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美国矫形外科专业人员中的性少数群体和性别少数群体认同的代表性如何?

What Is the Representation of Sexual and Gender Minority Identities Among Orthopaedic Professionals in the United States?

机构信息

Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.

Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA.

出版信息

Clin Orthop Relat Res. 2024 Aug 1;482(8):1313-1321. doi: 10.1097/CORR.0000000000003079. Epub 2024 Apr 24.


DOI:10.1097/CORR.0000000000003079
PMID:39031036
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11272280/
Abstract

BACKGROUND: There is substantial corroborating evidence that orthopaedic surgery has historically been the least diverse of all medical and surgical specialties in terms of race, ethnicity, and sex. Growing recognition of this deficit and the benefits of a diverse healthcare workforce has motivated policy changes to improve diversity. To measure progress with these efforts, it is important to understand the existing representation of sexual and gender minorities among orthopaedic professionals. QUESTIONS/PURPOSES: (1) What proportion of American Academy of Orthopaedic Surgeons (AAOS) members reported their identity as a sexual or gender minority? (2) What demographic factors are associated with the self-reporting of one's sexual orientation and gender identity? METHODS: The AAOS published the updated membership questionnaire in January 2022 to collect information from new and existing society members regarding age and race or ethnicity and newly added categories of gender identity, sexual orientation, and pronouns. The questionnaire was updated with input from a committee of orthopaedic surgeons and researchers to ensure face validity. The AAOS provided a deidentified dataset that included the variables of interest: membership type, gender identity, sexual orientation, pronouns, age, race, and ethnicity. Of 35,427 active AAOS members, 47% (16,652) updated their membership questionnaire. To answer our first study question, we calculated the prevalence of participants who self-reported as lesbian, gay, bisexual, transgender, queer, or another sexual or gender minority identity (LGBTQ+) and other demographic characteristics of the 16,652 respondents. Categorical demographic data are described using frequencies and proportions. Median and IQR were used to describe the central tendency and variability. To answer our second study question, we conducted a stratified analysis to compare demographic characteristics between those who self-reported LGBTQ+ identity and those who did not. Visual methods (quantile-quantile plots) and statistical tests (Kolmogorov-Smirnov and Shapiro Wilk) confirmed that the age of AAOS member was not normally distributed. Therefore, a Kruskal Wallis test was used to determine the statistical associations between age and self-reported LGBTQ+ status. Chi-square tests were used to determine bivariate statistical associations between categorical demographic characteristics and self-reported LGBTQ+ status. A multivariable logistic regression model was developed to identify the independent demographic characteristics associated with respondents who self-reported LGBTQ+ identity. Further stratified analyses were not conducted to protect the anonymity of AAOS members. An alpha level of 5% was established a priori to define statistical significance. RESULTS: Overall, 3% (109 of 3679) and fewer than 1% (3 of 16,182) of the AAOS members (surgeons, clinicians, allied healthcare providers, and researchers) who updated their membership profiles reported identifying as a sexual (lesbian, gay, bisexual, queer) or gender minority (nonbinary or transgender), respectively. No individual self-identified as transgender. Five percent (33 of 603) of women and 3% (80 of 3042) of men self-identified as a sexual minority (such as lesbian, gay, bisexual, or queer). AAOS members who self-identified as LGBTQ+ were younger (OR 0.99 [95% confidence interval (CI) 0.98 to 0.99]; p < 0.001), less likely to self-identify as women (OR 0.86 [95% CI 0.767 to 0.954]; p < 0.001), less likely to be underrepresented in medicine (OR 0.49 [95% CI 0.405 to 0.599]; p < 0.001), and less likely to be an emeritus or honorary member (OR 0.75 [95% CI 0.641 to 0.883]; p < 0.003). CONCLUSION: The proportion of self-reported LGBTQ+ AAOS members is lower than the 7% of the general US population. The greater proportion of younger AAOS members reporting this information suggests progress in the pursuit of a more-diverse field. CLINICAL RELEVANCE: The study findings support standardized collection of sexual orientation and gender identity data to better identify and address diversity gaps. As orthopaedic surgery continues to transform to reflect the diversity of musculoskeletal patients, all orthopaedic professionals (surgeons, clinicians, allied healthcare providers, and researchers), regardless of their identities, are essential in the mission to provide equitable and informed orthopaedic care. Sexual and gender minority individuals may serve as important mentors to the next generations of orthopaedic professionals; individuals from nonminority groups should serve as important allies in achieving this goal.

