强调性取向和性别认同数据的采集,以改善 LGBTQ+人群的心血管护理。

Emphasizing Sexual Orientation and Gender Identity Data Capture for Improved Cardiovascular Care of the LGBTQ+ Population.

机构信息

Department of Medicine, Georgetown University-WHC, Washington, DC.

Department of Medicine, University of Miami/Jackson Memorial Hospital, Miami, Florida.

出版信息

JAMA Cardiol. 2024 Mar 1;9(3):295-302. doi: 10.1001/jamacardio.2023.5267.

Abstract

IMPORTANCE

The rising self-identifying lesbian, gay, bisexual, transgender, and queer (LGBTQ+) population makes understanding the unique health care needs of sexual and gender minoritized patients an urgent one. The interaction between minority stress and cardiovascular disease has been well described among underrepresented minoritized populations. The underrepresentation of minoritized populations in clinical research is partly responsible for worse cardiovascular outcomes in these populations. The absence of sexual orientation and gender identity and expression (SOGIE) data makes it difficult to understand the cardiovascular health of LGBTQ+ adults, thereby widening health care disparities in this population. Advancing cardiovascular health equity for LGBTQ+ patients must begin with careful and accurate SOGIE data collection.

OBSERVATIONS

Current SOGIE data capture remains inadequate despite federal mandates. Challenges in data collection include political and regulatory discrimination, patient/practitioner hesitancy, lack of supportive guidance on SOGIE data collection, improper terminology, regulatory inertia, and inadequate and often incorrect integration of SOGIE data into electronic health records (EHRs). Additional challenges include grouping participants as "others" for statistical significance. The inclusion of SOGIE data has demonstrated an impact in other fields like cancer survivorship and surgery. The same needs to be done for cardiology.

CONCLUSIONS AND RELEVANCE

Potential solutions for improving much-needed SOGIE data collection include (1) implementing LGBTQ+ inclusive policies, (2) integrating SOGIE data into the EHR, (3) educating health care professionals on the relevance of SOGIE to patient-centered care, and (4) creating a diverse cardiovascular workforce. These steps can substantially enhance the ability to collect SOGIE data to address LGBTQ+ cardiovascular health care disparities.

摘要

重要性

不断增加的自我认同为女同性恋、男同性恋、双性恋、跨性别和酷儿(LGBTQ+)的人群,使得了解性少数和性别少数群体患者的独特医疗需求成为当务之急。少数群体压力与心血管疾病之间的相互作用在代表性不足的少数群体中得到了充分描述。少数群体在临床研究中的代表性不足部分导致了这些群体心血管结果更差。缺乏性取向和性别认同及表达(SOGIE)数据使得难以了解 LGBTQ+成年人的心血管健康状况,从而扩大了该人群的医疗保健差距。为 LGBTQ+患者推进心血管健康公平必须从仔细和准确的 SOGIE 数据收集开始。

观察结果

尽管有联邦授权,但目前的 SOGIE 数据收集仍然不足。数据收集方面的挑战包括政治和监管歧视、患者/从业者的犹豫、缺乏关于 SOGIE 数据收集的支持性指导、术语不当、监管惰性以及 SOGIE 数据在电子健康记录(EHR)中整合不足且常常不正确。其他挑战包括为了统计显著性而将参与者归入“其他”类别。将 SOGIE 数据纳入其他领域,如癌症生存和手术,已经产生了影响。同样的做法也需要在心脏病学中进行。

结论和相关性

改进急需的 SOGIE 数据收集的潜在解决方案包括(1)实施 LGBTQ+包容政策,(2)将 SOGIE 数据整合到 EHR 中,(3)教育医疗保健专业人员 SOGIE 与以患者为中心的护理的相关性,以及(4)创建多元化的心血管劳动力。这些步骤可以大大提高收集 SOGIE 数据的能力,以解决 LGBTQ+心血管保健差距问题。

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