Dataset Information

The Burden of Cancer and Pre-cancerous Conditions Among Transgender Individuals in a Large Healthcare Network.

ABSTRACT: The current study aimed to examine the prevalence of and risk factors for cancer and pre-cancerous conditions, comparing transgender and cisgender individuals, using 2012-2023 electronic health record data from a large healthcare system. We identified 2,745 transgender individuals using a previously validated computable phenotype and 54,900 matched cisgender individuals. We calculated the prevalence of cancer and pre-cancer related to human papillomavirus (HPV), human immunodeficiency virus (HIV), tobacco, alcohol, lung, breast, colorectum, and built multivariable logistic models to examine the association between gender identity and the presence of cancer or pre-cancer. Results indicated similar odds of developing cancer across gender identities, but transgender individuals exhibited significantly higher risks for pre-cancerous conditions, including alcohol-related, breast, and colorectal pre-cancers compared to cisgender women, and HPV-related, tobacco-related, alcohol-related, and colorectal pre-cancers compared to cisgender men. These findings underscore the need for tailored interventions and policies addressing cancer health disparities affecting the transgender population.

SUBMITTER: Yang S

PROVIDER: S-EPMC10996763 | biostudies-literature | 2024 Mar

REPOSITORIES: biostudies-literature

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The Burden of Cancer and Pre-cancerous Conditions Among Transgender Individuals in a Large Healthcare Network.

Yang Shuang S Li Yongqiu Y Wheldon Christopher W CW Prosperi Mattia M George Thomas J TJ Shenkman Elizabeth A EA Wang Fei F Bian Jiang J Guo Yi Y

medRxiv : the preprint server for health sciences 20240326

The current study aimed to examine the prevalence of and risk factors for cancer and pre-cancerous conditions, comparing transgender and cisgender individuals, using 2012-2023 electronic health record data from a large healthcare system. We identified 2,745 transgender individuals using a previously validated computable phenotype and 54,900 matched cisgender individuals. We calculated the prevalence of cancer and pre-cancer related to human papillomavirus (HPV), human immunodeficiency virus (HIV ...[more]

PMID: 38585849

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Project description:BackgroundTransgender individuals experience limited access to healthcare. This results not least from experiences of discrimination to which they are exposed in the health system. These contribute to transgender individuals having poorer health than cis individuals, i.e. individuals whose sex assigned at birth is in line with their gender identity. It is an ethical duty to take effective measures to minimize inequalities in medical care. At best, such measures should also be assessed as appropriate from the perspective of those affected in order to be accepted and thus effective. It is therefore important to know whether measures touch on the subjectively assumed reasons for experiences of discrimination. Hence, to be able to take appropriate measures, it is important to identify the reasons that transgender individuals see as causal for their experiences of discrimination in healthcare.MethodsWe conducted semi-structured interviews with 14 German transgender individuals and asked them about their own experiences of discrimination in healthcare and their assumptions on the reasons for discrimination. We analyzed the responses using the method of structured qualitative content analysis.Results13 transgender individuals reported experiences of discrimination in healthcare. These emanated from different professional groups and took place in trans-specific as well as general medical settings. We were able to identify a total of 12 reasons that transgender individuals see as causal for their experiences of discrimination: (1) internalized trans-hostility and "protection" of cis individuals, (2) lack of knowledge/uncertainties regarding transition, (3) "protection" of a binary worldview, (4) binary worldview in medicine, (5) structural deficits, (6) asymmetric interactions with specialists, (7) current political debate, (8) view of transgender individuals as a "burden for society", (9) objectification, (10) homophobia, (11) misogyny/androcentrism and (12) discrimination as reaction to discrimination.ConclusionsGerman transgender individuals have a very differentiated picture regarding their subjective reasons for experiencing discrimination in healthcare. Overall, disrespect regarding gender identity and a confrontation with foreignness seems to be seen as the decisive factor. Thus, it is not enough to focus only on measures that aim to remedy the information deficit on the part of medical providers. Measures must be taken that can create a granting and respectful attitude towards transgender individuals.

