South Thames Retrieval Service and Paediatric Intensive Care, Evelina London Children's Hospital, London, UK.
Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Lancet Child Adolesc Health. 2022 Dec;6(12):876-884. doi: 10.1016/S2352-4642(22)00280-2.
Transgender and non-binary young people experience discrimination that has been linked to suicidal ideation and self-harm, but few studies have examined this association systematically. We aimed to study the association between gender dysphoria-related diagnostic coding and hospital admission for suicidality or self-harm in a large representative pediatric inpatient database from the USA.
Using the 2016 and 2019 Kids' Inpatient Database (KID), we identified transgender and non-binary young people (aged 6-20 years) with International Classification of Diseases (ICD)-10 codes related to gender dysphoria. We identified suicidal ideation using explicit suicidality ICD-10 codes, and self-harm using 355 self-harm ICD-10 codes. Prevalence of suicidality (primary outcome), self-harm, and the combination of suicidality and self-harm (secondary outcomes) was compared between young people with and without gender dysphoria-related codes. Univariable and multivariable regression was used to test for an association between gender dysphoria and suicidality, self-harm, or suicidality and self-harm combined.
1 090 544 individuals were included from KID 2016 and 1 026 752 from KID 2019. Gender dysphoria-related diagnoses were prevalent in 161 per 100 000 hospital admissions in KID 2016 and 475 per 100 000 hospital admissions in KID 2019. In KID 2016 and KID 2019, among individuals who were White, privately insured, or from higher median income ZIP code areas, proportionately more had gender dysphoria-related codes. Prevalence of suicidality was greater in individuals with gender dysphoria-related codes than in individuals without gender dysphoria-related codes in KID 2016 (635 [36%] of 1755 individuals with gender dysphoria-related codes vs 55 351 [5%] of 1 088 789 individuals without gender dysphoria-related codes; unadjusted prevalence ratio [PR] 7·19 [95% CI 6·75-7·66]) and KID 2019 (2680 [55%] of 4872 individuals with gender dysphoria-related codes vs 38 831 [4%] of 1 021 880 individuals without gender dysphoria-related codes; unadjusted PR 5·45 [5·30-5·60]). This association persisted in multivariable modelling adjusting for confounders in KID 2016 (adjusted PR 5·02 [95% CI 4·67-5·41]) and KID 2019 (4·14 [4·02-4·28]). Increased unadjusted and adjusted PRs for individuals with gender dysphoria-related codes, relative to those without, were also evident for self-harm and when combining suicidality and self-harm in both the 2016 and 2019 datasets.
In a large representative national sample, transgender and non-binary young people with gender dysphoria-related diagnoses were frequently admitted to hospital for suicidality or self-harm. The lower rates of gender-dysphoria-related codes among young people who were non-White, publicly insured, and from low-income households suggest that underlying inequities might shape the identification and management of gender dysphoria. Structural and health-care provider-level interventions are needed to reduce discrimination and expand gender-affirming competencies to prevent adverse outcomes for hospitalised transgender and non-binary young people with gender dysphoria.
National Institutes of Health.
跨性别和非二元性别青年经历着歧视，这与自杀意念和自残有关，但很少有研究系统地研究这种关联。我们旨在研究美国大型代表性儿科住院患者数据库中，与性别焦虑相关的诊断编码与自杀或自残住院之间的关联。
我们使用 2016 年和 2019 年的儿童住院数据库（KID），确定了年龄在 6-20 岁之间与性别焦虑相关的国际疾病分类（ICD-10）编码的跨性别和非二元性别青年。我们使用明确的自杀意念 ICD-10 编码识别自杀意念，使用 355 种自我伤害 ICD-10 编码识别自我伤害。比较了有和没有与性别焦虑相关编码的年轻人之间自杀意念（主要结局）、自我伤害和自杀意念与自我伤害结合的发生率（次要结局）。使用单变量和多变量回归来测试性别焦虑与自杀意念、自我伤害或自杀意念与自我伤害结合之间的关联。
从 KID 2016 中纳入了 1090544 人，从 KID 2019 中纳入了 1026752 人。在 KID 2016 中，每 100000 次住院中有 161 次与性别焦虑相关的诊断，在 KID 2019 中，每 100000 次住院中有 475 次与性别焦虑相关的诊断。在 KID 2016 和 KID 2019 中，在白人、私人保险或从中位数收入较高的邮政编码地区的个体中，与性别焦虑相关的代码比例更高。与没有性别焦虑相关代码的个体相比，有性别焦虑相关代码的个体自杀意念的发生率更高，在 KID 2016 中，有性别焦虑相关代码的个体为 635 人（1755 人中有 36%），而没有性别焦虑相关代码的个体为 55351 人（1088789 人中有 5%）；未调整的患病率比（PR）为 7.19（95%CI 6.75-7.66），在 KID 2019 中，有性别焦虑相关代码的个体为 2680 人（4872 人中有 55%），而没有性别焦虑相关代码的个体为 38831 人（1021880 人中有 4%）；未调整的 PR 为 5.45（95%CI 5.30-5.60）。这种关联在调整了 KID 2016 中的混杂因素后仍然存在（调整后的 PR 为 5.02[95%CI 4.67-5.41]），在 KID 2019 中（4.14[4.02-4.28]）也是如此。在这两个数据集的自我伤害和自杀意念与自我伤害结合的情况下，与没有性别焦虑相关代码的个体相比，有性别焦虑相关代码的个体的未调整和调整后的 PR 也更高。
在一个大型代表性的全国样本中，与性别焦虑相关诊断的跨性别和非二元性别青年经常因自杀意念或自残而住院。非白人、公共保险和低收入家庭的年轻人中与性别焦虑相关的代码比例较低，这表明潜在的不平等可能会影响性别焦虑的识别和管理。需要进行结构和医疗保健提供者层面的干预，以减少歧视，扩大性别肯定能力，以防止有性别焦虑的住院跨性别和非二元性别青年出现不良后果。
美国国立卫生研究院。
