美国女同性恋、男同性恋和双性恋癌症幸存者的物质、心理和行为方面的经济困难
Material, Psychological, and Behavioral Financial Hardship Among Lesbian, Gay, and Bisexual Cancer Survivors in the United States.
作者信息
Waters Austin R, Wheeler Stephanie B, Tan Kelly R, Rosenstein Donald L, Roberson Mya L, Kirchhoff Anne C, Kent Erin E
机构信息
Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC.
Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC.
出版信息
JCO Oncol Pract. 2024 Dec;20(12):1721-1732. doi: 10.1200/OP.24.00114. Epub 2024 Jul 11.
PURPOSE
Driven by anti-LGBTQ+ stigma, emerging literature suggests that lesbian, gay, and bisexual (LGB) cancer survivors experience financial hardship (FH) more frequently than heterosexual survivors. However, few studies have used nationally representative samples to estimate this inequity.
METHODS
National Health Interview Survey data from 2019 to 2022 were pooled and weighted. Outcomes included material, psychological, and behavioral FH. The behavioral domain was further broken down into subdomains including medical care, prescription medications, and mental health care. Multivariable logit models controlling for a variety of factors were used to generate LGB and heterosexual predicted probabilities and differential effects for each FH outcome. Stratified estimates were generated by sex and age groups.
RESULTS
A total of N = 374 LGB and N = 12,757 heterosexual cancer survivors were included in this analysis. In adjusted analyses, LGB cancer survivors had significantly higher material (19%, 95% CI, 15 to 24 12%, 95% CI, 11 to 13; = .004), psychological (44%, 95% CI, 38 to 51 37%, 95% CI, 36 to 38; = .035), and behavioral (23%, 95% CI, 18 to 28 13%, 95% CI, 13 to 14; < .0001) FH than heterosexual survivors. LGB cancer survivors also had higher medical behavioral (11%, 95% CI, 7 to 15 7%, 95% CI, 6 to 7; = .030), prescription medication behavioral (14%, 95% CI, 10 to 19 10%, 95% CI, 9 to 10; = .032), and mental health behavioral (9%, 95% CI, 6 to 13 3%, 95% CI, 3 to 4; < .0001) FH than heterosexual survivors. Stratified estimates revealed young LGB cancer survivors had the highest probability of each outcome (material: 31%, 95% CI, 23 to 40; psychological: 58%, 95% CI, 50 to 66; behavioral: 45%, 95% CI, 36 to 53).
CONCLUSION
In this nationally representative analysis, LGB cancer survivors experience substantial inequities in all FH outcomes. It is crucial that future FH interventional work should prioritize populations at the highest risk of FH, such as LGB cancer survivors.
目的
受反 LGBTQ+ 污名化的影响，新出现的文献表明，女同性恋、男同性恋和双性恋（LGB）癌症幸存者比异性恋幸存者更频繁地经历经济困难（FH）。然而，很少有研究使用具有全国代表性的样本对这种不平等进行估计。
方法
汇总并加权了 2019 年至 2022 年的全国健康访谈调查数据。结果包括物质、心理和行为方面的经济困难。行为领域进一步细分为子领域，包括医疗保健、处方药和心理健康护理。使用控制各种因素的多变量逻辑模型来生成 LGB 和异性恋的预测概率以及每种经济困难结果的差异效应。按性别和年龄组生成分层估计。
结果
本分析共纳入了 N = 374 名 LGB 癌症幸存者和 N = 12757 名异性恋癌症幸存者。在调整分析中，LGB 癌症幸存者在物质（19%，95%CI，15 至 24；12%，95%CI，11 至 13；P = 0.004）、心理（44%，95%CI，38 至 51；37%，95%CI，36 至 38；P = 0.035）和行为（23%，95%CI，18 至 28；13%，95%CI，13 至 14；P < 0.0001）方面的经济困难高于异性恋幸存者。LGB 癌症幸存者在医疗行为（11%，95%CI，7 至 15；7%，95%CI，6 至 7；P = 0.030）、处方药行为（14%，95%CI，10 至 19；10%，95%CI，9 至 10；P = 0.032）和心理健康行为（9%，95%CI，6 至 13；3%，95%CI，3 至 4；P < 0.0001）方面的经济困难也高于异性恋幸存者。分层估计显示，年轻的 LGB 癌症幸存者出现每种结果的概率最高（物质：31%，95%CI，23 至 40；心理：58%，95%CI，50 至 66；行为：45%，95%CI，36 至 53）。
结论
在这项具有全国代表性的分析中，LGB 癌症幸存者在所有经济困难结果方面都经历了严重的不平等。未来的经济困难干预工作应将经济困难风险最高的人群（如 LGB 癌症幸存者）作为优先对象，这一点至关重要。
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