Project description:ImportanceScreening for lung cancer with low-dose computed tomography (LDCT) has been shown to reduce lung cancer mortality in trials that included relatively younger, healthier, and predominantly White populations. The comorbidity profiles among patients undergoing lung cancer screening in practice settings are poorly understood.ObjectiveTo evaluate the comorbidity profiles of patients in the Personalized Lung Cancer Screening (PLuS) cohort as a clinical setting vs the National Lung Screening Trial (NLST) participants in a clinical trial setting.Design, setting, and participantsThis multicenter cohort study was conducted across 3 health care systems in California, Florida, and South Carolina and included patients who underwent LDCT lung cancer screening between 2016 and 2021. Data were analyzed between January 1, 2016, and December 31, 2021.ExposuresReceipt of the LDCT scan identified through Current Procedural Terminology and Healthcare Common Procedure Coding System codes.Main outcomes and measuresDetailed comorbidity data, measures of pulmonary function, and study data abstracted from electronic health records and institutional, Surveillance, Epidemiology, and End Results (SEER), and state registries were compared with self-reported comorbid conditions of participants in the LDCT arm of the NLST.ResultsThe PLuS cohort (n = 31 795) included 49.0% participants aged 65 years or older vs 26.6% in the NLST cohort (n = 26 723); 23.3% were individuals of racial and ethnic minority groups in the PLuS cohort compared with 8.5% in the NLST. The prevalence of comorbidity was substantially higher in the PLuS cohort than the NLST group, particularly chronic obstructive pulmonary disease (32.7% vs 17.5%), diabetes (24.6% vs 9.7%), and heart disease (15.9% vs 12.9%). Among those in the PLuS cohort, 19.3% had a Charlson Comorbidity Index score of 4 or higher, 18.0% had a frailty index greater than 0.20, 16.9% had a forced expiratory volume in 1 second (FEV-1) lower than 50% of predicted, and almost 5% had an ejection fraction lower than 40%. The prevalence of multimorbidity and frailty was especially high among those in the 75 years or older age group.Conclusions and relevanceThis study found that the PLuS cohort members were older, had greater illness severity, and more racially and ethnically diverse than the NLST participants. Older patients and those with consequential comorbidity likely had different risk-benefit profiles, which may have affected screening outcomes. The high prevalence of multimorbidity, frailty, and impaired cardiopulmonary function in the PLuS cohort suggests that the balance of benefits and harms observed in the NLST group may not translate to the clinical setting.

Project description:This study investigates the needs and concerns transgender (short: trans) individuals have concerning trans healthcare (THC) in interdisciplinary THC centres. Trans individuals' gender does not (fully/constantly) match their sex assigned at birth. To be able to live in their gender role and to prevent or minimise gender dysphoria, they might require a multidisciplinary set of transition related healthcare services. The current shift from the traditionally highly regulated, hierarchical and pathologising approach to THC towards a more patient-centred approach has highlighted the importance of trans patients' satisfaction with treatment processes and results. As the still influential regulations have a negative effect on patient satisfaction, and might also keep trans individuals from seeking transition related treatment, it is crucial to investigate what trans individuals, whether patients or not, need and fear regarding transition related healthcare. Against the backdrop of mixed reactions received from the local trans community regarding the foundation of the Interdisciplinary Transgender Healthcare Centre Hamburg (ITHCCH), Germany, this study seeks to determine what trans individuals need with respect to THC in order to guarantee for high quality service provision at the ITHCCH. To this end, an online questionnaire was developed. The researchers employed a participatory approach to questionnaire development by involving a working group consisting of local trans support group representatives and (THC) specialists (N = 4). The sample consisted of N = 415 trans-identified individuals aged between 16 and 76. Most of them were based in Germany. 85.2% (n = 382) reported experience with transition related healthcare and 72.5% (n = 301) had (additional) treatments planned. Analysis revealed a need for communication and feedback opportunities. Furthermore, during the treatment process, addressing individual needs was considered crucial by participants. They agreed moderately with concerns towards THC centres. 96.5% of participants would like high decision-making power concerning treatment-associated decisions. The results demonstrate the importance of patient-centred THC that takes patients' individual needs and realities into consideration and involves patients in decision-making processes.

Project description:IntroductionTransgender individuals are at risk for HIV. HIV risks are dynamic and there have been substantial changes in HIV prevention (e.g., pre-exposure prophylaxis [PrEP]). It is thus time to revisit HIV prevalence and burden among transgender individuals. The objective of this systematic review and meta-analysis was thus to examine worldwide prevalence and burden of HIV over the course of the epidemic among trans feminine and trans masculine individuals.MethodsWe conducted an updated systematic review by searching PsycINFO, PubMed, Web of Science, and Google Scholar, for studies of any research design published in in a peer-reviewed journal in any language that reported HIV prevalence among transgender individuals published between January 2000 and January 2019. Two independent reviewers extracted the data and assessed methodological quality. We then conducted a meta-analysis, using random-effects modelling, to ascertain standardized prevalence and the relative burden of HIV carried by transgender individuals by country and year of data collection, and then by geographic region. We additionally explored the impact of sampling methods and pre-exposure prophylaxis (PrEP).ResultsBased on 98 studies, overall standardized HIV prevalence over the course of the epidemic, based on weights from each country by year, was 19.9% (95% CI 14.7% - 25.1%) for trans feminine individuals (n = 48,604) and 2.56% (95% CI 0.0% - 5.9%) for trans masculine individuals (n = 6460). Overall OR for HIV infection, compared with individuals over age 15, was 66.0 (95% CI 51.4-84.8) for trans feminine individuals and 6.8 (95% CI 3.6-13.1) for trans masculine individuals. Prevalence varied by geographic region (13.5% - 29.9%) and sampling method (5.4% - 37.8%). Lastly, PrEP effects on prevalence could not be established.ConclusionTrans feminine and trans masculine individuals are disproportionately burdened by HIV. Their unique prevention and care needs should be comprehensively addressed. Future research should further investigate the impact of sampling methods on HIV prevalence, and monitor the potential impact of PrEP.

Dataset Information

The Burden of Cancer and Pre-cancerous Conditions Among Transgender Individuals in a Large Healthcare Network.

Publications

The Burden of Cancer and Pre-cancerous Conditions Among Transgender Individuals in a Large Healthcare Network.

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