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03-07-2024 | Oncology | Editor's Choice | News

Health disparities highlighted for LGBTQ+ cancer survivors

Author: Dr. Shreeya Nanda

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medwireNews: LGBTQ+ cancer survivors are more likely than their non-LGBTQ+ counterparts to experience an elevated burden of chronic health conditions, disabilities, and physical and cognitive limitations, suggest US data.

“These findings align with other recent studies indicating that LGBTQ+ cancer survivors, as well as the general LGBTQ+ population, are at an elevated risk of chronic health conditions,” writes the team in Cancer Epidemiology, Biomarkers & Prevention.

For the study, the investigators used Behavioral Risk Factor Surveillance System (BRFSS) data from 23 US states that administered both the sexual orientation and gender identity module and the cancer survivorship module from 2020–2022. The BRFSS “is an ongoing nationwide telephone survey system that has collected data on health-related behaviors, health status, and healthcare access since 1984,” they explain.

Of the 40,990 cancer survivors included in the analysis, 1715 (4.2%) identified as LGBTQ+, with 3.9% identifying as lesbian, gay, or bisexual (LGB) and 0.3% as transgender or gender nonconforming (TGNC).

After adjustment for age at the time of interview, as well as the survey year and state, the prevalence of all chronic health conditions, disabilities, and limitations included in this analysis was significantly higher among LGBTQ+ than non-LGBTQ+ survivors. For instance, depressive disorders were reported in a respective 48.5% and 29.5%, cognitive limitations in 37.9% and 15.9%, difficulty walking in 31.4% and 18.5%, and asthma in 30.7% and 19.2%.

Multivariable analysis additionally adjusting for race and ethnicity, smoking status, education, and household income showed that at LGBTQ+ survivors were significantly more likely to report cognition limitations, difficulty dressing, depressive disorders, stroke, difficulty walking, difficulty running errands, visual disability, asthma, kidney disease, and diabetes, with adjusted odds ratios (ORs) of 2.30, 2.02, 1.94, 1.71, 1.65, 1.63, 1.61, 1.54, 1.54, and 1.30, respectively.

Of concern, “when multivariable models were run to compare TGNC survivors to non-TGNC survivors estimate magnitudes increased substantially across most outcomes,” note Austin Waters, from the University of North Carolina at Chapel Hill in the USA, and team.

Specifically, the risk for all outcomes assessed in the study, except for depressive disorders, was significantly higher among TGNC than non-TGNC survivors, with adjusted ORs ranging from 2.34 for asthma to 5.70 for myocardial infarction and 6.03 for kidney disease.

“Our findings and the existing literature can all be contextualized in cissexism and transphobia that effects every level of society from anti-transgender legislation to healthcare discrimination to minority stress and ultimately poor health outcomes,” write the researchers.

They draw attention to the limitations of the study, such as the potential for recall errors in the self-reporting of cancer status and chronic conditions, and the lack of cancer treatment data “as specific treatments are associated with conditions later in life.”

But Waters and colleagues nevertheless conclude: “Our findings reinforce the need for multilevel interventional approaches, from structural changes to patient-level to mitigate health disparities experienced by LGBTQ+ cancer survivors.”

medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2024 Springer Healthcare Ltd, part of the Springer Nature Group

Cancer Epidemiol Biomarkers Prev 2024; doi:10.1158/1055-9965.EPI-24-0166

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