Characteristics of Youth Presenting for Gender Care Compared to Background Populations: Examination of Social Determinants of Health.

IF 3.9 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
LGBT health Pub Date : 2024-07-30 DOI:10.1089/lgbt.2023.0271
Laura N MacMullin, Julia C Sorbara, Lindsay A Coome, Doug P VanderLaan, Mark R Palmert
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Abstract

Purpose: Transgender and gender diverse (TGD) youth in North American clinical reports are predominantly White with relatively high socioeconomic status suggesting that access to gender-affirming care is inequitable. This study examined whether socioeconomic and social determinant of health discrepancies exist between a clinical population of TGD youth and surrounding communities. Methods: Patient postal codes were used to link the Ontario Marginalization Index (ON-MARG) to a clinic-based TGD youth cohort (n = 298). Using ON-MARG, each patient was assigned a quintile score from 1 (least marginalized) to 5 (most marginalized) on four marginalization measures. Mean quintile scores were compared to background populations. Census-based Toronto neighborhood-level data on ethnic diversity and educational status were also examined. Neighborhoods were categorized as highly represented, less represented, or unrepresented based on representation in the clinic cohort. One-way analysis of covariance was used to determine associations between neighborhood-level variables and the degree of neighborhood representation. Results: ON-MARG data demonstrated that clinic patients hailed from areas with more individuals having paid employment. Patients from Toronto and surrounding areas came, in general, from communities with fewer recent immigrants and visible minorities. Highly represented Toronto neighborhoods had smaller proportions of visible minorities and immigrants compared with less and unrepresented neighborhoods. Educational status, represented by adults with bachelor's degrees, was lower among unrepresented neighborhoods. Conclusion: TGD youth seen in clinic, particularly those from Toronto, are disproportionally White and socioeconomically advantaged. Further research is needed to better understand the underrepresentation of racialized and low-socioeconomic status youth and to inform strategies to improve access to care.

与背景人群相比,接受性别护理的青少年的特征:研究健康的社会决定因素。
目的:在北美的临床报告中,变性和性别多元化(TGD)青年主要是白人,社会经济地位相对较高,这表明获得性别确认护理的机会是不公平的。本研究调查了变性和性别多元化青少年临床人群与周边社区之间是否存在社会经济和健康社会决定因素方面的差异。研究方法使用患者邮政编码将安大略省边缘化指数(ON-MARG)与以诊所为基础的 TGD 青少年队列(n = 298)联系起来。利用安大略省边缘化指数(ON-MARG),为每位患者在四项边缘化指标上分配了从 1 分(边缘化程度最低)到 5 分(边缘化程度最高)的五分位数。平均五分法得分与背景人群进行了比较。此外,还对基于人口普查的多伦多社区层面的种族多样性和教育状况数据进行了研究。根据在诊所队列中的代表性,社区被划分为代表性高、代表性低或无代表性。采用单因子协方差分析法确定邻里水平变量与邻里代表性程度之间的关联。结果显示ON-MARG数据显示,诊所患者来自有更多有偿就业者的地区。多伦多及周边地区的患者一般来自新移民和有色人种较少的社区。多伦多代表性强的社区与代表性弱和无代表性的社区相比,明显少数族裔和移民的比例较低。在没有代表的社区中,拥有学士学位的成年人所代表的教育状况较低。结论在诊所就诊的同性恋、双性恋和变性青少年,尤其是来自多伦多的青少年中,白人和社会经济条件优越者占很大比例。需要进一步开展研究,以便更好地了解种族和社会经济地位较低的青少年就诊率偏低的情况,并为改善就诊策略提供依据。
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来源期刊
LGBT health
LGBT health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH -
CiteScore
6.60
自引率
6.20%
发文量
80
期刊介绍: LGBT Health is the premier peer-reviewed journal dedicated to promoting optimal healthcare for millions of sexual and gender minority persons worldwide by focusing specifically on health while maintaining sufficient breadth to encompass the full range of relevant biopsychosocial and health policy issues. This Journal aims to promote greater awareness of the health concerns particular to each sexual minority population, and to improve availability and delivery of culturally appropriate healthcare services. LGBT Health also encourages further research and increased funding in this critical but currently underserved domain. The Journal provides a much-needed authoritative source and international forum in all areas pertinent to LGBT health and healthcare services. Contributions from all continents are solicited including Asia and Africa which are currently underrepresented in sex research.
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