Health Outcomes, Discrimination, and Stigma Among Sexual and Gender Minority People With Inflammatory Bowel Disease.

Abstract

Background: Sexual and gender minority (SGM) individuals often experience more discrimination and worse health than non-SGM people. Less is known about SGM individuals with inflammatory bowel disease (IBD). We studied IBD outcomes, discrimination, illness-related stigma, and SGM status in a cross-sectional survey.

Methods: In total, 1586 IBD Partners e-cohort participants self-reported sexual orientation, gender identity, and prior IBD treatment. They completed the Short Crohn's Disease Activity Index or Simple Clinical Colitis Activity Index, the Everyday Discrimination Scale, and the Paradox of Self Stigma (PASS-24) scale. We performed regression analyses controlling for age, race, disease duration, and IBD type.

Results: SGM people were 7.8% (n = 124) of the cohort. SGM participants were younger than non-SGM participants (median age 40 vs. 54 years, P < .001). Among SGM individuals, 67% (n = 74) were in remission based on disease activity scores. Among non-SGM individuals, 74% (n = 936) were in remission (P = .097). Similar proportions of SGM and non-SGM persons reported prior IBD-related hospitalization (40% vs. 37%, P = .426; adjusted odds ratio [aOR] 0.95, 95% confidence interval [CI], 0.62-1.45) and IBD-related surgery (52% vs. 54%, P = .707, aOR 1.25, 95% CI, 0.81-1.94). SGM respondents reported more discrimination (71% vs. 47%, P < .001), and 43% of SGM individuals reported healthcare-related discrimination versus 21% of non-SGM individuals (P < .001). SGM persons also endorsed more internalized stigma (median PASS-24 scores 53 vs. 47, P = .026).

Conclusions: SGM individuals with IBD are more likely to experience discrimination, including in healthcare, and illness-related stigma. These may significantly impact the quality of life and should be considered in the care of SGM people with IBD.