摘要

背景:大量证据表明,在种族、民族和性别方面,矫形外科是所有医学和外科专业中最缺乏多样性的。越来越认识到这一不足以及多元化医疗保健队伍的好处,促使政策发生变化以提高多样性。为了衡量这些努力的进展,了解矫形外科专业人员中性少数群体和性别少数群体的现有代表性非常重要。

问题/目的:(1) 美国矫形外科医师学会(AAOS)的成员中有多少人报告自己是性少数群体或性别少数群体?(2) 哪些人口统计学因素与自我报告的性取向和性别认同有关?

方法:AAOS 于 2022 年 1 月发布了更新的会员调查问卷,以收集新老会员关于年龄、种族或民族以及新增加的性别认同、性取向和代词类别的信息。该问卷是在由矫形外科医生和研究人员组成的委员会的帮助下更新的,以确保其具有表面有效性。AAOS 提供了一个包含我们感兴趣的变量的匿名数据集:会员类型、性别认同、性取向、代词、年龄、种族和民族。在 35427 名活跃的 AAOS 会员中,有 47%(16652 名)更新了他们的会员问卷。为了回答我们的第一个研究问题,我们计算了自报为女同性恋、男同性恋、双性恋、跨性别、酷儿或其他性少数群体或性别少数群体身份(LGBTQ+)的参与者的比例,以及 16652 名受访者的其他人口统计学特征。分类人口统计学数据使用频率和比例进行描述。中位数和 IQR 用于描述中心趋势和变异性。为了回答我们的第二个研究问题,我们进行了分层分析,比较了自报 LGBTQ+身份者和不自报 LGBTQ+身份者的人口统计学特征。使用定量-定量图和统计检验(Kolmogorov-Smirnov 和 Shapiro-Wilk)证实,AAOS 会员的年龄不是正态分布的。因此,使用 Kruskal Wallis 检验来确定年龄与自我报告的 LGBTQ+状态之间的统计学关联。使用卡方检验确定分类人口统计学特征与自我报告的 LGBTQ+状态之间的双变量统计学关联。开发了一个多变量逻辑回归模型,以确定自我报告为 LGBTQ+的受访者的独立人口统计学特征。为了保护 AAOS 成员的匿名性,没有进行进一步的分层分析。预先设定了 5%的 alpha 水平来定义统计学意义。

结果:总的来说,3%(33/1099)和不到 1%(3/16182)的 AAOS 成员(外科医生、临床医生、辅助医疗保健提供者和研究人员)更新了他们的会员资料,报告自己是性少数群体(女同性恋、男同性恋、双性恋、酷儿)或性别少数群体(非二进制或跨性别)。没有人自我认同为跨性别者。5%的女性(33/603)和 3%的男性(80/3042)自我认同为性少数群体(如女同性恋、男同性恋、双性恋或酷儿)。自我认同为 LGBTQ+的 AAOS 成员更年轻(OR 0.99 [95%置信区间 0.98 至 0.99];p < 0.001),不太可能自我认同为女性(OR 0.86 [95%置信区间 0.767 至 0.954];p < 0.001),不太可能属于代表性不足的医学领域(OR 0.49 [95%置信区间 0.405 至 0.599];p < 0.001),也不太可能是名誉会员或荣誉会员(OR 0.75 [95%置信区间 0.641 至 0.883];p < 0.003)。

结论:自我报告为 LGBTQ+的 AAOS 成员比例低于美国总人口的 7%。更多年轻的 AAOS 成员报告了这一信息,这表明在追求更具多样性的领域方面取得了进展。

临床相关性:研究结果支持标准化收集性取向和性别认同数据,以更好地确定和解决多样性差距。随着矫形外科手术继续向反映肌肉骨骼患者多样性的方向转变,所有矫形外科专业人员(外科医生、临床医生、辅助医疗保健提供者和研究人员),无论其身份如何,都对提供公平和知情的矫形护理至关重要。性少数群体和性别少数群体的个体可能是下一代矫形外科专业人员的重要导师;非少数群体的个体应该成为实现这一目标的重要盟友。

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