其中 5147 名（77%）参加了音频计算机辅助自我管理访谈。本研究包括 4256 名青年（640 名 LGB，3616 名非 LGB），他们在第 1 波和第 3 波完成了访谈，并回答了本分析中使用的关键项目。分析于 2021 年 6 月完成。
性取向（LGB 与非 LGB）。
过去 12 个月的医疗保健利用情况和与医生沟通的困难程度。
在基线时（第 1 波）参加研究的 4256 名 5 年级学生中，有 2171 名（48.9%）为女性；1502 名（44.5%）为西班牙裔或拉丁裔；1479 名（28.9%）为黑人；平均（SE）年龄为 11.19（0.03）岁；第 3 波时 640 名（14.5%）为 LGB。与非 LGB 青年相比，LGB 青年报告在过去 12 个月内未获得所需医疗护理的比例更高（调整后的优势比[OR]，1.68；95%CI，1.38-2.05），最常见的是性传播感染、避孕和药物使用。LGB 青年比非 LGB 青年更频繁地报告与医生沟通困难（OR，1.71；95%CI，1.27-2.30）。
本研究结果发现，青少年的医疗保健利用因性取向而异。这些发现表明，需要对临床医生进行培训，以满足 LGB 青年的医疗保健需求。定期收集性取向数据可能能够跟踪 LGB 青年的医疗保健利用指标。
